Its unbelievable that I haven't posted in 4 months, but such life when you are balancing a surgical residency and a family. So much has happened since April: 1. May 2012: This was my last general surgery rotation and it was pediatric surgery. It was actually a breath of fresh air finally getting a chance to take care of kids instead of adults, but this is Hopkins so the kids tended to be medically more complicated than you would think, but it was cool regardless. I actually got to operate a good amount on this rotation but in general this rotation confirmed that I chose Ortho well because none of the procedures really got me excited. Case in point, my rotation culminated in that the very last general surgery operation I took part of was a manual disimpaction (of stool for the uninitiated) in the OR which took ~ 2 hours!!! Needless to say I was happy to move on to Ortho. 2. June 2012: This was the best month of residency because I was on Anesthesia, and those guys generally have better hours than us surgeons. I actually had a chance to hang out with my daughter and bond more with her while my wife started her orientation for OBGYN residency. Since I hadn't had a vacation since the first 2 weeks of residency, it was nice to have this rotation before the hell of PGY-2 started. Now I am 1 month into my second year of residency and they were not lying when they said it was the hardest and most painful year. Intern year was actually a cake walk in comparison because when I was an intern on my Ortho rotations, they knew I didn't know much so their expectations were low and the residency work hours limited me to about 16 hours a day. When I was an intern on General Surgery they knew that I didn't plan on being a general surgeon so their expectations were low and of course our hours were great because of the ACGME rules. Now that I'm a PGY-2 I have taken my first bevy of 30 hour calls and it literally saps the life from you. The adrenaline of seeing patient's in the ER and reducing fracture after fracture keeps you going but then when you sit down to write a note your eyes start to get very heavy. Don't get me wrong, I am so happy that for now on I will only be seeing patient's with orthopaedic issues, but the biggest problem I've had being a PGY-2 and taking call is that its almost impossible to get through the 30 hours without pissing off someone, whether that be your attending, chief, an attending in the ED, one of your co-residents who wanted things done a certain way overnight while they slept, etc. It also sucks because each consult takes you forever to complete because you have to look up everything in the Handbook of Fractures and then figure out how to put it into practice. Then there is the dance of trying to figure out whether you should call and wake up your chief to ask for help. You don't want to be a maverick and possibly do the wrong thing for the patient, but you also don't want to call your chief for every consult you see. Honestly I've lost like 10 lbs this month just from stress and lack of time to eat. But I'm not complaining; this is what second year is about..its a steep learning curve and by the end of this year there won't be many fractures that I will have trouble dealing with, and I will also be used to the general level of sleep deprivation that surgical residents live under. I've still struggled to balance all of this with maintaining my spiritual and family life. I usually don't have any time to sit down and have a long, in-depth devotion, but having apps like the Tecarta NIV Bible on my phone the E.G. White app has allowed me to get quick devotions in between surgical cases or during brief down times through out the day. As for the family part, I try to at least get home before my daughter goes to sleep. If I do then I put her to sleep to at least spend that time with her. And of course on my post call days I try to spend as much time with her and my wife as possible. But its difficult, and it will always be difficult; all one can really do in a 2 physician family like this is always strive to spend time with each other. Eventually it will happen. When I'm not on call, I'm on my spine rotation and I actually really like it. Again, I'm at Hopkins, and so the spine cases are often crazy 12 hour cases. Meaning that the cases I'm scrubbing into, like a T1 to sacrum posterior spinal fusion with a vertebral column resection of T10 and multiple osteotomies, with 6 L of blood loss, etc just isn't the type of stuff most spine surgeons would do in their practice. I really like seeing a patient come in with terrible degenerative scoliosis and after a marathon surgery leave the room with a virtually straight spine (in the coronal plane of course). If I became a spine surgeon I don't think I would do cases that are as long and as complex as my attendings here, which is fine. My only reservation is again keeping my future mission plans in mind, I'm not sure that spine surgery would make much sense as it requires a high level of hospital care (anesthesia and ICU) which will likely not be available in rural environments. But I won't be overseas forever and so whatever I do when I come back to the states, I need to be able to enjoy. In other news my son will be born tomorrow (planned induction) so I'm super excited. Keep us in your prayers that the delivery is uneventful.