Day in the life of an MSIII – Surgery Rotation

4:00 AM – Alarm goes off.  It’s going to be dark for another 2 hours. Sweet.

4:25 AM – Leave the house. Relatively sure I forgot something, but my brain still isn’t functioning, so I ignore the warning bells.

4:40 AM – Invariably, my windows begin to fog up while I drive. I toggle between AC and heat, knowing that one of those two has to clear the fog. Neither of them do. At least there’s no one else on the road with this problem…because no one else is awake.

4:55 AM – Print out the team list for the day. I see that one of my patients was discharged, but we have 3 new patients. We divide up the new patients amongst the three med students.

5:00 AM – I grab my new patient’s chart. Rounds are at six, and I have 2 patients to see. Writing the note takes about 5 minutes, and flipping through the chart/ getting the labs takes 10 minutes, so I have 15 minutes to see the patient. Not  bad.

5:15 AM – I feel terrible as I knock on the door and turn on the lights. Yes, Mrs. S, it’s only 5:15. I’m sorry. Trust me, if we could do this two hours later, I would.

5:17 AM – Still no flatus? Damn. How’s the pain?

5:26 AM – I forgot to check what color the fluid was in her JP drains. Should I go back and check? Yep. There goes my schedule.

5:31 AM – Crap. Didn’t check the Foley output. Time to go wake up Mrs. S a third time.

5:45 AM – No new overnight events for Mr. C, except that he woke up in the middle of the night from a bad dream and wet his bed. Is that medically relevant?

6: 21 AM – Turns out Mrs. S needs an IVC filter placement this morning. My chief asks me what the indications are for an IVC.  Ummm… DVT’s?

6:22 AM – I have a new homework assignment for the evening.

6:48 AM – I tell my team about Mr. C’s bedwetting. The mid-level resident rolls his eyes. Note to self: Not Medically Relevant.

6:55 AM – We’re walking to breakfast…no, wait, we’re walking right by the cafeteria. What? Oh yea, Morbidity and Mortality conference at 7AM. No time to eat. Or get coffee.

7:20 AM – M and M conferences are valuable teaching experiences. They’re also a good place to practice your one handed suture tying. I race the kid next to me. He beats me with not only his right hand, but his left hand as well. When did he have all this time to practice?

7:35 AM – When the presentation is over, the conference always takes a turn for the intense. Invariably, a doctor did something wrong that adversely affected a patient outcome. Invariably, the other doctors at the conference pile on the poor doctor. It’s the most polite way of insulting someone that I’ve ever seen. For students, though, it’s fun.

8:00 AM – Conference over. Time for breakfast. Nope, not time for breakfast. Our case is starting in 5 minutes, and I have to go scrub in. The operative procedure? Laparoscopic distal pancreatectomy with splenic preservation. Should be a piece of cake.

9:15 AM - The case still hasn’t started yet. In no way is this surprising. My resident says to me, “dude, you should’ve grabbed breakfast. Too late now.” Thanks for telling me.

9:36 AM - Case begins. Attending surgeon turns to me and goes, “buckle up, this may take awhile. I’ve never been able to do this laparoscopically before.”

10:00 AM – Main Lap port is in. I have to say, it’s always pretty incredible when the camera gets put into the abdomen and all of the organs suddenly become visible. Love that feeling.

10:45 AM – 3 more ports have been inserted. The case is complex, but doable. Our patient has multiple pancreatic cysts in the tail of her pancreas. The goal is to remove the cysts with clean margins around them, while preserving the head of the pancreas. Certain splenic artery and venous branches also need to be ligated along the way. And the splenic vein lies directly behind the pancreas, so if it gets cut, 2 things will happen: there will be massive, massive bleeding, and we won’t be able to see anything, because the pancreas is in the way. Therein lies the rub.

12:00 PM – Slow going, but the pancreas is becoming more and more mobilized. At this point, I’ve been standing for 4 hours, and I need to shift my feet every 5 minutes to dull the pain. The surgeon did liver transplants for 10 years, which are typically 10+ hours. He looks pretty comfortable on the other side of the table.

1:00 PM – And the devascularization of the tail of the pancreas begins. Laparoscopic surgeries are much better for the patient because they vastly speed up recovery time, and decrease pain. For the med student, though? Staring at a computer screen for 5 hours and getting to do nothing is a slow, slow form of torture.

2:30 PM – The rest of our surgery team comes into the room to update our resident as to what is going on with our patients on the floors. My fellow med students give me looks of pity. At least, I think that’s what they are- we’re all wearing masks, so it’s tough to tell. The other patients are doing fine on the floors. They leave.


5:00 PM – And we’re done. 8 hours later. We did the whole thing laparoscopically! The attending is pretty excited. To be honest, I get a little excited too—seeing a surgeon get so interested in a case makes me know that he still loves what he does for a living.

5:05 PM - I can’t feel my feet. But now I finally get to participate- I get to help close up the 6 laparoscopic ports we’ve made. By the time I finish the first port, the resident has already done the three on her side. And hers look perfect. There’s a good chance the one I sewed up is going to scar. I get to close up one more, and the resident finishes the last one. Pretty cool. Nothing makes you feel like a future surgeon more than getting to suture.

5:20 PM – We wheel the patient to the PACU (Post-Anesthesia Care Unit). My resident tells me I did a good job in there today. I feel pretty good about that, even though I know my big accomplishments were not falling asleep and not contaminating anything. Still, you have to take your victories where you can get them.

5:30 PM – I check on the floors to see if they need any help. I get there just in time to do a rectal exam on one of our patients. Doesn’t sound so great, but truthfully, it’s exciting when you get to do actual things besides a history and physical. Carpe Diem.

6:00 PM – I leave. My chief reminds me to text her tonight with the indications for an IVC. All I can think about is the fact that I haven’t eaten in almost 24 hours.

6:40 PM – Arrive home. I have to be in bed in 3 hours, just so I can get about 6 hours of sleep for the next day. My roommate is on his family medicine rotation. He worked 4 hours today. He’s sitting in our living room, watching TV and drinking a beer. Nothing else to say about that.

9:00 PM – Indications for an IVC filter: 1) DVT or PE in patient with contraindication to anti-coagulation

2) DVT or PE in patient with complication of anti-coagulation therapy

3) Failure of anti-coagulation therapy

4) Free-floating ileofemoral or caval thrombus

9:02 PM - How do you fit all that in a text message?

9:45 PM – Bed time.


9:00 PM- Indications for an IVC filter: 1) DVT or PE in a patient with contraindication to anticoagulation therapy.

2) DVT or PE in a patient with a complication of anticoagulation therapy

3) Failure of anticoagulation therapy

4) Free-floating iliofemoral or caval thrombus

9:02 PM: How do you fit all that in a text message?

9:45 PM: Bed time.

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Filed under Day in the Life, Heard on the Floors, Hidden curriculum, Storytelling

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