Today in the operating room nothing truly dramatic or exciting happened. I’m just still green enough to get a kick out of the fact that I was actually IN the O.R.
For our last case of the day, we removed a dermoid. And by we I mean the talented surgeons removed the dermoid as I stood behind them gawking.
Teaching point: a dermoid is another word for a mature teratoma. The attending described it to me as an extremely strange immaculate conception. A group of germ cells (the reproductive cells) go haywire. The massive growth that ensues is the teratoma, and usually contains all three germ layers. When things are happening as they should, after fertilization, all three germ layers (endoderm, mesoderm, and ectoderm) go on to form the embryo. In the case of the teratoma, however, nothing resembling fertilization is taking place. The cells-gone-wild go on to form a nasty looking dermoid with the three germ layers, and can contain skin, hair, teeth, sometimes bone, thyroid tissue, or lung. It’s really pretty disgusting.
So, the day began with me removing scraps of shaved-off pubic hair from an obese woman’s vagina. The task was enthusiastically delegated to the bottom of the totem pole.
The day ended with me performing my first pelvic and rectal exams. After double and triple checking that I would be doing the procedure after she was drugged, the patient graciously gave me permission. The surgery that followed was laparoscopic, and I watched as the surgeons uncovered the dermoid. It was huge, so huge that the attending stopped the procedure to make an important announcement: this growth needs a name, and the med-student will do the honors. A few weeks ago I was driving across Utah in a rental car and decided that my cute little rental car needed a name, and that name would be Bert. Well, I hate being put on the spot, and before I could come up with anything witty or intelligent, BERT mmediately flew off of my tongue. And that was that. For the rest of the procedure we were no longer fighting a massive teratoma, we were dealing with Bert. "Okay so I’m going to move the clamp toward the round ligament, and as I pull back the ovary I’d like you to grab Bert from beneath and move him medially." Bert took on a personality of his own and was a tough little monster.
Once Bert was delivered, I rushed him down to the pathology lab for a frozen section. Here I actually got to look at the hideous little guy. He was gross, filled with nasty yellowish oily fluid, covered with hard cyst-like things filled with gray goop, and hair. Blonde hair. Our patient was a brunette. It was nasty, but thanks to Bert and our lovely patient, I’ll always be able to remember what a teratoma is, and hopefully always remember my first day in the OR.