Melinda is an Advanced Practice Lead Surgical Physician Assistant at a mid-tier institution where her main responsibilities include patient evaluation, pre-operative consultation, and first assisting in the Operating Room on all vascular surgery cases.
Melinda grew up in Newport Beach, CA and then obtained her BS in Biology from the University of Arizona in Tucson. Melinda then attended the Physician Assistant program at the Keck School of Medicine at the University of Southern California (USC). She admits that she hated her surgical rotations during PA school and vowed that she would never work in the Operating Room. She began her career in the Emergency Department at a Level II Trauma Center and loved being an ED PA. It was only until a short-staffed O.R., a deteriorating patient with a ruptured AAA, and a vascular attending asking for her help in surgery did Melinda find out that for her, surgery was most definitely an ‘acquired taste’
Within a month, Melinda requested a transfer to the Vascular Surgery service where she was the first Advanced Practice Provider (APP) on the service. Consequently, she also began dating the vascular surgeon whom she assisted that fateful night and is now her husband. Together they have twin girls who just turned 3 years old.
What is your role on the Vascular Surgery Team? I am our Lead Surgical PA so almost 75% of my time is spent first assisting in the Operating Room. However, as the first APP ever part of our Vascular Surgery service, I wanted to prove the value that a PA could bring and now each of our 4 attendings each have a dedicated PA / RNFA who supports them both with pre-operative evaluations and first assisting. I set up our training program to help integrate new APPs into the service and am now responsible for our Vascular APP’s performance evaluations, integration into the vascular service, and continuing education (mostly simulation-based). I love having the opportunity to help develop others and this role provides me an ample opportunity to take part in that.
What is it a steep learning curve coming from a non-surgical specialty to Vascular Surgery? It most definitely was. Having a surgeon who really wanted to teach me how to operate and build foundational surgical skills and techniques was amazing. But, I learned so much from our scrub nurses and surgical techs. When I am on-boarding a new APP on our Vascular Surgery team, I always tell them to leverage the vast knowledge of our operating room nurses and surgical techs. They know so much and have an insane amount of knowledge that is incredibly helpful in getting up-to-speed fast. Another thing that was important to my ramp-up was not being afraid to try. Vascular surgery is so technical and some of our procedures are very high-risk, but you can’t let fear stand in the way of learning. You certainly need discretion but the only way to learn how to operate and navigate complexity is to actually do it - it’s not a sideline sport and understanding that is incredibly important to becoming value-add.
What is it like operating with your husband? We both love it - it gives us a chance to be together, but it also reinforces to me how great we complement each other both in a work and non-work setting. When we operate together, there are very few words spoken. I’ve always believed that great surgery is ‘quiet surgery’ and I think having a partner who enables that seamless flow can only be a good thing for patient outcomes. But, when we are in the O.R. together, it is known to the entire team that he is the surgeon and I am the first assist - nothing more and nothing less. He expects the same technical excellence, preparedness and performance from me as any other first assist and is not afraid to let me know if I am not meeting those standards. In the O.R., I address him as “Dr. _____”. I think setting those boundaries are incredibly important to prevent any signs of favoritism. Additionally, my performance review process is a bit different to avoid nepotism issues.
We share the losses together. We do the full gamut of vascular surgery, including attempted repairs of ruptured AAAs. Unfortunately, those cases have a very high perioperative mortality rate and most do not even make it to the Operating Room. If and when we lose patients, we certainly lean on each other for emotional support because everybody that works in the Operating Room knows the horrible feeling of losing a patient during surgery. But, we also get to celebrate the wins together - being able to share in the joy of helping patients through surgical intervention is such a wonderful thing to share as a couple and we very much enjoy all of the successful outcomes we have together.
How has being a mother to two young twins affected your career as a Surgical PA? I took six months off after having our twins just to settle into motherhood and enjoy being a new mother. To say my priorities have not shifted would be a lie. However, having children has not lessened my passion for my career one bit. Yes, there are days if they are sick where being a mother takes priority. I want to be there with them and for them. But, I also want to instill in them a notion that being a mother does not make me less of a professional. I believe that in today’s world, it is more important than ever to show our young girls the power of passion and pursuit to do something with our lives that provides significant meaning, and first assisting in surgery has incredible meaning to who I am as a person.
How do you view your role in the O.R. with that of a Scrub Nurse? I always view and treat each member of the team with respect and dignity and I do this because I know that their work is as important as mine. I have great relationships with our scrub nurses because we are so reliant on each other to obtain a successful outcome. One of the scrub nurses who is on our high-risk team is actually one of my best friends now. We spend a lot of time outside of work and she is so good at her job. In fact, I was scheduled for a cesarean to deliver our twins at the same hospital where I work and asked my OB if she could be the scrub nurse on the team. The OB said “of course”, and she was a core member of the surgical team that delivered our twins. That type of bond that we now share will be something that is eternal. Those who view surgery in terms of strict hierarchy (and in some services, hierarchy is more important than others), dismiss the notion that we are all equals in helping our patients - the only difference is ‘our individual roles in doing so’.
