What I Learned During Surgery...

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aequanimitas11

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Lessons learned during my surgery rotation:

1. The most important question to ask your patients is, "Have you pooped today? If so, how many times, and what did it look like?"

2. Try and time your patient visits to avoid the regularly scheduled "burping of the colostomy bag." If you see the patient staring at her gas-filled colostomy bag while you are examining her abdomen, get out of the room as quickly as possible.

3. As a patient, the quicker you can get out of the hospital after your surgery the better. If you start to feel even close to recovered, get out of there ASAP before you end up with drains coming out of your body and infections in places you didn't even know you had.

4. Prisoners will do anything to themselves to get out of jail.

5. Motorcycle vs. 18-wheeler never turns out good.

6. When draining a perineal abscess, don't cut too far in either direction...you've got the sphincter on one side and the testicles on the other.

7.If the guy in room 8 who is always complaining's creatinine shoots up to 3.8 and his temperature is over 102, he probably really is sick today.

Feel free to add your words of wisdom! 😳
 
*if you're having trouble interviewing a patient in the ED b/c they got a little too much dilaudid and they keep falling asleep on you, you're going to be talking to a completely different person when that dilaudid wears off, that person might not be as pleasant to talk to.

*Signs that you're in for a complicated case in the OR- AOL Radio on classic rock starts to play: "Another One Bites the Dust", "Stairway to Heaven", "Live and Let Die"

*If the hospital overhead has to page your patient to return to their room prior the morning of their surgery because they were down smoking when transport came to pick them up, you might have some issues with tolerance and post-op pain control.

*SBO in a 19 year old kid always has a reason. Don't let an appy slip by you.

*That breast lump everyone was sure was cancer can turn out to be benign on biopsy. 😀

*Some residents that are great teachers get stuck on nights, unfortunately this leads to 4am teaching sessions in the SICU while on call.

edit (adding more):

*if you contaminate yourself after you finish scrubbing... the foam is the best thing ever.
 
Depakote said:
*SBO in a 19 year old kid always has a reason. Don't let an appy slip by you.

*That breast lump everyone was sure was cancer can turn out to be benign on biopsy. 😀
Click to expand...

These two are great examples of letting your clinical acumen guide your treatment.

In the first, an otherwise healthy kid shouldn't have an SBO, partial or otherwise.

In the second, if the diagnosis was made on a needle biopsy, and it doesn't fit with the radiographic or clinical picture, you need to do more. If you are still suspicious of a malignancy after a negative needle biopsy, the mass needs to come out - whether its the breast, the thyroid, etc. Sampling error does exist. Heterogeneous tumors do exist.

The above was evident to me in a patient with two needle biopsies positive only for radiation fibrosis.

She had angiosarcoma when I excised the growing mass.

Ok, back to your originally scheduled programming.😀
 
* Enjoy being at the bottom of the food chain. LOVE that you get to stare at someone else do surgery for 3 hours without saying a word to you.

* LOVE the fact that your surgeon doesn't give a $HIT about the patient, besides their surgical picture. Forget the kid that shows his hormone axis (Thyroid, Cortisol, etc) isn't functioning properly, is it a result of his surgery? NO - well, who cares then, someone else will find that out down the road.

* LOVE that the nurses will treat you like CRAP and give you poor info in the morning. Example: "Hey Sue, Good morning! Hey, how did Mr. X do last night? -----"Oh he was fine hun, no overnight events" -----"Really? Great! Thanks Sue" -----attending walks in....."Yo Sue, what's up with Mr. X' ----- "Well he spiked a fever, pressure dropped to 50/20, he was given 15L of fluids and started on pressors........."

* Realizing that other students will find ways to do LESS work than you and still manage to look better than you, since they'll be studying what they were told to look up in the morning and pimped later on, while you were caring for your patient, going to their surgery, making sure X,Y,Z were ordered.....
 
-Man vs. Nature: If nature fights back, retreat, or risk severe disfigurement.

-If you have the option of selecting what service you're on, figure out which attending is the loudest, and avoid him at all costs (especially true if you want any hands-on time in the OR).

-Happy resident + happy nurse/techs = CYA (cover your ass)
 
Is it bad that I feel like I've learned next to nothing in my first bit of surgery rotation? No one has time to teach anything (which I understand), and I have no time to read anything. I go and stand around all day while people talk about stuff that is over my head, but that I feel like I should be able to understand but don't. Maybe it's just me, but this sucks.
 
--Surgeons will never admit this, but a large portion of surgery is medicine. If you are knowledgeable about medicine, it will help you be knowledgeable about surgery.

--Being meek with scrub nurses and asking for their permission and help even when you don't need it tends to make things more pleasant. So does learning their names. You know you're in good when one of them says to you, "I've only told this to four people in the hospital besides you...."

--In contrast, surgeons will respect you more if you fight back. Just make sure you know what you're talking about.

--Scrubs are the most versatile pieces of clothing ever invented. They're also not very closely guarded by the hospitals. Most med students have an assorted collection by the end of their surgery rotations.

--It really is possible to get through an entire surgery rotation plus an entire OB/gyn rotation having only a vague knowledge of anatomy, and still do well overall.
 
Do whatever you can to avoid scrubbing a fem-pop bypass or a whipple unless you're really into standing for hours.

Avoid everyone who really likes to teach because you usually wound up stuck with them for hours while they're "teaching."

Hide out where the internal medicine people are because the surgery residents will never look there.

It's better to be invisible than obnoxious.
 
Doctor Bagel said:
Do whatever you can to avoid scrubbing a fem-pop bypass or a whipple unless you're really into standing for hours.

Avoid everyone who really likes to teach because you usually wound up stuck with them for hours while they're "teaching."

Hide out where the internal medicine people are because the surgery residents will never look there.

It's better to be invisible than obnoxious.
Click to expand...

I recommend whipple scrubbing. It's pretty awesome. You get to see a lot of anatomy.
 
From a step stool: "Watching your step means never having to say sorry."

Anaesthetists will make that patient wake up sometimes even if you're not done with suturing him up.
 
Doctor Bagel said:
At my hospital it was the internal medicine morning report room. A surgery resident wouldn't be caught dead there. 😎
Click to expand...
How could he not be caught DEAD there. If he was dead and someone put his body in there he would be caught, since he cannot leave due to him being dead.
 
golf-clap.jpg
FractureFixer said:
How could he not be caught DEAD there. If he was dead and someone put his body in there he would be caught, since he cannot leave due to him being dead.
Click to expand...
 
swtiepie711 said:
Is it bad that I feel like I've learned next to nothing in my first bit of surgery rotation? No one has time to teach anything (which I understand), and I have no time to read anything. I go and stand around all day while people talk about stuff that is over my head, but that I feel like I should be able to understand but don't. Maybe it's just me, but this sucks.
Click to expand...

Recently shadowed a general surgeon who was hosting a third-year DO student...neither of us did much of anything. At least I wasn't supposed to be learning!

Depakote said:
also...

Don't **** with the pancreas.
Click to expand...

The doc I shadowed said the same thing 🙂
 
Eat, poop, pee, and go home when you get the chance to do so.
 
Doctor Bagel said:
Do whatever you can to avoid scrubbing a fem-pop bypass or a whipple unless you're really into standing for hours.

Avoid everyone who really likes to teach because you usually wound up stuck with them for hours while they're "teaching."

Hide out where the internal medicine people are because the surgery residents will never look there.

It's better to be invisible than obnoxious.
Click to expand...

I scrubbed on a whipple and it wasn't bad. I think it was a little over two hours. Of course, one guy was a surgical oncologist and the other was an older GS and they had done tons of them together.
 
- If asked, "Why are you interested in surgery?", don't ever say, "I like to work with my hands".

- If ever asked to do something like pulling out lines or putting in foleys, always say "Gladly" and say it with some confidence. Surgeons can smell fear or low self-confidence from a mile away. Defeat their superior sense of smell.

- Don't take anything anyone says personally. Having a thick skin will let you survive and perhaps enjoy the rotation. Having a thin skin will make you an internist 🙂
 
Rollo said:
- If asked, "Why are you interested in surgery?", don't ever say, "I like to work with my hands".

- If ever asked to do something like pulling out lines or putting in foleys, always say "Gladly" and say it with some confidence. Surgeons can smell fear or low self-confidence from a mile away. Defeat their superior sense of smell.

- Don't take anything anyone says personally. Having a thick skin will let you survive and perhaps enjoy the rotation. Having a thin skin will make you an internist 🙂
Click to expand...


Out of curiousity then, what should one say? It seems like that's the standard answer that I hear from attendings and residents..
 
MossPoh said:
I scrubbed on a whipple and it wasn't bad. I think it was a little over two hours.
Click to expand...

That's pretty close to a record time. Most experienced surgical oncologists take about 4-6 hours (some longer) for a standard whipple, more if you have to do anything crazy like vein resection/reconstruction.
 
mmmcdowe said:
Out of curiousity then, what should one say? It seems like that's the standard answer that I hear from attendings and residents..
Click to expand...

The best answer is "I can't see myself doing anything else." but of course, that answer has to be actually how you really feel otherwise you're in for a torturous 5 years and will most likely end up quitting residency.
 
If you have a chance to scrub in on an axillary dissection, do it. Resembles Netters awesomely.

Unfortunately, don't get too fancy with your medicine knowledge. Many surgeons don't care about heart murmurs, tympany, etc. (RRR and CTA B are fine unless something is seriously wrong.)

Decide whether you want to study for the shelf or OR cases.

Wounds will get infected.

You will jump for joy when your patients fart, even more when they drop a deuce.

It is pretty cool if you give it a chance.

Clinic sucks.
 
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Rollo said:
The best answer is "I can't see myself doing anything else." but of course, that answer has to be actually how you really feel otherwise you're in for a torturous 5 years and will most likely end up quitting residency.
Click to expand...

There are plenty of specialties in medicine that allow a person to use their hands. Some of the reasons I want to go into surgery include (in no specific order):

1) To me, its not just "another hernia" or "lap chole". Every case is different, with different complications or challenges. Each case is interesting in its own way. Also, I see things like suturing as an art. Making the bites a certain depth, certain distance apart, etc. The incision is akin to an artist signing his painting. It's the one thing the patient sees and it reminds him/her of the operation. How the wound heals/looks is the doctor's calling card.

2) Ability to instantaneously fix something. I hated just waiting to see if a drug would work while on medicine wards. I was always wanting that immediate fix. Also I like being able to definitively know what's going wrong with the patient, which is one thing that drove me crazy about rads. There was no followup and you never knew 100% if the radiologist was right in a lot of cases.

3) Fast rounds, fast office visits. Medicine rounds were terribly boring. Granted as an attending I can round as fast or slow as I want, but I'd prefer to see the pre-op/post-op patients.

4) Don't have to be the one managing the diabetic or hypertensive patient chronically.

5) Love the environment in the OR and operating. Everyone is very personable and friendly. It's like a close nit group of friends. I want to be the one operating rather than monitoring the patient while they are under.

I have more reasons than this. I know I'm early on in my career in surgery (6 weeks as an MSIII) and some of this list may change as I progress through my training. I just wanted to offer a few of mine. Figured it may help someone who is on the fence between medicine and surgery.
 
bleeker10 said:
There are plenty of specialties in medicine that allow a person to use their hands. Some of the reasons I want to go into surgery include (in no specific order):

1) To me, its not just "another hernia" or "lap chole". Every case is different, with different complications or challenges. Each case is interesting in its own way. Also, I see things like suturing as an art. Making the bites a certain depth, certain distance apart, etc. The incision is akin to an artist signing his painting. It's the one thing the patient sees and it reminds him/her of the operation. How the wound heals/looks is the doctor's calling card.

2) Ability to instantaneously fix something. I hated just waiting to see if a drug would work while on medicine wards. I was always wanting that immediate fix. Also I like being able to definitively know what's going wrong with the patient, which is one thing that drove me crazy about rads. There was no followup and you never knew 100% if the radiologist was right in a lot of cases.

3) Fast rounds, fast office visits. Medicine rounds were terribly boring. Granted as an attending I can round as fast or slow as I want, but I'd prefer to see the pre-op/post-op patients.

4) Don't have to be the one managing the diabetic or hypertensive patient chronically.

5) Love the environment in the OR and operating. Everyone is very personable and friendly. It's like a close nit group of friends. I want to be the one operating rather than monitoring the patient while they are under.

I have more reasons than this. I know I'm early on in my career in surgery (6 weeks as an MSIII) and some of this list may change as I progress through my training. I just wanted to offer a few of mine. Figured it may help someone who is on the fence between medicine and surgery.
Click to expand...

Aren't you interested in ortho? If so, then more than half of the stuff above doesn't apply :laugh:

Good to hear we got a gen surg convert though.
 
When a surgeon asks you if you want to do a very simple procedure under supervision in an outpatient setting, they will be taken off guard by a thoughtful silence followed by, "nahhhhh."

They will probably ask you to do it anyway, at which point it would be impolite to refuse again.
 
Rollo said:
Aren't you interested in ortho? If so, then more than half of the stuff above doesn't apply :laugh:

Good to hear we got a gen surg convert though.
Click to expand...

I'm still thinking ortho. I was just listing reasons I like surgery, from a general perspective. I do like GS though. I have two weeks of ortho starting Monday so I'll know for sure after that.
 
I've never gotten yelled at for no reason until surgery.
 
On my first day in the OR my attending told me my job is to make myself as small as possible. Then he told me that when he was a student he was really bad at it.

Oh, and the only thing he ever pimps on is 80s rock.
 
southernIM said:
That's pretty close to a record time. Most experienced surgical oncologists take about 4-6 hours (some longer) for a standard whipple, more if you have to do anything crazy like vein resection/reconstruction.
Click to expand...
An experienced surgical oncologist/HPB specialist should not take 6 hours for a standard Whipple. I'll concur on the 4 hours. Two hours is a blitzkrieg, and unless it's a lap chole, it doesn't even seem like a long case.
 
TheProwler said:
An experienced surgical oncologist/HPB specialist should not take 6 hours for a standard Whipple. I'll concur on the 4 hours. Two hours is a blitzkrieg, and unless it's a lap chole, it doesn't even seem like a long case.
Click to expand...

I agree shouldn't, but some do...

and when you look at studies which talk about mean operative time, 4-6 seems to be the common range.
 
Rollo said:
Heeyy brother..

I thought the exact same thing when I saw that quote from that poster...:laugh:

I've made a huge tiny mistake.
Click to expand...
"Buster so excelled at being neither seen, nor heard, that he remained at the school, undetected for a full two semesters after he was supposed to graduate."
 
AlexMorph said:
"Buster so excelled at being neither seen, nor heard, that he remained at the school, undetected for a full two semesters after he was supposed to graduate."
Click to expand...

Just like the 11 months he spent in the womb...
 
1. If you're in the OR and you need to sit, for God's sake, FIND A PLACE TO SIT! Nobody wants to pick you up off the floor after you pass out.

2. Sometimes what you see on the laparoscopy screen really is what you think it is. Don't be afraid to say something simple (e.g., omentum).
 
bleeker10 said:
5) Love the environment in the OR and operating. Everyone is very personable and friendly. It's like a close nit group of friends.
Click to expand...

Where the hell was this? Between the scrub nurses, attendings, techs and such I've never seen such a concentration of bitchiness, bad vibes, and general douchebaggery anywhere else in medicine. With rare exceptions, the only truly decent people I've encountered in the OR are the anesthesia staff.
 
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dozitgetchahi said:
Where the hell was this? Between the scrub nurses, attendings, techs and such I've never seen such a concentration of bitchiness, bad vibes, and general douchebaggery anywhere else in medicine. The only truly decent people I've encountered in the OR are the anesthesia staff.
Click to expand...

Been in every OR I've been in. Could be that I've rotated/shadowed at community hospitals with PP surgeons and no surgery residents. I'm not saying it's like that everywhere, but just my experiences. I have encountered tool surgeons, nurses, etc but overall I've had positive experiences. I'm rotating at a surgery residency program in a couple weeks so maybe my views will change.

As far as the bitchiness, I encountered that the most in the ICU. Some of the nurses went out of their way to make things difficult.
 
dozitgetchahi said:
Where the hell was this? Between the scrub nurses, attendings, techs and such I've never seen such a concentration of bitchiness, bad vibes, and general douchebaggery anywhere else in medicine. With rare exceptions, the only truly decent people I've encountered in the OR are the anesthesia staff.
Click to expand...

I've been in two different ORs that one OR was led by a down-to-earth, genuinely funny and caring attending and the other OR led by intense, holier-than-thou attending. The rest of the OR staff was the same in both situations.

Guess what? Even though it was the same hospital, same surgical service, same OR staff; the fact that the surgeries were led by two completely different personalities made both environments completely different from each other. In the former, even the "bitchiest" of the OR staff calmed down and was able to crack a smile every now and then. In the latter, even the "nicest" of the OR staff had an unfriendly vibe/expression to them for most of the time.

My point is that the surgeon is truly the captain of the ship that is the OR and his/her personality will determine how the rest of the OR staff acts.
 
Rollo said:
My point is that the surgeon is truly the captain of the ship that is the OR and his/her personality will determine how the rest of the OR staff acts.
Click to expand...

Yea that's what I was getting at, albeit in a round about sort of way. Groups tend to feed off who is in charge, especially in stressful situations.
 
dozitgetchahi said:
Where the hell was this? Between the scrub nurses, attendings, techs and such I've never seen such a concentration of bitchiness, bad vibes, and general douchebaggery anywhere else in medicine. With rare exceptions, the only truly decent people I've encountered in the OR are the anesthesia staff.
Click to expand...

Best. Quote. Ever. Defines my life these days for sure.
 
dozitgetchahi said:
Where the hell was this? Between the scrub nurses, attendings, techs and such I've never seen such a concentration of bitchiness, bad vibes, and general douchebaggery anywhere else in medicine. With rare exceptions, the only truly decent people I've encountered in the OR are the anesthesia staff.
Click to expand...

100% agreed. Some of the attendings I've scrubbed with have been pretty good but the majority of the residents I've had to deal with have been generally unpleasant people. Maybe it's just the programs where I've done my rotations but I've rotated at both a "good" and a "bad" place by reputation, so... I dunno.

I've got some more snarky ones to add to this growing list.

1. Don't ever say you're interested in GI (which I am) to anyone but the residents, because often times the surgeons love to lambast them for being ******* or something to that effect.

2. Be prepared to read up your Surgical Recall book for useless knowledge that, if you're not going into surgery, you'll still have to recite verbatim because for some reason surgeons think this is what is important to your learning.

3. If you can hide or get away easily without it hurting you, do it. It's not worth slogging through a six hour surgery if you're not interested.

4. For the love of god avoid Whipples. They're very cool to see once, but I quickly lose interest after an hour and by hour six or so I wanted to stab myself just to make sure I had sensation below the waist.

5. You'll find out very quickly if you're the kind of person who's interested in surgery. As someone who thought they wanted to do it, I was in for a rude surprise when it turned out how little I liked being in the OR.
 
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