Panda’s Quick n’ Dirty Guide to Third Year Rotations: Part 4

(Disclaimer: I hated surgery with the burning fire of a thousand suns so you may have a different experience-PB)

General Surgery

Your Real Responsibilities:
Nothing. You’re a medical student. You don’t count. Your job on the surgery team is to be the butt of jokes and to give everybody someone to laugh at. Hey, I don’t make the rules. I’m just telling you how it is.

Your Pretend Responsibilities:
Post-operative management of patients on the wards. Assisting in the operating room although you can easily be replaced by any one of many finely crafted retractor frames. I all but refused to go to the OR after I learned about these things. “You mean to tell me that there is no reason for me to stand in the same place holding a retractor for six hours when all you have to do is hook up the frame and clamp the retractor to it? Why those no good, sadistic, lazy….”

But I digress.

Your other pretend responsibilities will include following patients as you would do on a medicine service as well as attending clinic where you will pretend to evaluate patients before presenting them to your attending.

Things You Should learn:
Ranson’s criteria are huge. I must have been asked about these at least once a day. (Ranson’s criteria help predict mortality from pancreatitis.) Also things like Charcot’s triad (fever, jaundice, and right upper quadrant pain), Reynolds pentad and other eponymous collections of symptoms. Surgeons love these things and if you can rattle them off your attending will think you are the best medical student ever even if you are an otherwise lazy piece of shit.

Don’t forget Panda’s Triad which is boredom, disinterestedness, and clock-watching.

Know the twenty-or-so common abdominal surgeries, their indications, and how they are done. If you know what a whipple is, for example, and the relevant anatomy you will do just fine in the OR under the pimping gun. Don’t ever say “Roux-en-Y” unless you know what it means. Also, don’t ever go into a case without at least knowing the patient’s name, his diagnosis, and the planned procedure.

Know how to scrub and what to do and where to stand in the OR. Extra points for knowing how to “self-glove” in a sterile manner because you might be expected to do this. Apparently, many scrub nurse have a clause in their contracts stating they don’t have to hold gloves for vagrants, migrant workers, cheerleaders, medical students, and others with no real purpose in their operating room.

Also know about wounds, how they heal, and the various methods used to dress and debride them. And for Mohammed’s sake learn how to tie a few common surgical knots. Practice before your rotation. Nothing says “dork” like throwing a granny knot.

Things That Will Suck:

No. Really. If you don’t like surgery (and you will know how you feel about it after, oh, maybe five minutes) It all blows hard combining as it does all of the worst aspects of every other rotation with real hard work. Standing in a case holding a retractor or trying to stay awake and not falling into the sterile field (which I saw happen) is grueling. Medicine, by comparison, is not hard, just annoying.

The higher than usual numbers of malignant attendings and tired, bitchy residents just adds a little kick to the fecal jumbalaya which is your surgery rotation. But I have no sympathy for them and you, also, need to resist that temptation. Sympathy is in the dictionary between shit and syphilis. We lay in the beds we make. Nobody holds a gun to anybody’s head and forces them into this career. It sucks but it’s not as if your tired, pissed-off residents didn’t know this before they matched. Your third year rotation gives you a pretty good overview of the life of a surgery resident. You will be getting up just as early and leaving just as late. I hated every single minute of my surgery rotation, the only good thing about it being that it was my first rotation of third year and nothing that came after even came close to sucking as hard.

Cool Things About the Rotation:
Nothing. Seriously. If you don’t like it and have no interest in being a surgeon it is all a grind. Even surgeons will tell you this. Surgery is a calling. You either love it to the exclusion of almost everything else in life or you will resent it mightily. Family medicine, psychiatry, Emergency Medicine, and Internal Medicine residency programs are littered with ex-surgery interns who discovered that they had other interests in life and that, while it may have seemed cool at one time, it just wasn’t worth it in the end. Married surgery residents have almost a one-hundred percent divorce rate for a reason. You cannot have a family life as a surgery resident. Period. The eighty hour work week is still a joke in most programs and the simple mathematics of the week dictate that you can’t have Q3 call, work 100 hours a week, get the bare minimum of sleep, and spend the time with your wife and family that they deserve. There are 168 hours in the week. How much sleep do you need? Forty hours a week? Do the math. It’s five long years, sometimes six.

By contrast, as an Emergency Medicine resident I work about sixty hours a week for three years and will probably make more as an attending for half of the hours and about a third of the bullshit.

But you know, it’s surgery. There is no question that it is a useful, highly challenging field which will never be replaced by mid-levels or outsourced. If you’re young, healthy, and motivated and like this kind of thing you may find your true calling in life on your surgery rotation. A lot of my classmates loved this rotation and yearned for fourth year when they could line up more of it.

Useless like most medical student call but not completely useless. On trauma call you will be handed the “Monkey Sheet” (the History and Physical) and filling it out during the trauma will help your tired residents immensely. And you may be a real help during cases late at night or early in the morning when nobody is around. You’ll still hold the retractor but at least you’ll be standing opposite the surgeon and not leaning in at an impossible angle.

Slacking Potential:
Excellent. Other than rounding in the early, early morning your residents and attendings will be busy during the day and not making a career out of leading you and the rest of their entourage around the hospital. I’m sure your school has a minimum number of cases in which you must participate but nobody ever failed the rotation for not getting into a whipple. Maybe during your rotation nobody needed one. A colectomy here, a hernia repair there and you can build up enough cases to keep the wolves from your door. After this there are a dozen perfectly legitimate reasons not to scrub in on a case without having to ever resort to the “I’ve had the runs all day” ploy. If you don’t like it and would rather be a Slurpee jockey than a surgeon, OR time is pretty low-yield anyways. No reason to kill yourself.


How to Scrub 1
How to Scrub 2
My First Day of Third Year