It’s finally done: the insane hours, only having 2 days off in a month, getting lost 100 times a day, and negotiating tasks with intense gunners at a top program has finally ended! As always, the exhaustion hits me long after a test/rotation is over. Here are some highlights, and low lights, of doing an away in surgery at a top 10 program:
Amazing cases. I got to see an ex vivo renal artery aneursym repair in healthy young person. Watching a kidney go blue on ice and reperfuse to a pretty pink was life changing. It was also pretty horrifying to watch the renal artery vein get chopped in half (on purpose), only to be put back together again by hand. I saw a surprising amount of ruptured AAAs (which ended not so surprisingly...), and saw an incredible open AAA repair that ended so well. Watching an aorta be clamped is mind boggling.
Performing CPR two times interoperatively. It’s bad enough when the person is closed up and on a bed, but much more “oh shit” when you can see their internal organs being slammed around. Good news: in both cases, ROSC was achieved.
Some of the interns were f*cking gunners. Like a level of insanity I didn’t know existed thanks to my nice school not picking those types of people to attend. These people were so naturally nuts I wondered if they did cocaine in the mornings, but no, they are just really pumped 24/7 about getting things done **eye roll** Of note, the nutty interns were off-service interns. Otherwise, I would not be applying to this program. The gen surg people were really chill. Thank the Lord.
“Go find a marking pen” was like the hardest task ever. So was “get a sterile drape for a bedside procedure” or “wheel the patient up to the PACU.” I got lost literally every day, and once I accepted there was no way to fix that, it became a little less annoying.
There are no work hour restrictions for med students. No one pushed me to stay late or anything, but when I did, no one sent me home (and I got mega points for staying late for good cases). One night, I was there until 1130pm, and was back at 415am. I actually was pretty alert and functional, and now I’m less afraid of intern year.
Pimping is indeed ubiquitous, therefore predictable. I was surprised how similar knowledge expectations of med students were, even at the “big fancy schools.”
You’ll notice little things that make a big difference to you. For example, in my school we all dress up for M&M, residents do not go back to workrooms until protected time is over, every time someone interacts with a patient a little blurb is entered into the chart. At this other school, everyone looks homeless at M&M, protected time almost doesnt exist...they all run back to work when they dont have to yet, and patients only get 1 progress note a day per service. I actually like my home schools ways of doing those things, and will ask about that stuff during interviews.
Feel free to ask me any questions about doing an away rotation!
Stay somewhere you like, that is quiet, close to the hospital, and restful. It’s worth the $$.
Know the “go-to” textbook for the service you are heading to. Download it, read as much as you can before and during the rotation.
Be early, leave late. Give up all hope of having a social life or exploring a new city. Commit to being present at the hospital as much as possible.
Know each patient inside out. I spent 2 hours each morning preparing a bible of each patient’s history. When no one could quickly answer what their lactic acid was on admission, I knew it. When no one knew how many days the patient had been NPO without clicking the chart, I knew it. Write it all down, stuff it in your pocket, and spit it out when you can so people know you are prepared. (NOTE: do not interrupt people, but if 1-2 seconds goes by and no one knows the answer, say it and save the team from getting scolded for not knowing the answer. The goal is to enhance the team, not steal the spotlight).
In your bag you need:
clinic clothes
enough food for the entire day
water bottle
compression socks, extra undies
a folder with printed book chapters, notes you’ve taken
the list for the last day or two (helped me remember the plans)
scissors (YOU NEED THIS!)
tape
lubricating jelly
marking pen
charges for all electronics
when you go home: straighten up your house, eat dinner, drink a bottle of water, shower, watch a dumb show (or whatever you do to chill), pack your bag for tomorrow, and go to bed by 8.
in the morning: make coffee, review all the patient’s charts, create a bad ass list with all lab values, and MAKE A PLAN for each patient. Even if no one asks you the plan, you 1) get great practice for intern year 2) can chime in with ideas if no one else remembered to mention the patients nasal cannula that is unnecessary or the fact they have no bowel regimen.
all day: say yes. Yes you will change the wound dressing, yes you will ask the nurse if the patient peed, yes you will scrub and retract for 5 hours with a shitty view of the case. Do it all, and do it smiling.
try to ask a question once a day that starts with something like “When I was reading [insert textbook title] last night, I was confused about why they recommend approaching the abdomen with this incision when I’ve usually seen it done another way. What are your thoughts?” These questions reveal you’ve read something, thought about it, and are curious about the topic. They also don’t pin the attending into some random fact-check convo they are not prepared for and gives them space to teach a point or discuss their experiences, something they enjoy more than nit-picky questions that are really just med students trying to show off. (NOTE: you are trying to show off here too, but in a less annoying way).
Be wary of too much caffeine. I became addicted to the hospital’s coffee shop cappuccinos, and I had serious shakes one day when the attending let me first assist on a case. I honestly didn’t realize caffeine could make you look so jittery, but I wished I was more careful with this!
Take care of yourself. For me, this was making meals once a week and therefore being able to eat healthy by meal prepping. I also did 20 mins of yoga a night, and would read recreational stuff before bed. You don’t want to become so busted and resentful too quickly, so create space for yourself when you can. Also remember this is only one month of your life that can make a huge difference in your future, so when you want to take a break and stay home, find the inner strength to truck along for a few more days.
Surgery people: help out in the OR preop. The attendings want to get going as fast as possible. Helping to move the patients, shave any hairy areas, insert a Foley, etc help to move the process along. HOWEVER, you want to be a doctor, not a scrub nurse, so when the attendings are in the room looking at a CT scan or discussing the case with residents, join the circle.
