And here we are again – another rotation, another roundup.
There were a few moments when I thought I’d never get to write this (only a few, thank goodness), but every med student dreads gen surg and every student gets through it just fine. And I certainly can’t pretend to have suffered more than most. In fact, I had a lot of fun most of the time.
But you’re not really interested in my pre-review rambles and feelings. You’re here for the dirt.
So let’s go dirt-diving.
The where: Royal Alexandra (3 weeks) and Misericordia (3 weeks)
The good: When it comes to surgery, efficiency is the magic word. And it’s a weirdly good feeling to feel capable of taking a pertinent history from an inpatient in 5 minutes or less. Obviously some people need more time or have more complex issues, but learning to be super speedy on rounds is a useful skill for those days when you just don’t have the time to chat.
We all know it. Surgery itself is pretty sexy. Rooting around in someone’s abdomen, looking for that mass causing a bowel obstruction, is something most people can’t even imagine doing. And there’s something intrinsically rewarding about excising something, whether it’s a breast mass or a gallbladder or an appendix. Physically removing some piece of pathology, holding it in your hands, getting a sense of just how wrong it feels… nothing like it. Unlike many other specialties, surgery is definitely the place for instant gratification.
And it’s not just the procedural stuff – surgeons enjoy a special kind of relationship with their patients, one that stems from the most intimate vulnerability, mediated by a scalpel blade. Very few things come to mind that require more trust than allowing someone to cut and hurt you for the sake of health. What you hear about surgeons being asses? As far as I’ve seen, generally not true. Sure, they’re big proponents of efficiency, but they really do care about what happens to their patients, which may even lead them to suggest no surgery at all.
For someone with OCPD traits like me, the flow of the OR is regular and soothing. Everything is done in a particular order with checks and double-checks along the way. You maintain sterility. Preserve important anatomical structures. Identify abnormalities and plan how to resolve them. Sure, it might sound a bit repetitive, but it’s safe. (Plus anesthesiologists love to label and colour code all their drugs, bless them.)
The not-so-good: The hours. Oh the hours. I never really adjusted properly, probably due to the call shifts that unfailingly screw up my sleep pattern. And I just can’t seem to sleep while the sun is still in the sky, no matter how tired I am. And it’s not just the getting up early, either – there were plenty of days where I didn’t leave hospital until 6:30-7:00 at night. Working that many 12 hour days was exhausting and left very little time to do anything besides eat and study (a bit). Plus I got a hell of a lot of weekend call. You just feel burnt out and apathetic, no matter how interesting the case.
I’m going to reiterate. Surgeons are generally good folks. But some of them take some getting used to. Some swear like sailors and some have very short fuses. Some are nitpicky about how you use your scissors and others love to poke fun at you. Learning a surgeon’s personality is half of learning how to function in the OR. I’m happy to say I was never the target of any anger or abuse, but I was in the room once or twice when someone else got the brunt of it. There’s nothing more intimidating and it absolutely ruins your opinion of them. (This goes for the residents, too!)
General surgery sees a lot of sick people. That can be very exciting and very rewarding to treat (the reason why I love appendicitis so much), but it can be utterly horrifying, too. I’ll never forget some of the trauma cases I’ve seen and heard about at the Alex. Needless to say, people have died in the most tragic and terrifying circumstances imaginable. While it’s a small relief to be spared from the fallout, you continue to think about those patients and their grieving families. Sometimes you even grieve with them.
The verdict: It’s really the hours that break this one for me. It sounds silly and superficial, but I honestly believe my internal clock just can’t keep up with such big changes. And being tired all the time is just miserable. But it’s certainly planted the idea of surgical assistant in my head…
Photo courtesy of: arztsamui | FreeDigitalPhotos.net