Friday, August 16, 2013

Surgery

My surgery rotation was exciting, intense, and fun with a lot of long hours. I was standing across the patient opposite the surgeon for all procedures and my name was on all the records as the first assistant. There are only two general surgeons at this hospital which covers this city as well as four or five other outlying smaller towns. This means that all ER trauma and abdomen pain patients, as well as all ICU and ward chest tubes, central lines, and port-a-cath placements, day or night, were seen by two people...with me in tow.

Additionally, each day part of a surgeon's schedule includes 'rounds' which involves checking in on patients, reviewing the chart, hearing a nurses report, evaluating fluid status, and making recommendations that move a patient closer to discharge. Important milestones that we would look for are a patient's ability to keep fluids and then solids down without nausea, the ability to control pain without IV pain medication, and an incision healing cleanly.

It was not uncommon for me to arrive at work at seven am and stay doing procedures and rounds until seven or eight pm and then be given a three hour assignment to have ready for the next day. Preparation for the next day would include familiarizing with the technique and relevant anatomy of the procedures involved. For most of my time there we had at least ten patients to round on and for one week we had eighteen and each patient took 20-30 minutes of attention.

I never felt light-headed or the desire to faint, but there were two times that I was very close to vomiting. The first episode was during an external hemorrhoidectomy in a 93 year-old male. Right when we were ready to begin cutting, he has a bowel movement that lasted about ten minutes. I'll spare you the description, but it required us to resterilize everything and left a horrible smell in the OR. I had to spend a few minutes rocking back and forth in the corner with all the nurses and anesthesiologist laughing at me. The second episode happened when I was given the responsibility to sterilize the abdomen which requires cleaning out the belly button. This happened to be an obese patient with a deep belly button that I'm convinced had never been cleaned. I stuck my finger in there and pulled out a hard something with 1.5 cm diameter as well as hundreds of smaller sand-like granules. Something about the situation caught me flatfooted and I wanted to vomit, but didn't. Again, the nurses all laughed at me. They find people with weak stomachs amusing.

The surgeons I worked with thankfully did not meet the stereotype. They were considerate, patient, and congenial with varying levels of didactic fervor based on how pressed for time we were. The anesthetists were the grouchy ones and they felt it was their personal duty to try to make my life miserable. 

Overall, I enjoyed my surgery rotation. I loved the excitement, the variability, and most of the people I worked with. I admit I had a rose-colored window into the surgery world because I was not required to come in for the three am appendectomies and other surgical emergencies. The hours that surgeons are required to put in and be operationally functional astounded me. At one point during a seventy-two hour stretch while one of the surgeons was on vacation the remaining surgeon was called in every night and was operating with only 1-2 hours of sleep per night...and they told me the five year residency was even worse. I think if I were single and without kids I'd pick general surgery, but I don't know if my family could handle it.

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