anatomy of a good day on the surgery rotation
We are two weeks into our eight week surgery rotation. It's been an interesting experience so far.
The way the story works: You perform a perfect suture after your attending's flawlessly executed bypass. The next day, the patient is recovering well -- sore, but keeping foods down, passing gas and urine. Your intern discharges the patient after less than a full day post-op. This is a good day.
You go in to get history and exam for a patient with a long, complicated history of back surgeries. The way the patient tells it, he's run into a slew of bad luck, less optimal circumstances, vicious cycles of illness, sedentary recovery, weight gain, and illness. He's morbidly obese and retired. He's primary caregiver to his elderly mother who was recently diagnosed with bladder cancer. He is not married, has no children. He needs to lose weight to have the next of many spinal surgeries. He does not appreciate that all these operations are the comorbidities of his obesity. All he needs is to drop the weight for the next surgery; his diabetes and ensuing recurrent neuropathies, his forty years of pack-per-day smoking -- these are merely incidental accidents as far as he's concerned. He speaks slowly and choppily, with many "uhms" and much stammering. He is polite and cooperative on interview, but he barks each word with an aggressive and frustrated timbre that is laden with desperation if you're listening. You try to listen. He does not seem to expect that he will ever fully recover. He is tired of all the surgery. He can't tie his own shoes. He can't wipe himself after he goes to the bathroom. He's been to hell and back. He has scars from severe burns on both legs, which are numb knee down. He is constantly in pain.
You present a heavily abridged account of this complicated case to the attending, who offers no critique. You and the attending go in to see the patient together. He really appreciates the few minutes he has with the doctor, who heartily shakes his hand at the end of their five-minute consultation. They will be in touch again in a few weeks. He nearly forgets his cane on his way out. The receptionist sets up a future follow up appointment on a date after your rotation is over. The attending did not critique your presentation, which means it might have been acceptable. This is also a good day.
The way the story works: You perform a perfect suture after your attending's flawlessly executed bypass. The next day, the patient is recovering well -- sore, but keeping foods down, passing gas and urine. Your intern discharges the patient after less than a full day post-op. This is a good day.
You go in to get history and exam for a patient with a long, complicated history of back surgeries. The way the patient tells it, he's run into a slew of bad luck, less optimal circumstances, vicious cycles of illness, sedentary recovery, weight gain, and illness. He's morbidly obese and retired. He's primary caregiver to his elderly mother who was recently diagnosed with bladder cancer. He is not married, has no children. He needs to lose weight to have the next of many spinal surgeries. He does not appreciate that all these operations are the comorbidities of his obesity. All he needs is to drop the weight for the next surgery; his diabetes and ensuing recurrent neuropathies, his forty years of pack-per-day smoking -- these are merely incidental accidents as far as he's concerned. He speaks slowly and choppily, with many "uhms" and much stammering. He is polite and cooperative on interview, but he barks each word with an aggressive and frustrated timbre that is laden with desperation if you're listening. You try to listen. He does not seem to expect that he will ever fully recover. He is tired of all the surgery. He can't tie his own shoes. He can't wipe himself after he goes to the bathroom. He's been to hell and back. He has scars from severe burns on both legs, which are numb knee down. He is constantly in pain.
You present a heavily abridged account of this complicated case to the attending, who offers no critique. You and the attending go in to see the patient together. He really appreciates the few minutes he has with the doctor, who heartily shakes his hand at the end of their five-minute consultation. They will be in touch again in a few weeks. He nearly forgets his cane on his way out. The receptionist sets up a future follow up appointment on a date after your rotation is over. The attending did not critique your presentation, which means it might have been acceptable. This is also a good day.
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