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Surgery Residency Diary, Mom of 2

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4 years 3 weeks ago #94926 by cardiacrn1
So I truly believe my program is the most chilled out surgery residency. Don't get me wrong, we are very busy and we work hard. Three area hospitals closed 2 years ago and our ED is extremely busy and we get very sick patients. So the way it is structured, its divided into 4 different teams. A- trauma/peds and covers neurosurgery at night, B- Gen Surg faculty and hepatobiliary C- Vascular, ENT, Breast, Plastics D- Colorectal, Gen Surg private attendings.. Each team has a chief, 4, 3, maybe a 2, and 3 interns as well as 1 or 2 PAs. On call there is a 5, 4- who covers floor consults, PACU, puts out fires on the floors that interns can't handle, supervises SICU; 3- who covers ED consults, 2 in the ICU, and 3 interns for A, B, C &D. All on call make up the trauma team after 6pm. The 3rd and 4th years alternate holding the floor consult phone on weekdays from 6am-6pm, and also put out fires since most seniors will be in the OR.

So today I was holding the floor consult phone. I get a call from a medicine resident and the story goes like this…. "I have an 84 year old male who is s/p right hip ORIF after fall beginning of the month and he was at rehab and came in 3 days ago for abdominal pain, constipation and decreased urine output. CT on admission showed fecal impaction. His abdominal pain has been getting worse over the last 2 days and he is very tender on exam. We sent him down for an abdominal X-ray and the radiologist called me to tell me there is a lot of free air under the diaphragm."

My response, "ok, whats the name? what room? I will meet you in 2 minutes!"
I went to see the patient with one of my interns. I laid my hands on him, he had 4 quadrant peritonitis. I asked the nurse to place a second IV and run 2L LR wide open, added flagyl to the zosyn and vanco he had already gotten while my intern was booking the case and I was talking to my attending. The patient was on the OR table within 40 minutes. I went to the OR later when I got a chance and they were finishing up, he had a sigmoid perforation- got an ex-lap, sigmoidectomy, ostomy and mucous fistula. He is in ICU, not on pressers; I think he will do well despite the fact that he had fecal peritonitis and he is not a young man.

Most hospitals have acute myocardial infarction protocols that aim for a door to balloon time of 30 minutes. I feel like there should be such urgency with true intraabdominal catastrophes; acute surgical abdomens like - pneumoperitoneum secondary to some perforated viscus, AAA rupture or impending rupture, Small bowel obstruction with peritoneal signs, Acute mesenteric ischemia, Gastrointestinal hemorrhage that has failed other forms of therapy, etc.. The aim should be to resuscitate the patient adequately and not delay going to the operating room. Resuscitation is very important because it sets the tone for whats to follow. If the patient is not adequately resuscitated then the anesthesiologist is playing catch up from the get go. Putting in a central line would have taken some time, we got 2 16 gauge AC IVs and ran the fluids wide open and in 40 minutes he had gotten 3 L and had urine in the tube (yes I am one of those people who will stand at the bedside and lift up the foley catheter tubing and watch the urine drain into the bag).. Preparation is everything.

I have the weekend off, very exciting. Thanks for reading everyone and have an awesome weekend! - Ciao

Remember, the days are long but the years are short.- Elizabeth Cooperstein

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4 years 3 weeks ago #94943 by cardiacrn1
For some reason I am having problems posting long posts. Anyway, will try again later.

Remember, the days are long but the years are short.- Elizabeth Cooperstein

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3 years 7 months ago - 3 years 5 months ago #95648 by cardiacrn1
Residency is long and hard and at times you don't see the light at the end of the tunnel. After a rough call, its easy to lose perspective. I am lucky to be one of those people who is very satisfied with my career choice. I can not see myself doing anything else, I truly love what I do. It is very satisfying when an operation goes well, or you help someone who is critically ill and they are well and discharged home or even when someone comes in with a perianal abscess and you drain them and send them home comfortable. Relieving pain and suffering is our goal. I hope I never lose sight of that and always be humane. It is very easy to focus on the task to be done, the rounds to be done, the cases to be scrubbed and forget that these patient's of ours are people, with lives apart from that little snippet that we see. I hope to always be compassionate and empathetic towards the patients I am privileged to serve.

Remember, the days are long but the years are short.- Elizabeth Cooperstein
Last Edit: 3 years 5 months ago by cardiacrn1.

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3 years 5 months ago - 2 years 5 months ago #95762 by cardiacrn1
Vacation is a beautiful time for reflection. Residency will end at some point,but that doesn't mean that while I am still in residency the rest of my life should be on hold. My relationships, hobbies, interests. Life doesn't wait for us to finish this grueling part of our training and at the end of the day it is but a very small part of the big picture. So live life, don't wait until you are done with residency or medical school or fellowship to truly live.

Remember, the days are long but the years are short.- Elizabeth Cooperstein
Last Edit: 2 years 5 months ago by cardiacrn1.

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