Let me tell you about surgery. You come in at 5 am. You round until 7. After that they work you like a dog, doing surgeries non-stop. You can leave at 6pm if you're lucky. You live like a camel, without food or water for days at a time. I last ate breakfast, like never, and I've had lunch maybe twice in the last 5 weeks. And you come in on weekends. I have two kinds of weekends: one on which I round both days, and ones on which I'm taking call on either Saturday or Sunday.
And if OB/GYN residents are whiny bitches, the people on Surgery are just nasty mother****ers out to get you.
At night I have these terrible dreams about being hounded by surgeons: "GO DO SURGERY GO DO SURGERY GO DO SURGERY GO DO SURGERY GO DO SURGERY GO DO SURGERY GO DO SURGERY GO DO SURGERY GO DO SURGERY GO DO SURGERY GO DO SURGERY". Yeah, it's the same dream every night. Then I wake up and I get to experience it for real.
There isn't even enough time to take a ****. When the surgeries start at 7am, you do them non-stop until 6pm. Without so much as a bathroom break or a drink of water. Why? Because you're the first one in the room and the last one out of the room. These other guys get 20 minutes between cases to have lunch, or jerk off or whatever. But you don't.
Medical students are expected to scrub every God damn case, doing 4 full days of surgery a week if not more (most surgeons do a couple of half days, if that. Residents work on medical management/ER consults half the time.). If you get a clinic day, consider it a vacation from your usual routine of torture.
To add insult to injury, I've been told repeatedly that there isn't any actual surgery on the surgery exam. It's all medical management of surgical patients, which I know practically nothing about, because these bastards just want me in the OR all day holding a retractor, during which I've learned practically nothing. I sometimes wish I could switch places with the Surgery Intern, because he complains that he's never actually gotten to do a Surgery in 3 months of working on... uhhh... Surgery. He wants to do the surgeries and i want to learn about the medical management of surgery patients for my test. I think "What if we could switch places", but then that would be too logical.
Maybe I was given alot more freedom on surgery than most, but after the first two weeks I rarely missed breakfast/lunch. I mostly ate in the stairwell on the way from the cafeteria to the OR, but I ate regularly. Dissappearing for 5-10 minutes to scarf lunch isn't going to kill your evals. It may even make you look sensible. The workday is anywhere from 12 to 30+ hours long on surgery and it takes time to turn over an OR -- use it wisely.
The rotation can get really out of hand if you don't take control and learn what you
want to learn. If you don't start a discussion on a specific topic then you will get hit with random pimp questions about the Bovie, the omni retractor, breeds of dogs and the variation of the branches of the celiac artery (none of which are helpfull to you right now).
For the last 6 weeks of my rotation I did nothing but corner the fellows/attending/residents and query them stupid about whatever I had read but didn't fully appreciate the night before:
Why do you repair emergently and primarily for Boorhave's within 24 hours, but not after 24 hours?
Why to GSW almost always go to the OR, but stab wounds don't?
How common is an obturator sign really? Psoas sign? Are they reliable?
Why are the different lymph node dissection levels so important in breast CA? Why? Why? Why?
Ask about acidosis and alkalosis with fluid replacement - hours of renal fun.
Ask about kids, often they are waaaaaay different .
Ask about endocrine problems DKA, Adrenal crisis after surgery, thyrotoxcosis, Cushing's, pituitary apoplexy and insufficiency.
Most common reason for different BP b/w R and L arms, neuro vs vascular claudication.
When to float a Swann? Chest tube? NGT? Straight cath? Intubate? SCV line?
Blood loss - what up with that?
Does Ranson even know all of the Ranson criteria?
What would you do if you were the only doc at a rural hospital and found someone down on your way to work in the early morning with abdominal/facial bruising and no external bleeding, no hx what so ever-only PEx, XR/US and basic labs?
What about a non-diabetic post-op pt with acute hyperglycemia?
These are all shelf potentials.
Beg them for info to get you started if you are having trouble reading - just ask them for crucial eponymonic signs (surgeons love eponyms and consequently surgical history). If the people are too busy they shrug you off, otherwise I found that many seemed to enjoy someone asking them pertinent questions with a little bit of knowledge. When I asked this stuff at the end of the day my residents would talk to me about it on and off for the next few days. The time goes much faster this way; you are tired, but entertained.
Absolutely do not get caught cold without having read a little first. At some point someone will recognize that you have read and asked Q's to augment your understanding not your memorization. Find those people and latch on for dear life. They are invaluable and will drop mad science on you.
If your residents are annoyed by your curiousity, f#ck 'em. You are there to learn, be selfish about gaining knowledge. Ultimately you have to care for people in the way you know best. Don't get me wrong I did more than my share of scut, but those 12 weeks were more valuable than my MS1 and MS2 years combined. Hope this helps.
