A Day In The Life: General Surgery

I'm over halfway through my four-week general surgery rotation and thought I'd share what my days look like. General surgery is undeniably cool. You get the chance (privilege!) to see stuff that few people ever do. In medical school it was such a thrill to touch the liver, feel the aorta pulse, and hold a colon cancer (freshly resected; the surgeon casually passed the piece of colon over to me).

It took me most of third- and fourth-year med school to realize that "This is new and exciting and so so cool!" does not mean "This is what I want to do for my career." I used to see surgery as the pinnacle of medicine. Surgeons were the ones who saved people. They made obvious differences to their patients' lives, with immediate and tangible results. They worked hard and remained calm under pressure. I felt that surgery would be the most challenging field of medicine to enter and to choose any other specialty would be wimping out. Looking back, all I can say is that I could not be more relieved that I snapped out of my Grey's Anatomy-inspired delusions of grandeur and picked a (non-surgical) specialty that was right for me.

While I still believe that surgery is one of the most challenging specialties, I know that my specialty (like any other) will challenge me in unique ways. Surgery is not for everyone and I'm glad I didn't end up pushing myself into it, only for the sake of taking the "hard route".

Enough rambling! Here's how I spend a typical day:

0530 h: I head to the hospital, get changed into scrubs, and print a list of my team's patients.

0600 h: The residents and medical students meet in the lounge. Whoever was on call fills everyone else in on the overnight consults and ward issues.

our lounge...dead because everyone's off working

0610 h - 0745 h: We divide into our three teams and hit the wards to round. Surgery rounds are super speedy! They consist of waking the patient up, asking "Any pain? Nausea/vomiting? Have you pooped/passed gas? Eating? Up and walking around?", feeling their belly (it better be soft), checking their incision, and looking at the nursing flowsheet to assess their vitals and drain output. We write a brief chart note and orders and move on to the next room.

one of the wards

0745 h: We head to the OR to hunt down our team's staff surgeons to update them on the ward happenings and discuss patient management. When they have breaks between OR cases the staff pop over to the wards to look in on all of their patients.

a glimpse of sunlight en route from ward to OR

0800 h: The residents go through the patient list again, dividing up tasks like discharging patients, phoning other services for consults, ordering tests, etc. Depending on what's going on that day, I might spend the rest of the day on the ward, assisting in the OR, or (if I'm on call) doing consults.

an OR

At some point I make my way back up to the lounge to eat my lunch, usually while looking over bloodwork results on the computer.

leftover rice, lentils, & a hard-boiled egg (the best lunch I can pull together at 4:45 am)

1700 h: At the end of the day we hand over to the resident on call and head home! ...Unless we are that resident on call, in which case we're there until around 8:30 or 9 am the next morning.

call room -- on my most recent call I spent exactly zero minutes here :(

Study Resources
Honestly, apart from looking things up in the moment on UpToDate, I haven't been doing any anticipatory or retrospective reading this block (residents just don't seem to get pimped in the same way as med students...so there's definitely less motivation). That being said, I did read plenty during my three months of surgery in medical school. My two favourite books were:

1. Essentials of General Surgery by Peter Lawrence -- I didn't read many textbooks in medical school, but this is one that I actually read just about from cover to cover. I found that it was very readable, included clear anatomy diagrams, and went into just the right amount of technical detail for a medical student or resident. The double-sided "fold on the dotted lines" step-by-step instruction page on open mesh inguinal hernia repair is the clearest explanation I've seen of that procedure (and that's one that you will be pimped on, so be prepared!)
2. Surgical Recall by Lorne Blackbourne --
   
   This book is written entirely in question and answer format, so it's harder (but not impossible, especially on gen surg) to fall asleep while reading it. It's helpful to read the relevant section before going into the OR, as it'll give you answers to a few of the questions that the surgeon will inevitably ask.
3. trauma survey -- If you're working in a centre where you'll encounter traumas, make sure you memorize the primary (ABCDE) and secondary survey components. Also know the mnemonic "AMPLE" (Allergies, Medications, PMHx, Last meal, Event/Environment). As a med student or resident it may be your job to perform and chart these things!

   

   (http://www.ebay.com.au/itm/Plastic-Lanyard-Card-GCS-Glasgow-Coma-Scale-Primary-Survey-ATLS-trauma-/221323678139)

4. PreTest Surgery -- Just like I did for my other med school rotations, I worked my way through this book of multiple choice questions when studying for my NBME. However, I can't say I'm sure it was very helpful.
   

If you've done a general surgery rotation and have any tips or study resources to recommend, please feel free to comment!