Reflections on General Surgery

….Weirdly enough, this has been one of my absolute favorite rotations so far (here’s what a typical surgery day was like for me)!

F: I’m really surprised about how much I loved this rotation. I’m so sad that it’s already ended! :[ The weeks flew by!
D: You know what, Farrah? I’m actually not that surprised that you liked it–you’ve always loved anatomy + making people feel better, and you’re good at working with your hands. I think you’d be really good at it, but your personality’s perfect for family med.

(Rest assured, I haven’t defected–I’m still FM all the way, but having such a fun surgery rotation was such a pleasant surprise!)

Reflections on General Surgery

The only “surgical” experience I’d had prior to my surgery rotation (unless you count sewing up faces in ER!).

1. Do your homework.
   Confession: since I knew I wasn’t interested in surgery (I had nothing against it–I just know it’s not something I personally want to do for a living), I went through all the evaluations past students had written on the different surgeons in the area, and specifically requested him to be my preceptor because they made him out to be a magical human being, which brings me to…
2. If I could make a wishlist for qualities I wanted in a preceptor, he’d have them all.
   I’m actually carving this one out for a whole ‘nother post so I won’t blather on for too long here. :O
3. As cheesy as this may sound, being referred to as a doctor made my heart jump for joy. :]
   He introduced me to his patients/refer to me as Dr. Fong. The first time he did this was on our first surgery day. (I actually didn’t respond at first because I figured I’d heard him incorrectly. ._. ) He’d include me in the decision-making process and ask what I thought about each case–what orders I thought we should write for them, what medications to give, whether or not they were stable enough to go home, etc. I cannot tell you how much I appreciated that, and how valuable it was.
4. It’s an absolutely amazing feeling to know that your preceptor has faith in you!
   On the second case of my first surgery day, he let me close up the patient on my own! I was a little concerned (“Are you sure you don’t want to stay in here to make sure I don’t kill the patient!?”), but said patient is alive and well. I got to close every patient since then, and he said I must have started suturing back when I was in the womb. :O (Good thing I got to sew up so many faces back in ER, right?!)
5. Having a sense of humor makes an enormous difference.
   I probably sound like a total fangirl right now, but my preceptor was hilarious, and always joking around, which added to the joy of working with him. Even on days where we’d have to call in the team to do an emergency surgery over the weekend, he’d keep the entire team laughing and in good spirits. Every day was a fun adventure that I’d look forward to! :]

Sometimes, we’d draw on people’s lunch boxes…

Memorable Cases

• A patient back in my very first rotation had colon cancer and needed to have surgery, but couldn’t make it in to the hospital on any day other than Sunday, so my preceptor called in his team to open up the operating room that Sunday so she could have her surgery done. (He apparently does this on a rather regular basis.)
• We had a lot of unintentionally themed days…for instance:
  • Gallbladder day! (6 cholecystectomies in a row)
  • Inguinal hernia days (3 repairs in a row)
  • Abdominal mass day! (5 patients in a row)
  • Abscess day! (Excisional debridements for everyone!)
• A girl with an opiate addiction who was diagnosed with hepatitis C
• I got to take out a gallbladder with ginormous stones! x_x My preceptor jokingly hid behind one of the nurses when I was pulling said gallbladder out, because it was putting up a huge fight, and he didn’t want to get splashed by all the juices.
• We also had two theories that we tried to test!
  • Procalcitonin and how well it correlated with detecting bacterial vs. viral infections in patients
  • Hiccups with hypophosphatemia + whether or not correcting the hypophosphatemia could stop the hiccups (sample size of 3 ._.)

Notable Quotes/Conversations

These are all with my preceptor + the nurses and surgical techs because the patients were all out cold! :O

• R: “You’re too nice to me, Farrah! We can’t have that! I’m going to have to make you mean!”
• “You are the best hope that medicine has. Remember that patient we had who had hep C and all the questions she had that I couldn’t answer? You went and found out all the answers to her questions and explained it all to her. Believe in yourself, Dr. Fong. You’re going to be just fine.”
  :]!!!
• “Why didn’t you tell me you’ve been suturing since you were in utero! You’re a natural at this!”
• “When I put a measurement down as _.1 x _.2 x _.3, my nurse knows that it means “SWAG,” which stands for Surgical Wild Ass Guess. That’s how I let her know that she needs to actually go measure the wound.”
• “It looks like we might actually get out before 6 p.m. today! That never happens, so next week, when we get out at 11 p.m. or midnight, I want you to look back on this day and remember that once upon a time, we made it out of the hospital before 6.”
• F: (yawns behind mask)
  D: I saw that! Farrah, don’t fall asleep!
  F: I’m not! I was just checking to see if my jaw would still open!
  D: Dr. M, you’re too boring! Your student’s falling asleep!
  F: Nooo!
  Dr. M: Young Dr. Fong is not sleepy!
  D: I saw her yawn!
  Dr. M: That was not a yawn. That was a silent roar. You’d best not be makin’ her mad!
• (Nurse): Are you Dr. M? I had a question about the patient in ___.”
  Dr. M: No, she is! (points at me)
  (Alternate answer = “Yes. Unless you’re the police.”)
• “Since the pus didn’t come shooting at you, you can record that as ‘a moderate amount of pus.”
• “If we keep this up, we gonna get locked up in Behavioral Health, and they’re gonna come after Farrah and question her on whether or not she saw the signs for when we started goin’ loony!”
• “Someday, Dr. Fong, you’re going to save a patient and become famous and I’m gonna see you on TV while I’m in my nursing home causing a ruckus and yellin’, ‘I knew she could do it! I told ya! She did it!’ and they’re gonna come quiet me down and think, ‘So he’s finally lost it.'”

Resources

• UpToDate
• NMS Surgery
• Surgical Recall, 6e, by Lorne H. Blackbourne, M.D. (affiliate link!)
• Medscape
• Boards & Wards (Carlos Ayala, Brad Spellberg) (affiliate link!)
• Pestana Surgery Review

Read about my other rotations here!