A week of surgery – some impressions

One only has to be minimally involved in a surgical procedure to understand the appeal of this profession. It is instantly gratifying and very rewarding to be able to just fix something. That, working under time pressure and mixture of physical and mental skill make it a very exciting way to practice medicine.

So after a week of this, and just getting off call around 1:00 this AM after scrubbing in on a liver transplant I’ll tell you what has surprised me about surgery so far, and some of the things I didn’t realize going in.

Surgeons are famous for having little traditions and quirks about their profession that, while fading, still represent slightly fratboyish and conformist attitudes. I don’t begrudge them this, but they are amusing. So here’s some of the funny things I learned about surgeons my first week that I had no idea about, and maybe this will be embarrassing to expose my ignorance this way.

1. Surgeons always tuck in their scrubs.
2. Surgeons must never have their stethoscope around their neck, it must be in their pocket (their least valuable tool – haha).
3. Carrying anything other than a stethoscope, some gauze and supplies, and a pen light will lead to ferocious mockery. Pity the fool who would dare to bring a reflex hammer onto the surgical wards.
4. Surgery is almost always about the “most likely” or “most common”. They don’t spend a lot of time worrying about about diagnosing things to death, and the consequences are often too severe for delaying interventions. For instance, it’s considered normal for a good surgeon to end up removing about 20% normal appendixes in cases of suspected appendicitis. It’s better to be more aggressive for many surgical problems and rapidly intervene rather than dither around and over-diagnose.
5. Surgeons, despite their reputations, are avid scientists. They track the literature, cite a set of studies that justify their practices, and are interested not just in cutting but in the pathophysiology of what they treat.
6. It’s amazing watching some of these open procedures than anyone can survive such rough treatment of their insides. Seeing the force put on things like retractors, you wonder how people ever recover.
7. The music playing in the OR is frequently way too appropriate. Tonight “Cruel to be kind” came on, and it was a little eerie.

There is much more, but these were the kind of things I’ve noticed so far. These also might not be universals as I am at a major academic medical center, which can be quite different than the surgical practice in many other places.

There were also many pleasant surprises and amazing experiences I’ve had in one week.

1. Women, at least of the residents I’ve encountered so far, appear to outnumber the men. This is a pretty fantastic sign of progress, as surgery, for various reasons, has always tended to be a male-dominated field. The fratboyisms were certainly a part of it, but also surgery has traditionally been very difficult to combine with any kind of family life.
2. Everybody is polite and professional, and if a surgeon is brusque with you there is very little reason to be upset. It’s nothing personal, they’re under pressure, and a fast surgeon is a good surgeon.
3. The 80 hour limit is obeyed with few exceptions, and the impression is that even if it doesn’t improve patient care, it’s certainly cut down on the number of divorces.
4. A surgeon at UVA in the course of a single shift has an amazing set of responsibilities. Over the course of about 12 hours today I followed a surgeon who ran a trauma, a code in the ICU, and then helped in a liver transplant. All without breaking a sweat I might add.
5. As a medical student (not to mention away from medschool for almost 6 years) on my first day they handed me instruments and just said, “go”. You aren’t necessarily cutting and stitching, but going straight from the lab to having my hands deep within peoples bellies, and driving laparoscopic cameras is pretty startling.

You understand why they get a whiff of the superhuman about them.

This week, time permitting, I think I’ll discuss some of the surgeries I’m doing with my current team. We’ll start with the Whipple tomorrow as I have two cases.