So I noticed that over the past couple of months I haven’t commented on what I’ve actually been doing as a resident. Starting in late December I began my general surgery rotations that are required as part of my orthopaedic surgery residency. It is kind of the luck of the draw in terms of which particular rotations you get but mine worked out to be 1.5 months of Vascular Surgery, 1 month of ICU, 1 month of Plastic Surgery, 1 month of Surgical Oncology and Endocrine Surgery, 1 month of Trauma Surgery, and 1 month of Pediatric Surgery. The last rotation of my intern year is actually anesthesia which is wonderful because its a low stress rotation and will allow me to rest up before the infamously terrible ortho PGY-2 year arrives.
I already commented on my time on Vascular Surgery and ICU. Plastic Surgery was truly a pleasant surprise. I must admit that I had no true concept of the scope of operations that plastic surgeons performed, but my month plastics opened my eyes. They were doing masseter nerve transfers for kids who lost function of their facial nerve after a tumor was resected to breast reconstructions, to repair of carpal and phalangeal fractures to closure of complicated spinal wounds, to in utero repair of spina bifida defects, etc. They did so much more than just the characteristic comestic surgery and they truly do work everywhere on the body. I loved the variety of sutures and the realitive healthiness of the patient’s which is what also drew me to ortho. During one of my last days on plastics one of the attendings liked my closure so much that she said I should consider switching to plastics, lol. I must admit, there really weren’t many other fields I liked besides ortho but after this month I could definitely have seen myself doing it. I don’t think I had the medical school grades to get into plastics, but I found out that you can actually do a plastics fellowship out of any surgical residency, including ortho, ENT, general surgery, etc. Doing another 3 years of plastics after my 5 years of ortho really isn’t palatable to me, but it was nice to fancy the thought for a bit.
Surgical Oncology/Endocrine Surgery
If you lined me up beside 1000 other ortho and non-general surgery surgical residents I would likely be ranked close to number one in terms of my disinterest in bowel surgery. So clearly I was dreading have to go through all day Whipple cases. However I was somewhat pleasantly surprised that most of the cases I scrubbed in on during surgical oncology were related to liver resections and I had no idea how cool liver surgery was. Our attendings here both preferred open approaches so I got to look directly at the biliary system, hepatic veins, and portal venous system. One time we were resecting a tumor that had incorporated itself into both the liver and the IVC that ran through it. When we got the last piece of tumor out a small hole appeared in the IVC and boy…DAT MOFO CAN BLEED, lol. I definitely have to give it up to general surgeons who on a day to day basis deal with life and death situations and barely break a sweat. Coming into medical school I thought I wanted to be that guy, but I’m too much of a softey to have my patients die on a somewhat consistent basis. Ortho is definitely for me, but again I was pleasantly surprised by the Hepatobiliary Surgeons here.
As for Endocrine Surgery, I must admit that the thyroid is by far the least exciting structure in the body. I guess what really made me not like the cases was that the field was too small. Every tool was itsy bitsy tiny, and you had to constantly worry about retracting too much. This is probably the reason why hand surgery so far hasn’t appealed to me. Who knows, that could all change.
This is the rotation that I am currently on and its amazing how variable my night could go (I’m currently doing 5pm to 5 am shifts). One night this past week, we had like 3 gun shot wounds come into the ER; they all came in as trauma arrests so the room is just full of people doing compressions, placing lines, putting in chest tubes etc. They all ended up passing away which was terrible…more dead black Baltimore 20 year olds. I can see how people who do this stuff for a career can get jaded. Moving on, last night, when I was on, there was not 1 trauma and the nurses decided not to page me for anything on the floor patients. So I stayed up and watched documenteries on Netflix and slept a couple of hours. You truly never know what the night will bring on trauma surgery. So far though I like it because again it teaches me how to take care of pretty sick surgical patients and it also gets me back to interacting with my ortho brethern since we consult them often.
Yesterday, Johns Hopkins dedicated its new, 1.1 billion dollar hospital:
We move into the hospital on the 29th of this month and guess who the administration has volunteered will wheel the patients from the old hospital to the new? Of course the interns; we have expertise in this sort of thing lol. Honestly though the process is supposed to be pretty straight forward in terms of when we are to transport a patient to the new hospital but I just forsee huge mishaps along the way. Its my hope that no patients get lost or misplaced :-).
The hospital has 6 trauma bays decked out with all sorts of technology. The ER is huge and should hopefully alleviate me having to see patients in the waiting room as I have often had to do. What this means for me also is that after spending all intern year learning how the Hopkins system works and where to find everything, I will have to relearn it again 2 months before the new interns arrive. But you can’t impede progress and quite honestly it will be cool working with stuff that is finally brand new.
There there ya go, that has been my general surgery experience so far. In other aspects of my life, my wife matched into an OBGYN residency in Baltimore City so I am still praising God for that. We also are moving out of downtown baltimore and into the suburbs of the city which are much nicer than anything you have seen on TV about Baltimore. Anyways, I will report back on any new events that occur in my residency.