Monday, July 6, 2009

My First LEEP

The GYN Oncology rotation is one of the most dreaded rotations of intern year. You are relegated to spending 12-14 hour days on the floor managing moderately to very sick cancer patients. As the go-to person on the floor, all the abnormal vitals, labs, imaging, nursing concerns and patient issues come your way. Add the litany of paperwork each patient requires and this makes for incredibly chaotic days. What makes this rotation so hard is that, unlike other surgery rotations, we don’t get to break up our day with the fun of going to the operating room. We are 99.9% handcuffed to the Oncology unit.

So imagine my joy when my senior resident asked me on Friday to head down to the OR to do a LEEP procedure*. It was the end of a long week of scut work** up to my eyeballs. I could think of nothing better in that moment than the reprieve of going to the operating room and working with my hands to do something definitively to help a patient.

It had been more than 6 months since I had seen the inside of an operating room but I wasn’t too nervous. I mean, the attending doctor knew I was an intern. He would show me what to do, right? I head to the OR and meet the attending doctor and the fellow. We scrub, get into our sterile gowns, don our sterile gloves. After the patient is getting prepped and draped, the attending hands me the loop. “Here you go.” Then he sits back and waits. Hmmm. Here I am, standing between the patient’s legs, with the loop in my hand, not quite sure what to do next. How deep do I go? Where does my excision start? Where does it end? I mean, I am all about being proactive, but this is a woman’s cervix I’m working on. Not only do I not want to be the one to mess up her girly bits, but it’s now or never that I learn how to do this right. “Um, Dr. T? Think we can do some practice runs? So I can get the motion down right?” Fast forward to 7 practice runs later, yes seven, and I am ready for the real thing. My hand is no longer shaking from nervousness. I hold the loop in my hand, push down on the edge of the cervix, push the “cut” button on the bovie, guide the instrument up until the perfectly round surface of the cervix is excised. “Look at that. That is great cut!” says the attending and I beam. It’s silly what a sucker medical trainees are for positive reinforcement.

By the time we get the patient cleaned up and out of the OR, it has been a mere half hour that I have been gone. But I was re-invigorated. Re-inspired. My quick surgical jaunt reminded me of all the operating that awaits me over the next four years…

* A procedure in which the surgeon shaves off precancerous lesions from the cervix using an electrically-powered loop

**Scut work: the glorified secretarial, errand-running, busy work that makes up the day to day life of an Onc intern (as described above)


  1. i love reading everything you write. so interesting!!!!!

  2. You captured the moment so well. I was SO happy when my cheif let me go to the OR for my first cone. I left remembering that my days as a secretary would soon be over.