Diaries of a Medical Student Intern: A Bahubali-esque kind of case

Aarya Ananthakrishnan

June 8th 2023

Day 17 as a medical student intern.

Today started off like every other day of my observership at the surgical oncology ward – I walked into the Doctor’s Room bidding my ‘good mornings’ and ‘how are yous’ and changed into an unflattering pair of teal scrubs and crocs about four sizes too big for me. As usual I had no idea which OT to walk into and what case was going on but just my luck, I bumped into a hilarious orthopedic oncosurgeon who whisked me into OT1 to check out a supposedly ‘beautiful mega-surgery’. I followed Dr. Pramod and his team into the operation theatre with nothing but enthusiasm and clumsiness to offer. Although I’ve often considered myself to be a relatively precocious and composed young adult, all levels of maturity left the theatre when I laid eyes on the ten men ready to drill, saw and hammer away at the patient’s tumor.

51-year-old Mrs. X walked into the hospital with knee pain in the left leg along with her family for a general consultation. MRIs and X-rays concluded that a rather sizeable yet benign tumor had developed around the left patella, encasing the distal femur and proximal tibial bones of the left leg. Patient history showed that Mrs. X had undergone partial femoral and tibial replacement surgery and was currently living with implants that aided her mobility. Although massive Fibromyxoid tumors are capable of growing and spreading across several bones and can sheath the many blood vessels within the thigh and leg compartment, what made this case interesting was the fact that the massive Fibromyxoid tumor was partially able to develop around the implants which are inanimate pieces of metal lacking Osteo-cells of any kind. It was inferred that there may have been chances of Fibromyxoid tumor cells being present at the area that required implants that could have been overlooked during the first surgery that Mrs. X underwent. During the operation the tumor cells could have been unintentionally smeared across the femur and patella and may have used the implants as leverage to grow and spread across the anterolateral thigh and leg compartment.

This 8-hour surgery began with me struggling to scrub in and almost contaminating every sterile surface in the theatre. After saying a prayer and clicking a few pictures, the Bollywood playlist began playing and the surgeons began cutting. Being the smallest and youngest person at the table this morning virtually made me invisible but also extremely inexperienced so you can imagine my euphoria when I was allowed to assist every now and again. Dr. Pramod and his team constantly danced around the table attempting to cut through the skin barrier, layers of muscle fascia and adipose tissue whilst I stood starry-eyed. Within 30 minutes or so the osteosarcoma became evident and many pulse lavages later, so were the implants. The bulk of the operation resided in the surgeons ligating the many blood vessels feeding into the tumor and tying up the major arteries, veins and nerves to identify them and prevent accidental damage. Approximately 2 hours in, the carpentry began. Drills, saws and mallets were brought out to dissemble the tumor and splash us all with blood, saline solution, bone debris and residual tumor. It was awesome. The highlight of my entire observership was what commenced after; I got to lift a 2kg tumor out of the patient’s leg with one-hand to the soundtrack of Bahubali. Despite having not seen the film myself, I still felt pretty majestic - probably more so than the actual actors of the film. I stood there posing for photos and holding the tumor in various poses suggested by the surgeons whilst they all laughed at my frivolity. Who says surgeons can’t have a sense of humor?

After 8 hours of palpable excitement, dehydration, starvation, possible lumbar dislocation and roughly 125 bloody gauzes that left the theatre resembling my local butchery the surgery was complete and was rendered a success. Mrs. X could now proudly call herself ‘cancer-free’ and move around better than ever thanks to her legs of steel (literally).

Interesting words I heard today in an operation theatre:

· Kink

· Bulldog

· Mosquito

· Mallet

Interesting things I did today for the first time:

· Feel a pulsating femoral artery.

· Mix the cement for the implants.

· Operate the saw used to cut into bones.

· Screw the implants at the distal femur.

· Danced to Bollywood songs whilst staring at a dismembered leg.

Today’s verdict:

I think I want to become an orthopedic oncosurgeon.

Diaries of a Medical Student Intern: A Bahubali-esque kind of case

Aarya Ananthakrishnan

June 8th 2023

Day 17 as a medical student intern.

Today started off like every other day of my observership at the surgical oncology ward – I walked into the Doctor’s Room bidding my ‘good mornings’ and ‘how are yous’ and changed into an unflattering pair of teal scrubs and crocs about four sizes too big for me. As usual I had no idea which OT to walk into and what case was going on but just my luck, I bumped into a hilarious orthopedic oncosurgeon who whisked me into OT1 to check out a supposedly ‘beautiful mega-surgery’. I followed Dr. Pramod and his team into the operation theatre with nothing but enthusiasm and clumsiness to offer. Although I’ve often considered myself to be a relatively precocious and composed young adult, all levels of maturity left the theatre when I laid eyes on the ten men ready to drill, saw and hammer away at the patient’s tumor.

51-year-old Mrs. X walked into the hospital with knee pain in the left leg along with her family for a general consultation. MRIs and X-rays concluded that a rather sizeable yet benign tumor had developed around the left patella, encasing the distal femur and proximal tibial bones of the left leg. Patient history showed that Mrs. X had undergone partial femoral and tibial replacement surgery and was currently living with implants that aided her mobility. Although massive Fibromyxoid tumors are capable of growing and spreading across several bones and can sheath the many blood vessels within the thigh and leg compartment, what made this case interesting was the fact that the massive Fibromyxoid tumor was partially able to develop around the implants which are inanimate pieces of metal lacking Osteo-cells of any kind. It was inferred that there may have been chances of Fibromyxoid tumor cells being present at the area that required implants that could have been overlooked during the first surgery that Mrs. X underwent. During the operation the tumor cells could have been unintentionally smeared across the femur and patella and may have used the implants as leverage to grow and spread across the anterolateral thigh and leg compartment.

This 8-hour surgery began with me struggling to scrub in and almost contaminating every sterile surface in the theatre. After saying a prayer and clicking a few pictures, the Bollywood playlist began playing and the surgeons began cutting. Being the smallest and youngest person at the table this morning virtually made me invisible but also extremely inexperienced so you can imagine my euphoria when I was allowed to assist every now and again. Dr. Pramod and his team constantly danced around the table attempting to cut through the skin barrier, layers of muscle fascia and adipose tissue whilst I stood starry-eyed. Within 30 minutes or so the osteosarcoma became evident and many pulse lavages later, so were the implants. The bulk of the operation resided in the surgeons ligating the many blood vessels feeding into the tumor and tying up the major arteries, veins and nerves to identify them and prevent accidental damage. Approximately 2 hours in, the carpentry began. Drills, saws and mallets were brought out to dissemble the tumor and splash us all with blood, saline solution, bone debris and residual tumor. It was awesome. The highlight of my entire observership was what commenced after; I got to lift a 2kg tumor out of the patient’s leg with one-hand to the soundtrack of Bahubali. Despite having not seen the film myself, I still felt pretty majestic - probably more so than the actual actors of the film. I stood there posing for photos and holding the tumor in various poses suggested by the surgeons whilst they all laughed at my frivolity. Who says surgeons can’t have a sense of humor?

After 8 hours of palpable excitement, dehydration, starvation, possible lumbar dislocation and roughly 125 bloody gauzes that left the theatre resembling my local butchery the surgery was complete and was rendered a success. Mrs. X could now proudly call herself ‘cancer-free’ and move around better than ever thanks to her legs of steel (literally).

Interesting words I heard today in an operation theatre:

· Kink

· Bulldog

· Mosquito

· Mallet

Interesting things I did today for the first time:

· Feel a pulsating femoral artery.

· Mix the cement for the implants.

· Operate the saw used to cut into bones.

· Screw the implants at the distal femur.

· Danced to Bollywood songs whilst staring at a dismembered leg.

Today’s verdict:

I think I want to become an orthopedic oncosurgeon.