ROTATION REFLECTION:

Completed 10/1/18-11/2/18 at NewYork-Presbyterian Queens in Flushing, NY.

Surgery, complete!  I loved this rotation and it reinforced my desire to work in surgery following graduation.  Understanding the surgical side of care, on top of medical management, was something I enjoyed greatly.  Additionally, being part of the colorectal team lead by the Chief Resident and Senior PAs (my preceptors) was an absolute pleasure.

 

To start, my first week was definitely unconventional.  During the morning of my first day, while getting situated, my wife called anxiously stating that her obstetric physician thought she would be delivering our first child later that day.  I left my site and rushed home.  Turns out she was not having regular contractions and nothing progressed over the next day.  I returned to my surgery rotation on Wednesday, and then later that afternoon my wife’s contractions became regular so I met her at the hospital.  In the end, our son was born early morning Thursday and I did not return to my site until Monday (start of week 2).

 

From there, I hit the ground running.  I would typically get to the hospital at 5:00 am, study and eat something for 30 minutes, then go pre-round on the 1-2 patients I was following.  At 6:00 am, we had morning report with all of the general surgery residents and PAs.  After about 10 minutes, each team would together round on patients assigned to their team.  This allowed for great practice and responsibility with presenting my patients and informing the team of any events that occurred overnight.  I was always expected to advise on the plan going forward and if it was incorrect the Chief Resident would explain why.  Some specific things I learned about were the Caprini score (risk assessment for DVT and need for prophylaxis), Enhanced Recovery After Surgery (ERAS) protocol, American College of Surgeons Surgical Risk Calculator (ACS NSQIP), Vancomycin dosing & troughs, bowel preparation for surgery, various colostomies, peritoneal carcinomatosis, among others. 

 

After rounding, the team would split up and those assigned to cases at 7:30 am would head to the preoperative area of the respective operating rooms.  Oftentimes, I was assigned to cases then but other times I would not be scheduled for the OR until later.  In the interim, I would assist my preceptors with seeing surgical consults in the ED, flush or remove drains, change dressings, and follow-up with patients on our team as needed. 

 

When it came to the OR, it was for sure an exhilirating experience.  The intimidating part is scrubbing into a case where the attending physician precedes to “pimp” you on all aspects of the case.  One time I was proud of myself was when I was there for a challenging submandibular gland excision.  After making the first cut, Dr. Babic preceded to rapid fire 1 question after the next about why the procedure was being done and of course the underlying anatomy.  Since I had prepared well, I remember thinking in my head, “well I passed the test.”  Other cases I missed questions on but learned from my mistakes.  One attending asked what the first branch of the external carotid artery was.  I got it wrong but will never forget now that it is the superior thyroid artery. 

 

Although I was assigned to the colorectal team, I was exposed to a variety of general surgery procedures.  These included lumpectomies/mastectomies, ENT mass excisions, appendectomies, and colectomies.  Some of the most memorable cases I scrubbed in for were a radical neck dissection (for squamous cell carcinoma) with subsequent pectoralis flap that lasted over 9 hours, 2 video assisted thoracoscopic surgery (VATS) for lobectomies (due to lung cancer), an exploratory laparotomy to determine source of bleeding (which turned out to be a ruptured appendix and abscess formation near the ligament of Treitz), a Right femoral artery endarterectomy & sartorious flap/Left femoral artery angioplasty/4 stents for a 43-year-old woman with significant smoking history (another 9 hour procedure), and lastly an open repair for incarcerated indirect inguinal hernia (that I witnessed being unable to be reduced in the ED). 

 

As mostly a second assist, I was responsible for suctioning, retracting, and cutting knots.  One thing I realized early on was that the 1-handed tie was a necessity, as the instrument is typically in your left hand as a righty.  I learned and perfected this throughout the rotation.  Additionally, I found out that subcuticular suture technique (either interrupted or running) are most often used to close the skin.  Luckily, I was able to gain experience with resident supervision on multiple cases. 

 

In reality, there is so much that I learned in this rotation that I could write a whole chapter in a book.  Being part of a teaching hospital allowed for a great experience as a student.  At the same time, expectations were high and I felt like I was being counted on to do a good job.  As I look for jobs, NYPQ will certainly be at the top of my list due to my experience this past 5 weeks.  Anyways, psychiatry starts tomorrow so let me go get ready for it!