Author: nanimov

I got to see a kidney transplant today. Truly one of the most amazing things I’ve seen in medical school so far, maybe after delivery of a human baby. The transplant surgery was everything I imagine when I think of surgery. High precision, high stakes, anatomical engineering. We took a kidney procured from a deceased person off ice, hooked up all the plumbing (artery, vein, ureter) to appropriate, but not identical vessels in the body of a totally different person, in a place that was not originally intended to house a kidney, let the blood of this person flow into it, and all of a sudden this kidney, that was once in a pale stasis, is all of a sudden red with life and a pulse that is in sync with it’s new owner.

Also all the surgeons I worked with today were super nice, and they aren’t even on my service. The 1st year fellow who had the misfortune of having to close the patient with me was very patient in helping me with my suturing, guiding me and letting me take my time instead of rushing me or just taking over.

Also I saw a robotic surgery today (liver resection). The technology is super cool and it was very sci-fi to watch these weird arm things plugged into someone’s belly, manipulating things inside. Also the thing that the surgeons look through allow them to see inside the person abdomen in 3D which was also amazing. But being a bystander to the surgery was pretty boring. Just basically watching organs get manipulated and cut and pinched and burned for the time equivalent of viewing the Return of the King extended edition.

I really like my team right now. This week we got a new chief resident (4th year) and a new senior (3rd year) resident. They are both so nice and so chill, and perhaps most importantly they set clear expectations and act like they want us to learn and be part of the team. I don’t blame the previous ones at all for not really engaging with us. I imagine the life of a surgery resident is super tough and having to deal with medical students is just another thing to manage on top of everything else, but I guess that’s why it means a lot when residents take time to engage with us (and in fairness our prior residents did, it was just harder).

The team around you makes such a difference in your experience. Because I like my team currently, I’m kinda looking forward to going in tomorrow. That is how it was on Internal Medicine. The hours were long and I had to wake up at the wee hours of the morning, but I kinda looked forward to getting to spend time with the team and learn.

Hopefully this keeps up.

It was a long day today. Not only because of hospital/ clinic work but other commitments, but having to get up at 5 am certainly doesn’t help. Rounds started a little earlier today with our new chief resident and then we went to clinic later with the attending (we were late because the schedule we were given was wrong). It was nice to be back in the clinic though. It being a surgery clinic, there were some pretty heavy conversations had. In some ways, it feels wrong for me to be there in these important moments, as a spectator/ medical student. Another part of me feels lucky to be able to be present in those moments. If I did go into surgery, I can see clinic being something I enjoy. Our attending also did a lot of patient education which I thought was nice, especially since the image of surgeons can often be kind of cold and fast paced. But I am very sleepy so that is all for now.

Today was my first weekend shift on surgery. There were no procedures, so today was just rounding on the patients who were already in the hospital or got admitted yesterday. Compared to internal medicine, handoff in surgery seems very inefficient and almost haphazard, but it also feels like there are less issues being tracked, but those issues may be slightly more volatile. The resident I worked with today is supposed to stay at the hospital until tomorrow morning. Part of me is confused as to why. Why does someone have to be on call for 24+ hours. Is it a continuity thing? Based on what I’ve seen, it’s not like being around the first half of the day makes you any better suited to care for a patient overnight than someone coming in fresh who received a strong sign-out. It almost feels like one of those archaic practices that is held on to as a source of pride, like “look at me able to withstand a 28-hour shift.” But also what do I know, I’m literally talking out of my ass. Maybe it is better for physician wellness. Maybe it is better for patient care. I bet there’s gotta be some studies out their pointing one way or the other.

We didn’t have any cases today, so (thankfully) I didn’t have spend any time in the operating room (even though watching surgery is cool, yesterday was just a lot of standing). So it most basically like an internal medicine day, minus the long rounds and comprehensive discussions of pathology. I actually like the residents on our surgery team. The chief is kinda scary, or just very surgeon-y, she can be kinda terse, but also very nice at times and willing to be patient with us and help us learn when there is time.

There was supposed to be a liver transplant today which I was really looking forward to but it got cancelled (perhaps for the best), so we got a chance to sit down with the team a bit more and set expectations and stuff. And we got to go home a little earlier which was quite nice.

It’s only day 3 but I think I already know surgery, as awesome as it, is not going to be for me. The giddy has mostly worn off.

I got to scrub in on 2 liver resections today. Both cases of rectal cancer with metastases to the liver. This procedure is another great example of how kinda straightforward surgery is (again, besides all the technical parts of it); there’s something wrong with part of the liver, let’s just cut that shit right out. And when we cut the liver, I was kinda expecting this clean margins, like you’d get if the thing was made of Play-Doh. Nope it looks janky as heck.

If anything see all of this is, whole organs being chopped up, tissue being burned apart and sewn back together, it’s all a testament to how amazing our bodies (and living things in general are). We can put our body through hell, and yet it find away to put things back together, more or less in the way it’s supposed to, something we often take for granted.

We’re back to the early mornings. Yesterday our intern told my fellow medical student and I to show up at 6:00 AM at the hospital. Turns how it was his first day on the the service and first day working at this hospital as well, so the morning was a bit chaotic. The intern ran off without telling us much, and then the senior resident showed up and was like wtf. She took us to go round which was a very different experience from IM; walking rounds, but very brief visits with the patients. We finished in like 30 mins and then the resident was like ok go scrub into whatever surgeries are going on. And we were like uhhhh.

This was my first time actually working in this hospital and the scrub orientation/ OR tour we had yesterday was for the county hospital. After some running around with my classmate we eventually made it to our respective ORs. I got to go to a Whipple procedure, which I was pretty excited for. It’s basically a big plumbing job (like many surgeries). As technical and difficult and high-risk these procedures are the concepts are kinda basic, just take out what you need and make sure things are connected and stuff doesn’t leak out (obviously this is an oversimplification, you need to know what you are cutting and why).

This particular procedure is supposed to take 8+ hours. I was there for only for 4. It was amazing to watch the surgeons work. I feel like I often think about internal organs as so vital and almost delicate, but watching surgery proves otherwise. Sure the surgeons work with great care and precision, but at the same time things are flopping around, getting pushed and squeezed and cut and stitched and disconnected and reconnected and then later when the patient comes to they are still able to live as a functional human. Wild.

I will say as amazing as it is to watch, just watching does get a bit boring after a while. Though I can imagine actually doing the procedure being less so.

The surgical fellow straight-up told me that if there is something else I enjoy in medicine, do that and to avoid surgery if I can help it. After what I saw today I think that may be good advice. I can’t really imagine doing what these guys do into my 50s and 60s and not being an attending till I’m nearly 40.

Still looking forward to seeing more cool procedures though.

Today was orientation day for surgery. While I don’t think I want to end up in surgery (nor am I probably competitive enough to match even if I wanted to), I am actually pretty excited for all the cool shit I’m about to see during this rotation. I’m going to be on the hepatobiliary service and I am very much hoping I will get to see a transplant. I’m honestly not 100% sure if this service does transplants or if there’s a transplant specific service because I’ve heard conflicting things. Today we had some workshop for practicing IV insertion and surgical knot tying. The practical and hands-on nature of surgery is something that has always appealed to me about surgery, so I’m excited to learn these skills and hopefully be able to use them on actual patients. It’s going to be a rough next 6 weeks, but I don’t know why I’m kind of feeling giddy about it. We’ll see how long that lasts. Stay tuned.