Having surgery as my first rotation was admittedly a daunting prospect initially, I’d probably attribute this to this to being told about the long hours, complex patient presentations, and stern environment. All these sentiments turned about to be exactly true, but I didn’t let it stop me from gaining the most I could from the rotation.
During my time I was able to see how patients change from their initial presentation to the day of discharge. I found it considerably valuable to see how no two cases were alike despite having the same diagnosis which is a defining aspect of medicine as a whole. I was grateful to join in on pre-rounds discussions about plans to advance diets, advice from various disciplines such as cardiology & nephrology, complications such as post-op ileus etc. Then on rounds I observed how various providers skillfully managed to see sometimes upwards of 18 patients in a focused and efficient manner. In the clinics I was given the opportunity to see patients independently, gather history alongside a focused physical exam, and then present to the PA and surgeon on duty. I saw a variety of vascular, breast, proctologic, oncologic and general surgery disorders that I had spent the past year learning about in the didactic phase. These clinics taught me how to recognize presentations that are good candidates for surgical intervention as well how to manage post-op patients especially in terms of surveillance following intervention for malignancy. In the OR I was exposed to the nature of collaboration between nursing, anesthesia, technicians, and the general surgery team. Most importantly I gained a better understanding of the role that PA’s play in surgery as I saw them operate as first-assist affording them the opportunity to prep surgical sites, make and close incisions, and operate laparoscopic cameras.
This rotation also presented me with numerous opportunities to get hands on experience, for example I was allowed to remove staples and sutures of post-op patients during clinics. I would also regularly change dressings during daily rounds allowing me to become increasingly comfortable with managing various type of surgical wounds, port sites, and drains. These encounters help me to establish a sense of confidence in my wound assessment and in how to gauge expected vs abnormal postop findings. One of my fondest achievements was being trusted to suture laparoscopic port sites in the operating room. It allowed me to feel more actively involved in the procedures and it was nice to see my work in the following days on rounds.
Beyond, the procedures and clinical insight I noticed some key areas of growth which coincide with the feedback I received upon completion of this rotation. First and foremost being around such knowledgeable individuals influenced how I describe acute GI complaints. I now notice myself using different terminology such as peritonitic or describing a patient with poor physiologic reserve as deconditioned. I also have made strides in my understanding of what constitutes a patient that needs surgical intervention vs. those that can be managed conservatively. Such decisions require consideration of complicating factors such as perforation, abscess formation, hemodynamic stability, and the overall clinical picture, in addition to key labs such as white count and lactate. Overall, I don’t think my perspective about surgery has changed but I believe I was able to demonstrate that if it is my calling I’m fully capable of operating in that environment. My biggest takeaways are that surgery is about more than just technical skills you must be adept in teamwork, decisive, and able to maintain composure in the face of urgency.
