Agraphia Medical Tragicomedy


The Long Hard Road

Surgery has been far worse than I expected. It's actually not the patient care problems; my fears prior to this rotation were (mostly) unfounded. Somewhere in the last month I've realized that I am much more capable than I've suspected in the past.

Today alone I corrected severe electrolyte imbalances without needing to ask how, transfused a woman with approximately half of her normal blood volume, admitted 7 patients to my service with hardly any guidance from my upper level surgeons, and was told by the nurses on the surgical floor that they want to keep me to themselves, never to return to the ER.

That said, General Surgery is the most difficult, frustrating, and downright unpleasant rotation I have ever done.

The one substantial thing I failed to realize about surgeons - which, looking back on it, is a no brainer - is that they are always in the OR. This means they don't respond to pages, and it is exceptionally difficult to get in touch with anybody. On top of this, they're surgeons, and there is a machismo of "do it yourself" that pervades everything they do.

All that you have heard about resident work hour restrictions and duty compliance? Doesn't apply to surgeons. I've worked at least 95 hours each week on service so far, with 32+ hours on call every night with no sleep. Official guidelines state 80 hours/week and 30 maximum on call. Oh, and 10 hours of time off between leaving the hospital and returning in the morning, which is laughable.

I don't say this to garner pity, because I can hash it for a month. I say it for posterity, and for the sake of my patients who are getting poorer care than I want to give them. There is also no question in my mind that the surgeons are working even harder than I am, which is staggering.

My typical day starts at 5 AM. I need to round on 15 or more patients (our service is absurdly large and understaffed) in the space of 2 hours. This breaks down to approximately 7 minutes per person, most of whom I should spend about twice that much time on.

There are extremes in medicine, as there are in anything. Internal Medicine is known for rounding as a group for hours and hours at a time, spending upwards of 20 minutes on each patient to ensure that every i is dotted and t crossed. Attendings, senior residents, and interns all chat about patients in a formalized, clear fashion. There is a clear demarcation of who is responsible for what.

Our service, on the other hand, does not round at all. In fact, I'm lucky to talk to my senior surgeons for 10 minutes throughout the course of the day, which leaves me - an intern with 3 months of experience as a doctor - to essentially manage all of the problems that occur on the floor while they are operating.

From 7AM until 7PM or so, I respond to every call about the 40+ people on the surgical service. The pagers (I carry 2) go off every 10 minutes or so. Blood pressure too high. Blood pressure too low. Too much fluids. Too little fluids. Patient dying. Patient vomiting. At this point I really only call my upper levels about "patient dying", as I figure this is a fairly important thing to pass along.

Today is the first day that I got home in time with 9 hours until I need to be back at work. I've got an hour to write before I go to sleep.

I suspect this is why surgeons don't blog very much.

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  1. Enjoying your blog. Thanks!

  2. And this, my friend, is why I want surgeons to earn plenty of money. I want to Save the Surgeons! Medicare keeps cutting their reimbursements and has made certain important surgeries difficult to come by. For example, post-mastectomy TRAM flap breast reconstruction yields a breast made of the patient’s own tissue so it ages with the rest of the body. Placing an implant is a lot faster and more lucrative for the surgeon as a result. In addition, the last cardiothoracic surgeon I met told me CT surgeons are a dying breed. Could the 40-50% salary cuts since the stenting boom be partly responsible for this? Who is going to do your CABG when you have 3-vessel disease 30 years from now?

    Glad to hear you are making it through your surgery rotation and becoming more self-confident through increased competence!

    P.S. I am not going into Surgery, although I loved my med school surgery rotation! :-)

  3. Thanks for reminding me of why I shouldn’t go into surgery. Sometimes I fantasize about it — I loved my surgery rotation — but then the reality that I like sleep more than operating hits me and I remember that I should really just accept the fact that I’m going to be a Neurologist, and get over it.

    It sounds like you’re learning A LOT though. Nice work!

  4. Just be glad that for you it’s a rotation and not your career choice. I know some really nice med students that were abducted by surgery residencies. I haven’t heard from them since.

  5. I sent this post by email to a bunch of people. Hope that helps.

  6. Bleh, I start my surgery rotation on Monday. I’m scared.

  7. I agree, Doc D. Never something I’d want to do for a lifetime, but certainly an experience that’s worth having once. If only for how much I’ve learned this month.

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