awesome!

[PostCall]

in another thread i mentioned how the chief resident is totally ignoring me but i take it back, well sort of. last night was the ultimate highlight of med school. a penetrating trauma came in with vitals but got lost in the trauma bay. so yep, you guessed it: thoracotomy time! i'm standing next to the chief who takes the scalpel and makes the incision and opens the ribs with the spreader and puts on the xclamp like a pro. he puts his hand in and starts massaging the heart. he does it for a while then he turns to me and asks if i want to go for it! dude! he says be careful as you reach in so not to get poked by any jagged ribs then he shows me the proper way to cardiac massage using both hands not just one. i have to say i was already decided on surgery but this clinched it. also how can anyone diss trauma surgery?!! people say it's alot of nonoperative babysitting but come on it doesn't get anymore intense than this. and this was a further example of not judging a book by its cover. this quiet to the point of asocial resident who seems to live in his own world turned into a cowboy when it was go time. i know he'll probably return to ignoring me tomorrow, but just saying it was cool to see anyway. how anyone can not go into surgery after stuff like this i don't understand.

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[asmallchild]

I'm sure even that gets old after a while.

 

[JackADeli]

...thoracotomy time! i'm standing next to the chief who takes the scalpel and makes the incision and opens the ribs ...hand in and starts massaging the heart...turns to me and asks if i want to go for it! ...how can anyone diss trauma surgery?!! people say it's alot of nonoperative babysitting...

Surgery can be a rearding career. Good luck.
As for the question above about trauma..... you pretty much already answered why. Few of your traumas are thoracotomies. Most of your thorocotomies will die. The excitement is in the trauma bay... the torture is on the floor. Worse, torture will continue in the court room when you get sued.

JAD

 

[Winged Scapula]

how can anyone diss trauma surgery?!!

How much time do you have?

Trauma and surgery are VERY cool, especially as a student.

They are much less cool, when you've been woken up (or never slept) night after night, year after year, in the trauma bay. Usually by drunks who spit on you, vomit on you, call you names or worse yet, hurt innocent people. Even the non-drunks are boring after awhile.

Only in the biggest KAGC places are thoracotomies routine. But believe me, since nearly all of them die, even trauma surgeons find them a tad disinteresting after while. It becomes a procedure like any other but with a high psychological and legal cost to you.

But glad you enjoyed it.

 

[filter07]

I am glad some people enjoy it.

 

[moneduloides]

Trauma is the garbage dump of surgery. The world needs more garbage collectors who enjoy finding something special in the dump that someone else discarded. That person can be you. Congratulations.

So eloquent. Have you considered a career in advertising?

 

[surgres88]

in another thread i mentioned how the chief resident is totally ignoring me but i take it back, well sort of. last night was the ultimate highlight of med school. a penetrating trauma came in with vitals but got lost in the trauma bay. so yep, you guessed it: thoracotomy time! i'm standing next to the chief who takes the scalpel and makes the incision and opens the ribs with the spreader and puts on the xclamp like a pro. he puts his hand in and starts massaging the heart. he does it for a while then he turns to me and asks if i want to go for it! dude! he says be careful as you reach in so not to get poked by any jagged ribs then he shows me the proper way to cardiac massage using both hands not just one. i have to say i was already decided on surgery but this clinched it. also how can anyone diss trauma surgery?!!

Awesome experience for you. As it has been said the mortality of these patients is quite high. Worse if it is blunt trauma.

Though trauma is clearly not for everyone, my advice would be to do a sub-i on a trauma service where you get to see more of this action. Remember trauma attendings will cover critical care and consults at a lot of places.

 

[SouthernSurgeon]

How much time do you have?

Trauma and surgery are VERY cool, especially as a student.

They are much less cool, when you've been woken up (or never slept) night after night, year after year, in the trauma bay. Usually by drunks who spit on you, vomit on you, call you names or worse yet, hurt innocent people. Even the non-drunks are boring after awhile.

Only in the biggest KAGC places are thoracotomies routine. But believe me, since nearly all of them die, even trauma surgeons find them a tad disinteresting after while. It becomes a procedure like any other but with a high psychological and legal cost to you.

But glad you enjoyed it.

It took me a while to realize this...trauma was the best few weeks I've had in med school...I got to do and see so much cool stuff. But the things that make it a good rotation for a student are not the things that make it a good career.

 

[Sarcoidosis]

he puts his hand in and starts massaging the heart. he does it for a while then he turns to me and asks if i want to go for it! dude! he says be careful as you reach in so not to get poked by any jagged ribs then he shows me the proper way to cardiac massage using both hands not just one.

DUDE!!!! I envy you!

 

[TomC727]

Yeah for every ED thoracotomy, you get 1000 crap cases, babysitting ortho and neuro problems, drunks, low-lifes, gangbangers that you are just a cramp in their style, and just overall crap. So if you can put up with the 1000 crap cases for that 1 ED thoracotomy and maybe a good OR case here and there, go for it.

 

[smq123]

They are much less cool, when you've been woken up (or never slept) night after night, year after year, in the trauma bay. Usually by drunks who spit on you, vomit on you, call you names or worse yet, hurt innocent people. Even the non-drunks are boring after awhile.

I never truly believed those stories that you hear about on TV until this year when a) a drunk guy with facial knife lac purposely spit blood at the trauma resident's face, and b) a random guy wandered into the hospital and assaulted the (female) trauma chief for "trying to save that ***hole's life."

<sigh>

 

[Winged Scapula]

I never truly believed those stories that you hear about on TV until this year when a) a drunk guy with facial knife lac purposely spit blood at the trauma resident's face, and b) a random guy wandered into the hospital and assaulted the (female) trauma chief for "trying to save that ***hole's life."

<sigh>

Fine upstanding citizens they are.🙄

 

[Thanatos]

Fine upstanding citizens they are.🙄

They always told me they were just minding their own business....and while I can believe that two dudes shot you for no reason, I never understood why they put drugs in your pockets afterwords.

 

[DHT]

They always told me they were just minding their own business....and while I can believe that two dudes shot you for no reason, I never understood why they put drugs in your pockets afterwords.

Minding your own business is probably the most dangerous thing you could possibly do at 2am.

 

[hans19]

in another thread i mentioned how the chief resident is totally ignoring me but i take it back, well sort of. last night was the ultimate highlight of med school. a penetrating trauma came in with vitals but got lost in the trauma bay. so yep, you guessed it: thoracotomy time! i'm standing next to the chief who takes the scalpel and makes the incision and opens the ribs with the spreader and puts on the xclamp like a pro. he puts his hand in and starts massaging the heart. he does it for a while then he turns to me and asks if i want to go for it! dude! he says be careful as you reach in so not to get poked by any jagged ribs then he shows me the proper way to cardiac massage using both hands not just one. i have to say i was already decided on surgery but this clinched it. also how can anyone diss trauma surgery?!! people say it's alot of nonoperative babysitting but come on it doesn't get anymore intense than this. and this was a further example of not judging a book by its cover. this quiet to the point of asocial resident who seems to live in his own world turned into a cowboy when it was go time. i know he'll probably return to ignoring me tomorrow, but just saying it was cool to see anyway. how anyone can not go into surgery after stuff like this i don't understand.

Um that sounds fascinating, but after everything was said and done, did the patient actually make it?

 

[Winged Scapula]

Um that sounds fascinating, but after everything was said and done, did the patient actually make it?

I'll bet not.

 

[Dimoak]

Minding your own business is probably the most dangerous thing you could possibly do at 2am.

Especially if it's outside a church or on your grandma's porch.

 

[PostCall]

such negativity from u guys. yeah the guy did make it! i didn't know cuz he was rushed up to the o.r. as they paged the ct fellow and we were massaging the heart on the way up in the elevator. i sooo wanted to scrub in but when we got there the ct fellow and a fourth year student doing a ct subi were gowning up. then a few minutes later the ct attending busts in through the door ready to roll so there were 3 people already scrubbing in. so i thought i would at least watch the action but lo and behold the chief decided he wanted to run the list and gave me a bunch things to do. i'm still trying to decide what is more badazz, being the guy who first cracks open the chest in the trauma bay and gets him to the o.r., or the the ct surgeon who comes in to take care of business!

 

[ESU_MD]

i'm still trying to decide what is more badazz, being the guy who first cracks open the chest in the trauma bay and gets him to the o.r., or the the ct surgeon who comes in to take care of business!

I think the real money player in these situations is the person who can fix the injury- in most cases of survivable cardiac trauma, an experienced trauma surgeon can fix the heart, etc.. I've been in situations called in for stab wounds to the heart- by the time CT rolls in, the trauma guys usually have the heart sewed up, temporary pacing wires on and just want to know what to do with the transected coronary.

it is extremely rare to have to go on pump in the trauma bay, but does occasionally happen

I always think its funny how the er guys always want to do thoracotomies. I think they should be careful what they wish for- I would like to see one of those guys open a chest with a few experienced er nurses to find a proximal PA injury: guarantee that will be the last time they ever do that. everyone wants to play hero-

In general, a good rule of thumb: if you dont know how to close a thoracotomy, then dont open a chest.

 

[PostCall]

it is extremely rare to have to go on pump in the trauma bay, but does occasionally happen

go on pump in the TRAUMA BAY?! u mean as in cardiopulmonary bypass?

 

[hans19]

such negativity from u guys. yeah the guy did make it! i didn't know cuz he was rushed up to the o.r. as they paged the ct fellow and we were massaging the heart on the way up in the elevator. i sooo wanted to scrub in but when we got there the ct fellow and a fourth year student doing a ct subi were gowning up. then a few minutes later the ct attending busts in through the door ready to roll so there were 3 people already scrubbing in. so i thought i would at least watch the action but lo and behold the chief decided he wanted to run the list and gave me a bunch things to do. i'm still trying to decide what is more badazz, being the guy who first cracks open the chest in the trauma bay and gets him to the o.r., or the the ct surgeon who comes in to take care of business!

The answer is D none of the above. The real winner is the bariatric surgeon who gets paid in cash and does his cases from 9-5 electively, doesn't have to deal with the often uninsured, Trauma population at 3 am.

 

[PostCall]

The answer is D none of the above. The real winner is the bariatric surgeon who gets paid in cash and does his cases from 9-5 electively, doesn't have to deal with the often uninsured, Trauma population at 3 am.

maybe, but i'd get soooo bored banding bellys all day. you go thru all that badazz training just so u can keep banker's hours and miss out on the action? maybe if u do the 9-5 gig but also do trauma call so you can rock it like a superstar in the trauma bay and o.r. once in a while.

 

[JackADeli]

....maybe if u do the 9-5 gig but also do trauma call so you can rock it like a superstar in the trauma bay and o.r. once in a while.

IMHO, when it comes to surgery you don't "rock" anything if you only do it "once in a while". The jack of all trades model really does not lend itself to being a "superstar". Those that I have seen with years of experience are often mediocre in the subspecalty areas. I have seen trauma surgeons attempt the "occasional" penile reconstruction with disasterous outcomes, general surgeon attempt occasional thoracic oncology procedures with poor outcomes, same for the occasional whipple. Numerous GSurgeons doing the occasional breast cancer case and doing innadequate procedure, etc.... You want to be a rockstar in trauma then you probably need to be in a high volum trauma center ... and do high volume trauma coverage.

JAD

 

[surgres88]

I always think its funny how the er guys always want to do thoracotomies. I think they should be careful what they wish for- I would like to see one of those guys open a chest with a few experienced er nurses to find a proximal PA injury: guarantee that will be the last time they ever do that. everyone wants to play hero-

In general, a good rule of thumb: if you dont know how to close a thoracotomy, then dont open a chest.

ESU you are right on about this.

Two months ago our fellow took an ER fellow through placing just a chest tube for spontaneous PTX...took 45 minutes! Dismal.

 

[skiz knot]

Yeah for every ED thoracotomy, you get 1000 crap cases, babysitting ortho and neuro problems, drunks, low-lifes, gangbangers that you are just a cramp in their style, and just overall crap. So if you can put up with the 1000 crap cases for that 1 ED thoracotomy and maybe a good OR case here and there, go for it.

Tru dat! That's why ortho is way better. We treat hurt people, not sick people. We leave that up to other services😉

 

[Raidergate]

The answer is D none of the above. The real winner is the bariatric surgeon who gets paid in cash and does his cases from 9-5 electively, doesn't have to deal with the often uninsured, Trauma population at 3 am.

I've hated nothing more in residency than bariatrics. Crazy patients, pts with multiple comorbities, horrible complications when things go wrong, and even the operations themselves are pretty boring after awhile (band/bypass, rinse and repeat.)

Cash is great and all, but I just can't deal with those patients. Give me a gang-banger anyday over the BMI=50 crowd.

 

[Bill_Brasky]

Numerous GSurgeons doing the occasional breast cancer case and doing innadequate procedure, etc....
JAD

Not sure where you are but around here in the hinterlands almost all of the lumpectomies and mastectomies are GS cases. They get margins and good cosmetic results as well.....I mean its blob surgery, what am I missing?

 

[Winged Scapula]

Not sure where you are but around here in the hinterlands almost all of the lumpectomies and mastectomies are GS cases. They get margins and good cosmetic results as well.....I mean its blob surgery, what am I missing?

You'd be suprised.

General Surgeons here:

- do incisional biopsies when the mass could be removed entirely
- do excisional biopsies without marking margins
- do not do percutaneous needle biopsies (which is considered standard of care by the American Soc of Breast Surgeons)
- do not have privileges to do sentinel node biopsies, so either don't do it or go straight to axillary node dissection
- don't place brachytherapy catheters and refer all patients for external beam
- do mastectomies when breast conservation would be appropriate
- don't offer immediate reconstruction

Your general surgeons may do a good job, and the vast majority of them do. But there are many, even in large cities, who shouldn't be doing it. Frankly, the margin thing is what gets me the most.

 

[smq123]

Not sure where you are but around here in the hinterlands almost all of the lumpectomies and mastectomies are GS cases. They get margins and good cosmetic results as well.....I mean its blob surgery, what am I missing?

Good cosmetic results are one thing....but what kind of survival results are they getting?

 

[Bill_Brasky]

You'd be suprised.

General Surgeons here:

- do incisional biopsies when the mass could be removed entirely
- do excisional biopsies without marking margins
- do not do percutaneous needle biopsies (which is considered standard of care by the American Soc of Breast Surgeons)
- do not have privileges to do sentinel node biopsies, so either don't do it or go straight to axillary node dissection
- don't place brachytherapy catheters and refer all patients for external beam
- do mastectomies when breast conservation would be appropriate
- don't offer immediate reconstruction

Your general surgeons may do a good job, and the vast majority of them do. But there are many, even in large cities, who shouldn't be doing it. Frankly, the margin thing is what gets me the most.

Yikes. I can say all that is done here in my part of the boonies, but then again there may be a reason per my DME I rotated only with some of the surgeons on staff and not others. Of course with month long rotations I can't respond to the survival stats query (I can only recall one missed margin and he then just took a little more, we waited on path and didn't have to re-open) but both are valid concerns.

edit: errrr, all the good stuff of that list is done where I am

 

[JackADeli]

Not sure where you are but around here in the hinterlands almost all of the lumpectomies and mastectomies are GS cases. They get margins and good cosmetic results as well.....I mean its blob surgery, what am I missing?

First, I think WScap pretty much gave an excellent reply.
"blob surgery"? I beg to differ. There still exist inadequate or innapropriate resections, inadequate staging, and nerve/other injuries..... for simply "blob surgery". It is oncology and all oncology needs to be respected & done right the first time.

Second, I have kicked around teaching hospitals for about 12 yrs (counting 4yrs medschool). This has included teaching community programs and University level programs. I will say it is a real eye opener when you finally leave the teaching centers! Numerous hospitals out there are begging just to get a warm body to "take care" of the medical/surgical problems. Board certification is often not a requirement for numerous sub-specialty positions (at these hospitals). Remember, there are numerous old timers that have been doing things for years and filled niches. It doesn't mean they keep up with modern therapies.... You will only start to understand this when you tour a hospital and look up their staff. You might find an old timer surgeon with "board eligible" and some sort of specialty after their name.... go figure! How long he going to be "eligible"?

In general, I have found even the community hospital teaching centers do keep up (at least their teaching staff).

JAD

 

[ThinkTooMuch]

omg i almost fainted. im soooo not going into surgery. thx for reminding me why.

 

[jbean]

They always told me they were just minding their own business....and while I can believe that two dudes shot you for no reason, I never understood why they put drugs in your pockets afterwords.

It's always those two dudes... where do those guys live anyway?

 

[docmartin252]

It's always those two dudes... where do those guys live anyway?

No one knows, they just pop up out of nowhere for no reason, and prey on unsuspecting bible readers. Patients never seem to get a good look that those "two dudes" because it always seems to be too dark, which is why this pandemic may never be resolved. I just hope one day those two dudes will be apprehended and brought to justice.