Saturday, September 30, 2006

Done with General Surgery

Yesterday was my last day of general surgery. The whole month is a blur. I had to go in to round on Saturday and Sunday, fortunately for only about three hours each day. Monday was clinic. Tuesday I got to first assist on two laparoscopic gastric bypasses (the intern was in class for the week, so I was the only other person aside from the surgeon to scrub in) which was pretty neat. I held the camera while the ports were being placed (then the robot took over) and held intestines back with a laparascopic grabby-thingy. A trained monkey could have done equally as well, but at least I was actually a necessary part of the surgery. Wednesday was lecture for eleven hours, then evening rounds with the resident. That evening I was supposed to bring pizza to my Bible study at 7:00. I ordered it from the hospital at 6:15, clinging to the hope that I would leave by 6:40. When 6:35 came around with no signs of leaving, I had to call one of my friends and ask them to pick it up. I left at 7:20. Fortunately they saved me some pizza. Thursday I scrubbed into a breast tumor excision which was interesting—before removing the tumor the surgeon injects some dye and a radioactive substance into the breast, and within a few minutes both substances are brought into the lymph node closest the tumor. They use some type of radiation detector to find the node, then remove it to look for tumor spreading. This particular surgeon tends to drive the residents nuts because of his micromanaging, but he is good at pointing things out to students which is nice, particularly since I am going to have to try to do a month with him early in my fourth year to get a letter of recommendation for residency. That evening, the bariatric surgeon took the students and residents out to dinner at a fancy restaurant—I got veal with prosciutto and eggplant which was excellent. Very nice of the surgeon. Friday I saw a laparoscopic hernia repair and an ileostomy reversal. The surgeon for the latter also has some micromanaging tendencies apparently, and my senior resident started showing her frustration by the end of the case. I imagine that after eight years of school and three years of surgical residency it must be annoying to be ordered around about every little thing. My duties consisted of standing in a really tight corner and holding retractors at awkward angles for long periods of time. I left the hospital at 6:30, thus finishing my 120 hours of work in 12 straight days marathon. Monday I start cardiothoracic surgery.

Saturday, September 23, 2006


The last couple days have been rather uneventful what with almost all our attendings being on vacation or at conferences. Wednesday was lecture, Thursday had no operations or clinic. We finished rounding at 9:00, then proceeded to stay and study at the hospital until after 3:00. We should have been allowed to go home at nine; I decided at the beginning of this rotation not to let anything phase me so I was OK, but the two other students were steaming by the time we were finally sent home. Friday we had a couple of cases in the morning, I scrubbed into a hemorrhoidectomy—I hope I never have to have that operation. There again was no clinic, so the residents took us out to lunch at a Mexican restaurant. Very nice of them. I had to go in this morning to round on patients with the resident, and have to go in again tomorrow—payback for having the last two weekends off. Fortunately we round later and leave by ten or eleven on the weekends, so it is not too bad, but unfortunately I have to miss church.

Tuesday, September 19, 2006


This morning I saw a reversal of an ileostomy. The patient apparently had had rectal cancer previously and had undergone surgery to treat it. The surgeon created an ileostomy (small bowel empties into a bag stuck to patient’s skin) to let the colon heal. Now that it has healed, the ileostomy could be repaired. I got to sew the incision at the end.

The afternoon was spent entirely in clinic with one other student. One patient was a 97 year old lady who had a sebaceous cyst on her chest that had grown to the size of a small apple since July. The doctor decided to do an incision and drainage to get all of the pus and nasty stuff out. He handed me the scalpel, so I got to make an incision on a live person for the first time in my life. Very neat.

One of my other patients has had intermittent burning epigastric pain for the past several years. A CT scan she had last month showed some gallstones, so she assumed the pain was due to that and made an appointment with the surgeon (for some reason she doesn’t have a primary care doctor). Turns out she has had acid reflux and probably could have easily corrected it by seeing a family doctor years ago.

We have lecture all day tomorrow. It can be annoying sometimes, but it can be a nice break too.

Friday, September 15, 2006


This week has been busy, I calculated that I worked 62.5 hours in five days although that really doesn’t sound like that much compared to how long I feel like I have been working. I saw four surgeries including two biopsies (I didn’t do anything except watch), a laparoscopic Roux-en-Y gastric bypass (I just watched), and a subtotal gastrectomy with revision of the gastrojejunostomy. The lap bypass was very interesting, it was amazing to see the surgeon do everything including suturing with long instruments through tiny holes in the abdominal wall. What was discouraging was that one of the surgeons (did a laparoscopic fellowship after surgery residency and has been in practice for several years) kept getting yelled at by the head surgeon for making mistakes—I always thought that once one got out of surgery one didn’t need supervision anymore. This could be a longer road than I thought…

The gastrectomy was interesting though I couldn’t see a lot of it since the surgeon was blocking my view. The patient had a gastric bypass a couple years ago, and a fistula (connection) had developed between her stomach pouch and the rest of her stomach, essentially making her bypass useless. The surgeon opened her up, and spent several hours with the resident dissecting to the proper area. They ended up just taking out the main stomach since it had lost much of its blood supply. The resident let me staple the incision, and I grabbed some ties on the way out to practice my knot tying (I learned the one-handed tie a couple of days ago) at home.

This morning was GI conference, and I was supposed to present a patient who had left the hospital the second day of this rotation, I had never spoken to him. Yesterday I had to track down his chart via the very crabby nurse practitioner, and when I did get it it really didn’t have much information. I spent 1-2 hours piecing together his history, and fitting it into a one minute spiel. I got home last night and had to practice it in the small amount of time I had before going to bed. At the conference this morning, the attendings spent so much time talking about other patients that I thought they wouldn’t get to me. Fortunately my resident spoke up before everyone left and asked if we could go over the patient I was to present really quickly so I was able to give my presentation. Not that I especially wanted to talk in front of everyone, but after putting so much effort into preparing I would have been a little miffed at not presenting.

I have tomorrow off, I am very excited about that. I might not get out of bed at all (one thing I have learned on this rotation: it is a bad sign when instead of feeling sorry for patients you feel envious of them since they are always in bed when you see them—one of the residents mentioned that one of the patients spent 70% of her day at home in bed and my first thought was “that sounds great”. It is also a bad sign when the nurse practitioner stomps through the room loudly saying “I’m going to shoot myself if this pager goes off again”]). The only problem is that I have to work both Saturday and Sunday next week, but usually we are out by noon on the weekend so it shouldn’t be too bad. The weekend after marks the end of this rotation—it has gone by very quickly. Next is cardiothoracic surgery, but there will only be one other student so it is unlikely that I will be getting full weekends.

Friday, September 08, 2006

More surgery

Yesterday I might as well have stayed at home. There were only two surgeries scheduled, and it was the other two students' turn, and there was no clinic. I rounded on our patients for about 40 minutes in the morning, then went to school to study for several hours, went back to the hospital to check in on things, then studied in the work room for several more hours. When I was about to die from boredom I was finally able to go home. I just hate having to sit around with nothing to do, it drives me nuts. I can do nothing at home a lot more comfortably than doing nothing at the hospital. Adding to the problem was the fact that due to Bible study the night before I had only gotten 5 hours of sleep in--lack of sleep always puts me in an unpleasant mood.

Today was a bit better, much due the fact that I went to bed at 8:30 last night so I got a little more than seven hours of sleep. This morning I was in three short procedures, all dealing with an unpleasant part of the body (I am so thankful I was not the patient in all three of the cases). We didn't have to scrub in because the procedures were not sterile, and because there was not a lot of room I didn't really do anything other than watch and write the op notes. I will spare the details of the procedures, but one of them required a lot of suction and the circulating nurse's applying wintergreen fragrance to each of our surgical masks.

The cases were done before noon, and there was no clinic today, so again I and one of the other students sat around with nothing to do for a good long while. Later in the afternoon the intern had to admit a patient so I went with him and wrote up the history and physical (much shorter in surgery than in medicine!). Then I was able to go home.

Since as far as we can tell (we asked the senior resident, but she just made a joke and didn't actually answer the question) only one of us has to come in each weekend day, we each should get one more full weekend off this month. I was going to have it next weekend, but was paged when I got home to find out it will be tomorrow. I would have preferred next weekend, because taking this weekend off will mean I have to go three straight weeks without a full weekend, but hey, I'll take what I can get. We have actually gotten off a lot easier than the students on this rotation the month before us, they were working 75 hours a week, we have really only had to be there 10-12 hours a day. I still think I am interested in surgery as a career, most of the things I dislike about this rotation (not having anything to do, having to figure out how clinic works with four attendings, not having anything to do, etc) are only issues I have to deal with as a student, and will not be things I have to worry about as an attending. That is one of the hard things about being a student, one doesn't really get a realistic idea of what we will be doing for most of our lives, we just see what it is like to be a student and observe a little of what it is like to be a resident, both in an academic setting which I think is misleading.

There is not much going on aside from medical things. I have been reading a book about the Tudors. One of the things that struck me as interesting is that aside from the fact that all the royals marriages were arranged, the parents of the bride never seemed to have attended the wedding--they just shipped their daughters off with entourages. I guess what with not having as fast travel times back then it makes a little bit of sense, but come on.

Wednesday, September 06, 2006


Yesterday I scrubbed into my first surgery. It was very neat--it was an ileocecal resection on a patient with Crohns disease (an inflammatory bowel disease). Basically, the surgeon removed about a 20cm section of small bowel. I got to the OR late (because I thought the resident was going to get me when it was time and she assumed that I knew how and when to go down there) and they had already opened, but once I got there I got to scrub in and gown up. My main job was to hold back organs with retractors and to suction any intestinal contents that emerged from the severed small bowel. It was really interesting, although I have no idea how the surgeon distinguishes what parts of the bowel are where. At the end they let me suture up half of the incision with a subcuticular suture (one sutures side to side so that the suture never comes above the skin and is thus not visible) which I had fortunately learned how to do on a pig's foot that morning in our suture lab. I really enjoyed being in the OR, it made up for the all the confusion involved with this rotation (ie feeling like everyone expects you to telepathically figure out where to be and what to do, although I'm sure that feeling which will ease in another week or so). I can see myself wanting to do this as a career.

I went to bed at 8:30 last night, and had to get up at 4:00. It was darker when I left the house than when I went to bed. I pre-rounded on the patient I had been in surgery with, rounded with the residents, then had lecture from 7:00 to 5:00. Fortunately there was nothing to do afterwards. Tomorrow I again have to get up at 4:00, but the other two students will go to the scheduled surgeries (there are far less than I expected, I thought we would all be in the OR most of the day which is not the case) and I'm not sure if there is clinic so I will probably be doing a lot of reading (for some reason it's called "reading" from third year on instead of "studying"), hopefully I'll be able to go home early. I really hate just sitting around with nothing to do that I can't do (more comfortably) at home. Tonight I have Bible study, which means I won't get to sleep until late--hopefully I'll be able to crawl out of bed when my alarm goes off.

Saturday, September 02, 2006


Yesterday was my first day of surgery. I had to get to the hospital by 6, so much of the day is a daze. I have two other students on my team, an intern, and two senior residents. We rounded on our team’s patients with the residents, then went to orientation at 8. We got the standard orientation spiel giving information about grading and what-not, then had to get access badges from security so we can get into the OR. At noon, we went to OR orientation which consisted of scrub nurses teaching us how to scrub in and put on gowns and gloves while keeping everything sterile. It is a lot harder than you would think, and I have no doubt that I will violate the sterile field and have to re-scrub quite often. After two hours of this, we went to surgery clinic. I saw one patient who was there for gallstones. The doctor sent me in to talk to her for ten minutes. The first seven consisted of her telling me about her back problems—I was finally able to extract some incredibly vague and dubious information about some abdominal pain that she had a year ago and was coming back. Then the doctor came in the room, and I had virtually no information to give him. Fortunately, he didn’t ask for it and just started talking to the patient who almost immediately started telling him about her abdominal pain. Grrr… He still had to talk to her for almost 45 minutes to explain everything to her though, I was very impressed with how nice and patient he was with her. At the end of the interview, he mentioned to her that he had an aunt whose married last name was the same as hers. It came out that they were second cousins by marriage, and they started talking about Aunt Josephine and various relatives. It was one of the most bizarre moments of my life, for a minute I almost wondered if the doctor was making it up to boost her confidence, but it became clear that was not the case. After that, we went and rounded on our patients again (we students were starving since we hadn't eaten for 12 hours), and the residents told us that since there are no scheduled surgeries or clinic over the Labor day weekend, only one of us would have to come in each day. I went in today, so I get tomorrow and Monday off! That was totally unexpected, but definitely not unappreciated.

I went in this morning at 7:30 (I had to go to bed last night around 9 since I got up at 4:30), I didn’t have to pre-round because I won’t have any patients to follow on my own until I am in on a surgery. I looked up all the labs on our patients (this hospital’s computer system doesn’t even come close to the VA’s), and rounded with the intern and one of the residents. I came home at noon.

This will be an important two months for me since I am interested in surgery—hopefully by the end I will know for sure whether I want to pursue it or not. It is difficult though, because there are so many factors that go into each rotation. For example, I really enjoyed last month, but it wasn’t necessarily because I like internal medicine, it could be just because I had a really great team. If I do/don’t like this month, I will have to figure out if it is because I do/don’t like surgery, or if it is some other factor. My senior resident told me that she originally wanted to go into family practice, but by the Thursday of her first surgery rotation realized she wanted to do surgery. I think the main thing that would turn me away from surgery would be the lifestyle, but while it can be bad, I’ve been told that there is a group of surgeons around here who only work four days a week and only take call every sixth weekend. I think that would be very doable, one would just have to get through the 5-7 years of residency.