Tips for Doing Well in the Surgery Rotation

I think a lot of people are pretty intimidated by surgery, especially if you don't see yourself as the surgery type. But honestly, surgery is a lot of fun if you work hard and make an effort to learn how to be useful in the OR. Here are my tips for getting more out of your OR experience. Some are only applicable to Case students, but most are applicable to any med students.

1) Learn how to tie knots. I had a terrific attending who let me do a lot in the OR, and she let me do even more once she realized that I had learned how to tie knots. It was terrific. The best thing to do is to get one of the residents to show you and then practice on your own. You can probably get a few suture kits from the OR and use those to practice. Once you get the hang of it, practice using gloves. It's a lot harder tying knots with gloves on because the gloves are kind of slippery, and you can't feel the sutures as well.

2) Be assertive. Surgery is not going to be as much fun if you are more the quiet wallflower type. You have to tell residents and attendings that you want to scrub, suture, etc. and not wait around hoping for them to notice you. I don't consider myself to be particularly quiet, but my attending thought I was anyway because I'm not as forceful as she is. No other preceptor I've ever worked with has said that I need to be more aggressive. I really think it's a surgery thing!

3) Don't take being yelled at personally. It's not just you. Surgeons are tired, overworked, and a bit obsessive compulsive. They love efficiency, and third year med students are the wrench in their works. We're all a little clumsy, so we all get yelled at.

4) Don't fight with scrub nurses. No exceptions on that one. Just don't do it. You've already lost with the very first word out of your mouth. If a scrub nurse tells you that you've contaminated yourself, apologize and ask them what they want you to do. If they tell you to re-scrub, re-gown, and re-glove, do it without arguing. If you don't fight them, they won't make your life nearly as miserable. I had to change a few gloves and gowns, but I never had to re-scrub from scratch.

5) Try to read for half an hour every day. Surgery is one of those rotations that is more a 5-to-9 job than a 9-to-5 job. But you still need to read about your patients, log them, and complete your learning objectives. If you keep up with this regularly, you won't be swamped and panicky at the end of the rotation. I liked the NMS Surgery Casebook and did not use the Lawrence book that was recommended for the rotation at all. I also liked Cope's Early Diagnosis of the Acute Abdomen, which was one of the recommended supplements for the rotation. It's kind of quaintly written, but it's also written in a conversational style. Since most of us were on gen surg or colorectal teams, understanding indications for abdominal surgery is pretty important.

6) Don't be a martyr when preparing for the oral exam. When I first started the rotation, I wanted to prepare for all of the questions by myself. I quickly realized it would be impossible. There just aren't enough hours in a day when you're on surgery. Things went much better after I split the work up with one of the other students on the rotation with me.

7) Try to read about the surgeries before you scrub, including the anatomy you are going to see. This is good for two reasons: one, you will get more out of the surgery if you know what is going on, and two, you will be more prepared if you get pimped. I at least tried to read the appropriate chapter of Surgical Recall before scrubbing for my subspecialty surgeries. For those of you who are at CCF and don't want to buy your own copy, they have one in the library. I checked it out instead of buying it since I was pretty sure I wouldn't be going into surgery.

8) Eat breakfast every morning, especially on OR days. A lot of people try to eek out those last few minutes of sleep and skip breakfast. It's a bad idea. Really. Your chances of passing out will be seriously higher if you skip breakfast. Don't forget that if you're scrubbed in all day, you probably won't be eating lunch, and there's a very real chance you won't be eating dinner, either.

9) Make sure you keep tabs on your patients and know what's going on with them. Check their labs every day and pay attention to anything that is irregular. When you write up your notes, make suggestions for what you think might be wrong and what you think should be done about it. You'll be wrong at least half the time, but it's better to try to figure it out and be wrong than to not try and just look uninterested.

10) Don't despair when the going gets tough. Surgery is physically and mentally difficult, but it's doable. Thousands of other med students have made it though this rotation, and you will, too.

End of Surgery

I can't believe that my entire surgery rotation is over already. It was way too short. Here I have finally reached the point where I was starting to get the hang of things and enjoy the rotation, and bam, that's it. Time to move on. Apparently I'm not the only one who feels this way, because the new clinical curriculum is going to have more time devoted to surgery.

The rest of this week has been kind of easy and relaxed. On Wednesday, I wanted to scrub in for a vascular surgery. But there were some bigwig visitors from another hospital there, so I got relegated to watching the screen in the control room. The surgery wasn't all that interesting anyway, at least not up until the point where they deployed the stent. That was really cool. The stents are self-expanding. I'm still not totally clear about what they do to get the stent to stay retracted while they're manuevering it, and then to expand once it is in place. But you can actually watch it spring open on the screen.

Afterward, I went to see what my team was doing and find out if my attending wanted me to scrub. They were running late in the OR, so I offered to go round on our patients myself and then present to them. The attending agreed, and I went to collect our patients' labs and check on their progress. This worked out tremendously well. Not only did I help get all of us out earlier by presenting to them in the OR, but she wrote a very good eval for me about the initiative and teamwork I had shown.

The attending has her outpatient surgery day at one of the satellite clinics on Thursdays, so I had a reading day to get ready for my presentation today. I presented on a woman who had a breast lump. There was a mammogram and an ultrasound available, but I couldn't figure out how to get them to open in Epic. It turns out that only some computers on campus have whatever karma is necessary to open those films, and the fellow on my team had one of them. So he helped me get the films open and copied into my presentation, and overall it went well.

Our didactic today was on bariatric surgery, which is cool. But we had already seen a lot of this stuff last year, so it wasn't the most exciting. The afternoon research seminar was even more painful. It was on how to make a good presentation. Why the research curriculum people thought we should cover this topic in our third year of med school is beyond me, since we've been doing research presentations for two years already. I also don't understand the need to beat the topic to death for three straight hours on a Friday afternoon. But no doubt this is why I am not designing medical school curriculums. To make matters even worse, we had a class meeting afterward to teach us how to sign up for electives and advanced rotations. I've already signed up for some of both with no instructions, and it is extremely simple. You go to the online elective catalog, pick out what rotations you want and when you want to take them, and email the list to the registrar. That's seriously all there is to it. (You may have noticed that I feel a bit cranky this afternoon!)

Oral Exam and a Lucky Break

I spent the weekend studying for my oral exam, which was supposed to be this afternoon at 2:30. My attending let me out of evening rounds early yesterday so that I could study, and she told me not to scrub in this morning either. So I was feeling pretty relaxed because I had so much time, and I even slept in this morning. Then I got a page at 10:30 saying that my examiner wanted to move the oral three hours earlier, in one hour. Crap! That call made me finally start feeling a little stressed, because now I wouldn't be able to get through the whole review in time.

I was cursing myself for not getting up earlier, but it turned out ok. Even though I struggled a little with the first question, I got it in the end with some prompting. The second one I knew cold, and the doc couldn't find anything wrong with my answer to that one. It was kind of hard to concentrate during the exam because his telephone and pager kept going off every other minute. He is a transplant surgeon, and an organ (a liver) was possibly going to arrive this afternoon. First the organ was coming, then it wasn't, then it was again, and finally he told his assistant to contact the patient and get the team and OR set up. He made a comment about all the calls, and I felt bold enough after doing well on the second question to ask him if I could scrub in. He said it would be ok, and to page his assistant in a few hours to find out where and when the surgery would be. Then he said I had passed, and I left to go have lunch. The thought also occurred to me that I shouldn't have asked him to let me scrub for the transplant before checking with my attending. Fortunately, she was excited that I had passed the exam and enthusiastic about me getting the chance to see a transplant, so I didn't get into any trouble for not asking first.

The operation was long and laborious. This time, I was mostly watching and retracting (although I did get to do a little bovieing), but it was totally worth it. It took the team a few hours to remove the patient's old liver. That liver was shrunken, hard, a sort of sickly greenish color, and knobbly all over. (The patient had really bad cirrhosis.) In contrast, the new liver was large, brownish and glistening. Its surface was smooth, and it felt soft and spongy to the touch. Putting in the new liver took several hours also, because all of the hepatic blood vessels had to be anastomosed (connected). Once they were all connected, the surgeon opened the clamps, and blood began to perfuse the new liver. First, the tissue closest to the hepatic artery turned pinkish, and then slowly that pinkish color began to spread like a wave all throughout the organ until the whole thing turned pink. It was so amazingly alive compared to the old liver. Everything had gone well. We scrubbed out at 8:30 while the residents finished suturing.

Tonight I am on call, but I'm not doing too much. I'm tired and not really in the mood to stay up all night. Fortunately, I am here with the same cool resident again, and he didn't mind that I showed up three hours late for call. He also told me it's ok if I leave, and I think I will do that in another hour or two. All in all, this was a pretty awesome day. I don't want to live a surgeon's lifestyle, but I can definitely understand why surgery is so appealing to a lot of people.

More Cool Subspecialty Surgeries

I've scrubbed in for a lot of cool surgeries in different subspecialties this week. Tuesday it was ortho, as I've already mentioned. Wednesday I scrubbed for a mastectomy. This was a lot more interesting than I expected it to be. The surgeon I scrubbed with does what is called a nipple-sparing mastectomy. Besides him, there is only one other surgeon in the entire country who does this particular procedure.

In a nipple-sparing mastectomy, the surgery team takes out all of the fat and glands from the breast, but they leave behind the skin and nipple. They also remove what are called the sentinel lymph nodes (lymph nodes closest to the breast) from the patient's armpit. This is done instead of taking out all of the lymph nodes in that area. The benefit of taking out fewer lymph nodes is that it decreases the chance that the patient will get really bad edema (swelling) in that arm. Edema can occur because with the armpit lymph nodes gone, fluid tends to back up in the arm with nowhere else to go. It's cool how they find the lymph nodes, too: they inject a blue dye (methylene blue) into the breast, and the dye gets carried out into the lymph nodes under the patient's arm. This dyes the lymph nodes that are closest to the breast a dark blue so that the surgeon can see them. The nodes are pretty small, about the size of a pencil eraser.

The woman can choose either to have implants placed in the breast during the surgery, or use temporary implants so that she can see what she'll look like before having permanent implants put in, or not have any implants at all. Some women choose not to have implants because of all the problems (leakage, immune reactions, more difficulty screening what is left of the breast tissue for cancer, etc.) that can happen with implants.

The main question that occurred to me while I was watching all of this was how they can keep the nipple and skin of the breast from dying. They are removing all of the tissues underneath, so how does the nipple get enough blood supply? Well, amazingly, it does.

Yesterday, I scrubbed for a nose septoplasty with an ENT (ear, nose and throat) attending and his resident. The surgery was cool to see, but I didn't get to do anything since it's all laparoscopic. It's also really tight to be in there around the patient's head with a few other people! ENT is cool, but as you can probably imagine, it's also pretty gross. The attending was surprised that I thought ENT was grosser than colorectal surgery, but I did. Somehow, sinuses full of snot and pus kind of get to me.

This morning, we had our normal surgery and medicine case presentations. I have to present again for surgery next week since there are only two of us in my group on surgery right now, so that kind of sucks. I'm getting a little tired of preparing these presentations. It's a lot of work, especially when you're on a time-intensive rotation like surgery. Afterward, we had a seminar on coughing and shortness of breath. That was pretty good. There were a bunch of cases, and an internist and surgeon went through them with us.

In the afternoon, we had an FCM session about apologizing to patients for medical mistakes. We had to do an exercise where one person pretended to be the doctor who had to explain about a mistake, and the other person pretended to be the patient. I was "lucky" enough to be selected to play the doctor, and I was doing my best to try to explain the mistake (the patient was given an antibiotic she was allergic to) the way I would have really done it. My partner kept laughing every time I looked her in the eye and started talking. After a few false starts like that, she started apologizing to me for not being a good actor, so by then, everyone was laughing. To add insult to injury, one of the faculty came in to tell us that we had standardized patients we could use instead of having a student pretend to be the patient. At that point, we were all hysterical. My classmate told me later that the reason she kept laughing is because I looked so serious. :-P

Next week is my last week on surgery. I just found out that my oral exam will be on Tuesday afternoon, so this is not going to be a weekend of fun and games. Tuesday night is also my last call. Yeah, I really know how to have a good time.

Drunk Driving Aftermath and Total Knee Replacement

My Saturday call was pretty quiet, so I wound up leaving at 10 PM. I had the same cool senior as last time, and mainly I just ate dinner and hung out with him for a few hours. He had taken some time off before going to med school, and I found out that he had been a chaplain for a few years. That is probably the most interesting thing I have ever heard of someone doing before med school. It's especially interesting that he went from being a chaplain to being a surgeon! Sunday I mainly spent working on the questions for the oral exam. It's going faster now that I've been dividing up the questions with the other surgery students, but sadly I am still not done.

Yesterday, I was in clinic all day with my surgery attending. We spent a couple of hours with one patient who had a very sad story. He was a college kid who was driving drunk on the highway when he lost control of his car and hit a tree at high speed. The airbag deployed and saved his life, but his lower body was crushed. There was a girl riding with him who was killed. We were seeing him because he had become fecally incontinent since the accident. He had to have several tests to measure his anal sphincter function, and at the end, the attending told him that unfortunately, there wasn't anything she could do. The kid didn't say much, but his mom was sobbing. It was really awful on so many levels. Maybe the worst thing is that all of this tragedy was preventable. Now this guy will probably have to spend the rest of his life in a wheelchair, wearing diapers, and living with the knowledge that he killed his girlfriend, all because he made a really dumb decision to get behind the wheel that night.

Today I scrubbed in for an orthopedic surgery. It was a bilateral knee replacement, and it was really cool. The patient couldn't have general anesthesia, so he was awake and talking to the anesthesiologist the whole time. That was kind of weird. But I got to watch a spinal block, which I hadn't ever seen before. It's kind of like a spinal tap, except that instead of withdrawing spinal fluid, the anesthesiologist injected anesthetic. Then the patient was prepped like normal. I mostly watched for the first knee, but I got to do some drilling and cementing for the second knee. At the end, the attending left the intern and me to suture up the patient's knee. It took us a while since neither of us was very experienced, and the anesthesiologist and scrub nurse were kind of getting annoyed with how long we were taking, but we got it done in the end.

I don't really want to be an orthopod, but I can understand the appeal. You get to play with a lot of cool hardware and instruments that don't get used in other surgical fields. It's also very physical work and requires a pretty good understanding of geometry and biomechanics. For any of you readers who ever scrub into an orthopedic surgery, make sure you wear a face shield, because it's messy. Also, you might not want to make a knee replacement the first surgery you see, because it's a lot bloodier than the other surgeries I've scrubbed for. Fair warning!

Finishing My Second Week of Surgery

The rest of this week has been a lot easier than last week was. Wednesday, I scrubbed into a pediatric hernia surgery. That was an incredibly pleasant experience compared to scrubbing into adult surgeries. The peds OR areas are decorated with cartoon characters and colors instead of being stark and white. The scrub nurses are really nice. (For anyone who has never done a surgery rotation, the phrase "nice scrub nurse" is almost an oxymoron.) I didn't get to do very much besides retract since the patient was a little kid, but it was still a good experience nonetheless.

Yesterday, I lucked out and got a study day because my attending was off doing surgeries at one of the satellite family centers. I'm still working on those surgery prompts for the oral exam, which I have to be ready to take in nine days. But I got a lot done yesterday, because the only clinical thing I had to do was go on rounds in the morning and evening.

I also had to present a patient at morning report today. Since I didn't have a really good surgery case, I decided to present the patient with abdominal pain who I saw on my first call night, the one who turned out not to have a surgical problem at all. The presentation went well, and the surgeon who was leading the discussion wrote me a very complimentary eval. Afterward, we had our medicine presentation, and then our seminar was on diabetes. That was a bit crazy, because the original seminar leader was sick or something and didn't show up. So the block leader led the seminar instead. To her credit, she did a pretty good job, especially considering that she didn't find out she was going to have to do this until the last minute.

This afternoon, we had a research seminar on designing questionnaires. I don't think I'd have liked it even if I wasn't sleep deprived and cranky from being on surgery, but that certainly didn't help. They also made us do this stupid group exercise. All in all, I am really starting to hate these Friday afternoon seminars. I understand that physician scientists need to know things like how to tell if a questionnaire is properly designed. But I still don't think it's necessary to make us sit through three hours of it on a Friday afternoon when it could have been covered in one hour. Plus, I still had to go on evening rounds afterward, so I didn't get much of a break.

Tomorrow night I am on call again with the same senior resident I had call with last time. Amazingly, I am actually looking forward to taking call this time. It doesn't hurt that I'll get to have Sunday off afterward, either. :-)

Dealing with Being Post-Call

Saturday I came in to round on my patients in the morning, and then I spent most of the day working on my surgery questions for the oral exam. Sunday I did my laundry and all that kind of stuff that is hard to get done while you're on surgery. Later, I went in for my call night, which started at 6 PM. I had a different senior this time because the residents are on a new rotation month now. After we introduced ourselves, he told me that I could do whatever I wanted. I jokingly asked if I could just go home, and he told me, "Go ahead if you want." I have to admit that I was more than a little tempted, but I decided to stick around for a few hours at least. I mean, I was already there anyway, and the administration would probably not be too happy if they found out I had blown off my call completely.

The first page we got was for a patient who had just coded and died in the ICU. The senior had to pronounce him dead. So we went to the ICU, parted the curtains, and there was the patient, lying in bed like any other patient, except that the heart monitor and the respirator were eerily silent. My senior handed me a pair of gloves and told me to feel for a pulse at the patient's wrist. While I was doing that, the senior was feeling for a pulse on the man's other wrist. The patient had obviously just died, because he was still warm. I didn't really feel much of anything, but the senior told me to keep pressing on the man's wrist. He said, "If you wait long enough, you will start to feel a pulse." Sure enough, I did feel one after a minute or so. It was really freaky. He told me, "That's your own pulse you're feeling." Wow. We filled out the patient's paperwork and the senior signed the death certificate. I decided that I was going to hang around some more.

One of the interns was in the surgery resident office when we got back. She got paged a few minutes later, and I went with her to see the patient. This patient was a woman who was post-surgery for breast cancer (lumpectomy). We took her history and did an exam. All of her lymph nodes on that side had been removed, so she had really bad lymphedema (swelling because there are no lymphatic vessels to take the fluid from the tissues back to the blood vessels). Her arm and breast were swollen to the point that they were at least twice the size on that side versus the normal side. Unfortunately, there's not any surgical solution to lymphedema. We had her elevate the arm and told her to keep it elevated. Then we paged the senior to discuss whether the patient needed antibiotics, too. I wrote a note and the intern corrected it and gave me some feedback.

Things slowed down for a while, and I practiced tying knots a little, then just hung out with the senior in the resident office. Around 2 AM, I was getting pretty tired, so I decided to go to bed. I had to get up at 4 AM to pre-round, but at least I got a couple of hours of sleep. I wasn't feeling so hot though. My attending had clinic all day Monday, so I went in for the morning. It felt like the room was spinning, and I was pretty nauseated. I asked one of the nurses if I could lie down for a minute when things got slow, and I managed to doze off a little. My attending didn't realize that I had been on call the night before, so she thought I'd be there in the afternoon, too. I told her that I would stay if she wanted me to, but she said I should go to bed since I was post-call. I didn't need to be told twice.

This morning, I was supposed to scrub in for a vascular surgery, but it got cancelled. So I went and scrubbed in with my regular team, and it was a crazy day. We were in the OR for 12 hours, during which we did four surgeries with no meal breaks. I was really glad I had at least eaten breakfast. Today she let me suture, and I am getting pretty good at it. But now I feel too tired to eat and too hungry to sleep. The one good thing about missing so many meals on surgery is that you don't gain weight.

Here are the answers to a couple of surgery questions that I have been asked. First, yes, it really is possible to doze off in the middle of an operation. Assuming you are just standing there retracting and no one is pimping you, it's quite simple to close your eyes for a few minutes here and there. Second, needing to use the bathroom during the surgery has not been a problem for me so far. I go right before it's time to scrub in, and then since I'm often not eating or drinking anything all day anyway, it hasn't been an issue. I do come out of the OR feeling really parched though. When you first walk into the OR, it's freezing cold. But once you get gowned and gloved and those hot lights are beating down on you, it gets warm enough to make you start sweating. If the patient is being warmed by the anesthesiologist, oh wow, that really gets uncomfortable.

First Call

I had my first call on Wednesday this week. It was kind of rough, mainly because I felt like a total jerk by the time it was all done. CCF has a night float system, which means that the residents who are here at night get to sleep during the day. However, the students do not get to sleep during the day. So I was in clinic in the morning, in the OR all afternoon, and then on call that night. The senior resident had me go see a consult in the ER who was having abdominal pain. My patient was an elderly man and kind of out of it because he had been given pain medication, but he was still in a lot of pain. I had no idea what was wrong with him based on the history and physical. Really the only thing I could find was that his stomach hurt any time he moved, and there was a huge bruise on the lower part of his stomach where he had been injecting himself with blood thinners.

When I went to present to the senior, I wasn't the most organized. Afterward, I realized that I should have taken notes while I was talking to the patient, because my memory was just shot by that point. Somehow, I muddled through with the resident correcting my presentation every few sentences, and then the resident asked me if I had done a rectal exam. Done a what?!?! He scolded me a little for not having done one. We went to see the patient and he did it himself. The poor patient was in pain every time he had to move, so rolling over for the rectal wasn't exactly a small ordeal. I had spent a couple of hours doing my history and physical, and then the resident poked and prodded the patient for another half hour or so. I still couldn't figure out what was wrong with the patient, so the resident finally told me that the patient had a rectus sheath hematoma. That's basically a fancy name for a big abdominal wall bruise. I found a review article about it, read it, and wrote up my patient log. At that point, it was 2:30 AM, and the resident told me to go to bed.

I was feeling pretty bad about having basically tortured this patient for a couple of hours for something that wasn't even a surgical problem. The building where the call rooms are was completely deserted except for a janitor who was mopping the floor. As I passed by him, he said, "Good night, Doc." That made me feel even worse.

Yesterday morning I was back in the OR with a different attending who was doing a laparoscopic repair of a hernia. The senior on this team was into teaching, and she let me do some suturing. Fortunately, I had been practicing while I was on call and at home. There are some really good websites that have instructions for suturing. My favorite is the site from Boston University. I also got to drive the camera for a while, which is a lot harder than it looks. It was a good experience, but I was feeling kind of sick because I had only gotten about two hours of sleep. But since I was post-call, I got off at noon and could go take a nap. At 5 PM, I met my team for evening rounds, which was incredibly stupid of me. We didn't get done until 9:30, plus my attending gave me three new learning objectives to do. That's what I get for trying to be responsible and part of the team. Sigh.

Today we had another point-counterpoint presentation, this time on the best way to treat atrial fibrillation (quivering of the upper chambers of the heart). I wasn't presenting this time, and it was a lot less fun being in the audience. Afterward, there was a seminar on treating blood clots. In the afternoon, we had another round of meetings with the Block Assessment Team. I can't even put into words how much I hate these stupid, pointless BAT meetings! I was so tired and cranky and not in the mood for this. It was hard to stay awake all morning in class, and then I was sitting around in the libary on my so-called afternoon off, waiting to have a five minute meeting so that the faculty can tell me I'm doing fine so far. Don't even get me going about how they assign the order for our meetings. After the block leader changed the order around for the third time today, we didn't wind up meeting with the BAT in our scheduled order anyway. Stupid, stupid, stupid.

Surgery is Awesome!

My weekend wasn't very exciting, and I didn't get very many of the questions done. At first I wanted to try to do them all myself, but now I realize that it's impossible. Each question takes me like 3-4 hours, and there are 20 of them. So now the students are working on different questions and sharing our answers.

This morning I got up at 5 AM and went on rounds with the fellow at 6 AM. Then we went to the OR. Today was my first day scrubbing in, and it was just amazing. No one yelled at me for my scrubbing technique, and I muddled through getting gowned and gloved with the scrub nurse's help. Our first case was for a patient who needed part of his colon resected. The surgeon hands me the scalpel and tells me to go ahead and make the incision. After hearing stories from my friends at other schools about how all they did was just hold retractors and get pimped, I was not prepared for this. I didn't even know how to hold the thing! So she showed me, and I muddled through that too, albeit with some comments that I was not carving a turkey. I didn't mind her mocking me a little bit though, because it wasn't malicious. Then she hands me the bovie (an electrocautery instrument--see picture) and tells me to cut through the fascia (layers of connective tissue under the skin). So I did that too.

Next, she and the fellow started working on the colon, and she asked me to hold the small intestines out of the way. While I was doing that, I had some time to just observe everything that was going on in the surgical field. I was watching the arteries pulse all over this patient's abdomen. There were big ones and little ones, all pulsing in unison. It was awesome. Then I noticed that the patient's intestines were moving in my hands. I was watching as they were peristalsing (contracting by segments--this is how the intestines move food through down to the colon), and I could actually feel them moving. It was incredible. I don't think I'll ever forget that feeling for the rest of my life. We closed up the patient and I got to do the staples. That was surprisingly easy and fun to do. Using the surgical stapler is not so different from using a regular desk stapler.

By this point, it was 1 PM and I was so hungry that my stomach felt like it was eating itself. The surgeon turns to me and says that she and the fellow are going to start the next case. Was I doing ok? Of course, I wanted to scrub out and go eat lunch more than just about anything, but how could I do that while she and the fellow kept going? There's no crying in surgery! So I told her that oh, no, I was fine to go for another case. Fortunately, the second case went faster, and by 3 PM, the fellow and I had about 5 minutes to run downstairs to the cafeteria and wolf down a sandwich before we went back for the next case. We did four cases in all, and then we went on evening rounds. The surgeon didn't really pimp me in the OR, but she did pimp me a bit on rounds. It wasn't awful though. I knew some of the questions and didn't know some of them. Overall, this was a very long but good day, and surgery is much cooler than I could have possibly imagined.