End of Rotation Review: General Surgery

So as I wrote in my previous, and first, entry to my “End of Rotation Review” series, family medicine was super chill (click here to read it). My attending was very empathetic to the med student experience and ensured that I had a good time during my month with him.

During my last week, he said to me, “are you ready to get your ass kicked by surgery next?” Most med students dread surgery as it’s notoriously known as an arduous, soul-crushing experience. Despite being pretty sure I wanted to go into a surgical field, I was a little bit intimidated. It’s natural. I had shadowed a handful of surgeons in the past few years but only scrubbed once before. As a first year med student fumbling my way through the foreign land of the operating room, I was kicked out of the procedure for breaking sterile field twice. Not my finest hour.

After showing up on my first day dark and early, I waited to meet the educational coordinator person (idk what her title is) who didn’t arrive until forty-five minutes after we had planned. After a brief tour of the O.R.’s, pre-op, PACU, endoscopy suites and all that jazz, I eventually arrived at my attending’s office, sat down and discussed the expectations for the rotation. “Do you know what you want to do yet?”, he asked.

As always, I like to keep my answer to this question relatively vague (i.e. if you’re on pediatrics, hate pediatrics, and would rather quit med school than pursue it as a career, you keep that to yourself and say you’re undecided but interested in what every specialty has to offer). However, it was surgery, and I want to do a surgical subspecialty. I am still remotely considering anesthesia as well. So I conveyed this to him.

He outlined the plan:

“So recently we’ve decided to start doing something different. You’re going to do whatever you want. You are not going to be tied to me or any other attending. You have the freedom to make this rotation yours. If you see something on the schedule that interests you, ask if you can scrub in. You pay so much money for every day you’re here and you have so little time to explore and figure out what you want to do for the rest of your life.”

These were his terms. My grade would be determined by comments from surgeons, residents and other staff. As long as I logged enough bread & butter general surgery cases (lap choles, appy, hernias, etc) and worked hard, I was given full freedom to spend my time with whatever specialty, surgeon, and procedures caught my interest.

Again, I struck gold.

My attending: Like my family med preceptor, my attending was once again very understanding of the medical student experience (probably because he has two kids in medicine). Very down to earth guy. We could talk about medicine, old college tales, sports, and everything else in between that comprises life. And while he loved to tell a story about his college days and joke around, he was also wildly intelligent, a dedicated teacher and took my education very seriously. I’m not the type to suck up and bring a gift for my attendings at the end of every rotation, but his compassion and understanding compelled me to write him a thank you letter. Dudes a hero. By the end of the rotation, he said, “Jordan, you, me and [pgy3] need to stop down at [new local pizza place] and get some beers”. He truly made me feel like I was part of a team and not simply a nuisance.

Daily routine: Wake up at like 4:30-5:00 and arrive at the hospital somewhere between 5:30-6:00 depending on the day. Check out the schedule for the day and map out my plan of action. Round/pre-round on patients with residents. Have a coffee and do some reading. Surgeries typically started at 7:15. Lunch with residents at noonish or whenever there was time between operations. End time was variable; usually somewhere between 4:00 and 7:00.

Shelf Exam & Study Resources: I read through Pestana’s Surgery Notes about 1.5 times throughout the rotation and did the questions in the back, which were golden. It doesn’t go into the depth you’d like for shelf/board questions, but it gives you a really strong base and it’s the perfect book to throw in the white coat/back pocket of your scrubs and read during downtime. Highly recommend it. You can purchase it here for about 20 bucks.

While I chose Pestana’s, I’ve also heard great things about de Virgilio’s surgery review book if you’d like something more in depth. The shelf exam was heavy on medicine; I read the GI and endocrine chapters in Step Up to Medicine which I found very helpful. Lastly, I completed the UWorld surgery questions and about 500 medicine questions. This was sufficient to honor the shelf exam.

Thoughts on Surgery: Time flies when you’re having fun. There are a million variations of this cliche, but surgery proved it to be true. I have never been a morning person, but I was excited to get out of bed just about every day while I was on my surgery rotation. My 4:30 a.m. surgery wake up time felt easier than getting up at 8:00 for pediatrics. Twelve hours in the hospital felt quicker than six hours in an outpatient clinic. I simply love the OR. I love the energy, the atmosphere, the “team” vibe, and yes, I loved many of personalities; the nonstop banter, the jokes, the interesting life discussions while using years upon years of training to restore health to a sedated human being.

I was lucky enough to work with talented surgeons across all surgical subspecialties. I learned to admire their work, because surgery can truly be a beautiful thing. It’s just.. really cool to me, you know? Using a two million dollar robot to remove a prostate. The precision and delicacy of the plastic surgeons sewing with sutures thinner than a human hair. Removing a cancerous neck mass while watching the carotid artery pulse millimeters away. Restoring confidence to a post-mastectomy breast cancer patient via augmentation. Even something as routine as the efficiency and workmanship of a general surgeon removing gallbladders was a thing of beauty. I could go on and on, but you get the point.

Obviously, not every day was sunshine and puppies in surgical fantasy land – there were complicated cases, long hours, frustrations, bad moods, and so on. But you accept the good with the bad. Some surgeons were an absolute joy to work with while others were cranky. Some played good music while others preferred a silent OR. Some loved to joke around while others were all business. Some liked to teach while others hardly acknowledged my existence.

That’s just the way it goes.

Fortunately, my residents were friggin’ saints. Despite the stress and fatigue associated with general surgery residency, they were eager to teach and made sure I got involved as much as possible. They knew I wanted to do surgery (which is key) so they always tried to find cases where I could get my hands dirty. Of course I often assumed the typical med school roles of camera holding, retracting, closing, etc but I was also very thankful for the privilege to assist on things like parathyroidectomies and neck dissections.

I think the highlight of the entire rotation was in my second week. Before heading home one evening, I checked the next day’s schedule and saw that an ENT was scheduled to remove a cancerous parotid gland. I went home that night, watched a Youtube video of the procedure, and reviewed the anatomy to prepare for the case. Having previously discussed my interest in ENT with him, he invited me to scrub in. After prepping the patient, he grabbed his surgical marker and marked the Blair’s incision.

To my surprise, he turned to me with the scalpel in hand and said, “go ahead”. To this point I hadn’t done more than camera driving and closing, yet here I was holding a razor-sharp object so close to vital vessels and nerves. The sympathetics were activated. Heart pounding in my chest, I grabbed the scalpel and carefully cut along the marked line. I smiled like an idiot for the next five minutes behind my surgical mask (and good thing for the mask because I probably looked like such a dork). But I was so happy in that moment. It may not seem like much, but that will forever be one of my fondest medical school memories.

However, what I loved most of all during my time on surgery wasn’t an operation or any particular experience – it was the people. I am completely aware of how cheesy that sounds, but it was true.

The scrub techs would make sure I was able to scrub and and get a good spot at the table. The nurses and CRNAs treated me like a friend. The residents coached me on suturing techniques, made sure I was actively involved in every case possible, while instilling a wealth of wisdom and advice in between. The surgeons would pimp me, talk about life, and of course – make fun of me at every opportunity possible.

I learned a wealth of clinical knowledge. I gained experience and confidence in basic surgery skills. I saw fascinating cases and technology. Several of the surgeons I worked closely with invited me to come back whenever I’d like. And by the end of it, I realized that this wasn’t simply a workplace thing or networking experience – I made genuine friends.

The physicians and residents invited me to get pizza and beers with them. One of the nurses even tried to set me up with her daughter. I still keep in contact with many of the people I met. We had deep discussions on life in medicine, family, and current events. And we also joked around constantly. I didn’t simply feel like med student #546; I felt like I was part of the team.

Attending Evaluation:

“Jordan is one of the best students to ever rotate through this facility”.

I had a phenomenal experience on my general surgery rotation. I do know that I was lucky to rotate at this hospital and that others might not have the same experience, but I also feel that I get what it takes to succeed, thrive, and even enjoy surgery rotations. Check out how: