Surgery with a Baseball Bat

Addis Ababa, Ethiopia

Placing a myringotomy tube is one of the first surgical skills that I learned as an otolaryngology resident. The steps are to make a small incision in the ear drum and wedge a tube about the size of a grain of rice through the hole. It's kind of like the game, Operation. Don't bump the ear canal wall with your sharp instruments, don't rip the ear drum, don't drop the tube into the middle ear.

I remember the first time I placed a myringotomy tube. That morning, I had watched my mentor place several tubes and I was eager to put one in myself. When the next case rolled in, my mentor looked at me and said, "It's your turn." I wasn't sure whether it was nervousness or excitement, probably a combination of both, but my heart started pounding and hands became clammy. When I sat down under the microscope, there was an unfamiliar tremor in my hand. Every-time I put in a new instrument, I would bump into the ear canal and cause bleeding. I could feel my mentor staring at the back of my head and thinking, "WHAT ARE YOU DOING?" And although I managed to finally insert the tube, it certainly wasn't pretty.

As a fellow at the Pittsburgh Ear Associates, I had the opportunity to travel to Addis Ababa, Ethiopia with the same mentor who trained me as a resident and participate in a medical mission trip to perform otologic surgery on children. By this time, I had long forgotten about the days of putting in my first myringotomy tube and was learning how to reconstruct ear bones, place cochlear implants and remove tumors of the ear.

On the day of surgery in Addis, I was tasked with two cases. An ear drum reconstruction and removal of a cholesteatoma. Although challenging cases, I was able to complete them in a reasonable fashion. After I closed my room, I went next door to my mentor's room. A 6 month old baby was just wheeled in and needed myringotomy tubes. My mentor looked at me with a mischievous grin and said, "Want to give it a shot?"

I responded, "Sure! Why not!" But that's when I saw it, a baseball bat which had been MacGyvered into a microscope stand... I knew exactly what my mentor was grinning about. As I sat down in the chair, there was a familiar feeling that came across me - a sense of both nervousness and excitement. The tremor that I thought I had conquered was back. I once again felt like a 1st year resident sitting down to perform my first myringotomy tube. I could feel my mentor staring at the back of my head as I awkwardly wrestled the microscope to get a view of the ear drum.

However, this time, things were different. I slowed my breathing and gathered my thoughts. My tremor slowed and my nervousness subsided. I did what I had been doing for years. I made the incision on the ear drum and wedged the tube through the hole.