The Surgery Rotation:
Breaking down my 24 hours on call!
A Guest post by 3rd Year Medical Student Yang
An overview of 24-hour call on surgery as a third year medical student. Enjoy!
4:15AM Wake up, turn on my coffee maker, brush my teeth and take out my overnight contacts with the goal of heading out the door by 4:30. I try to have a peanut butter-banana sandwich on my walk, but more often than not I end up just eating a granola bar.
4:40AM Luckily the student housing is only a few blocks from the hospital. So I’m upstairs and in the resident call room in about 10 minutes. I change into scrubs and then log on to the computer to check out the patient list. As a MS3, our responsibilities include looking up and also writing down vitals (T, BP, HR, RR, %sat, and urinary/NG/JP drain outputs). I try to pick 2 or 3 patients that I’m familiar with and look up more information (h&h, WBC, imaging results, etc).
5:00AM The day team arrives and the overnight resident gives sign-out to the interns. They discuss any acute events overnight and plans for the day. I pay attention as they “run the list” and jot down things to check on later.
5:30AM The team begins rounds, also known as pre-rounding where the residents see the patients before the attendings. We enter the patient’s room and ask how they’re doing, and also let them know the plans for the day. If they’re postop, we check their wounds and change dressings as needed. Usually the residents tell the chief about any issues or updates overnight. I answer questions about vital signs or drain outputs. In the beginning they went through everything so quickly and I had a hard time keeping up! It’s amazing how they keep the patient plans in their heads and know immediately which patient needs what.
6:30AM On Tuesdays we have education day after morning rounds. This consists of 1-2 lectures in the morning followed by some time in the skills lab. Skills lab is one of my favorite parts of the week! We’ve learned how to place Foley catheters, practiced our stitches, and even learned how to create anastomoses with real pig bowel!
11:00AM We have a lecture by one of the residents which covers Trauma and Burns. The lectures are prepared in anticipation of the shelf exam and cover high-yield topics that may arise. It’s an informal lecture so it’s a good opportunity to ask questions about that day’s subject, or even other topics that we’ve studied.
12:30PM We head back to the hospital to begin cases. I look up the first case, an incarcerated hernia repair, and go introduce myself to the patient. Before the case begins, I try to help set up the patient in the room (transfer the patient, move SCDs, place Foley catheter) and also help out anesthesia if they let me! During the case, I retract and suction as the resident and attending repair the hernia and place mesh to prevent recurrence. As the attending finishes up, he tells the resident to let me close the skin, which is awesome! The resident is very patient with my suturing and gives me some helpful tips in maneuvering the needle driver for the subcuticular suture. Definitely need more time in the skills lab to practice.
2:25PM After the patient has been transferred to the PACU, I quickly go to the physician’s lounge for a cup of water and granola bar. The next case is also a hernia repair, but the cool thing about surgery is that everyone’s anatomy is different, so there’s always more to see and learn.
4:00PM The case has finished. The attending is getting ready to go assist on another case, a laparoscopic cholecystectomy with possible conversion to open. The resident has finished putting in orders and the patient transferred to the PACU, and I head into the case. The surgeons have already started but they tell me to scrub in. They are switching to an open case! Open gallbladder cases are rare these days and I was excited to see one! My role stays the same, retracting and suctioning. However, this case is much more intense and the surgeons are moving much faster. They comment on the adhesions in the abdomen and discuss the best way to get the gallbladder out. By the end of case, there was a small cup of gallbladder stones next to the gallbladder.
6:30PM My classmate on the Subspecialty team tells me that the cardiovascular surgeon is finishing up a CABG (coronary artery bypass graft) and is about to start the next one. I never had the chance to see one when I was on the team. She graciously let me have the case. This one would have 3 grafts – the two internal mammary arteries and the great saphenous vein. The cardiac cases have a specific protocol for setting up so I try to stay out-of-the-way as they get the room ready.
They spread the ribs and open the pericardium – the heart is exposed! A wave of awe washed over me and I couldn’t stop staring as heart continued beating in the chest. Of course, the surgeon immediately got to work. The CABG cases are so incredibly delicate and refined. I loved scrubbing into it almost as much as I loved the vascular cases!
10:00PM This case is finally finished and I head back to the call room to catch up with the night team.
10:45PM We receive a call asking for a chest tube placement in the ED. The patient is a female who was stabbed in the back and developed a pneumothorax. The senior resident oversees the intern as he sets up for placement of the chest tube. Afterwards, they go see another patient and ask that I continued to hold pressure on the wound on the back until the bleeding stops.
11:30PM I meet up with them in the ICU, where they were paged for placement of an arterial line on a patient for BP measurement. He sets up for a radial arterial line and talks me through each step, including the anatomy, indications, and contraindications. At the end he shows me how to tie the line so it doesn’t move, and lets me practice my knots and finish tying the line down.
12:20AM Back in the call room, the intern asks me to write-up a H&P for the patient we saw in the ED while he takes care of orders for other patients. We review it together and he gives me some tips on how to improve for next time.
1:00AM There’s a call about a patient who developed a fever, and the intern orders a CXR. He asks me if I know the causes of postoperative fever, aka the 5W’s. (I tell him excitedly that these were covered in the first episode of Grey’s Anatomy…and he laughs at me). In between writing notes and updating the patient list, he goes through the 5 causes with me. He also goes through the management of each one. We are unclear of the wonder drugs, so he asks me to look them up and teach him (antimicrobials, cardiovascular meds such as diuretics, phenytoin, heparin, allopurinol, PTU, to name a few). In between teaching me, he answers calls and puts in medication orders.
2:30AM The intern and I go do post-op checks, meaning that we evaluate patients who had surgery that day.
3:00AM Our postop checks get interrupted due to a stat consult for a patient with concerns of a possible bowel perforation. On physical exam, his abdomen is very distended and tender to palpation. The senior resident explains to the patient and his family that he would require an exploratory laparotomy emergently to check for a perforation or infection. She also calls the attending and gets confirmation that the patient will head to the OR in an hour.
3:40AM The intern and I finish up the postop checks. I help patient transport take the patient down to the OR.
4:30AM The patient is ready to go, already prepped and draped in the OR. My chief resident enters and tells me to go on morning rounds with the day team.
5:15AM Morning rounds begin, and I try to help out with information about the patients admitted from the ED.
5:45AM Rounds are finally over. I thank the intern for teaching me so much during the night and then head home.
6:10AM My face is wash, my teeth are brushed, and I am half-asleep scrolling through Instagram. I pass out within minutes. My plan is to sleep until noon and then spend my post-call day studying (or writing a blog post, like I am now!)
Yang is a 3rd Year Medical Student who blogs about medicine, lifestyle, and fashion on her website Yang’s Wear Abouts. This post originally appeared on her site.
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