SURGERY

SURGERY

I can’t think of a single reason why I should be a surgeon, but I can think of a thousand reason why I should quit. They make it hard on purpose. There are lives in our hands. There comes a moment when it’s more than just a game, and you either take that step forward or turn around and walk away. I could quit, but here’s the thing. I love the playing field.

- Meredith Grey- Grey’s Anatomy

Surgery was my second rotation as a clinical clerk. I always dreamed to become a surgeon since childhood because I was thrilled in the movies and TV series that I watched regarding surgeons. They are not ordinary doctors that usually manage you with a drug but they have a magnificent hands that not anyone can have. According to a famous quote, “to become a surgeon, you need an eye of a hawk, the heart of a lion and a hand of a lady”, because of the delicate structures in the body that you need to work on. Also, as a surgeon you need to have a lot of patience and endurance due to long hour procedures and you need to have a lot of knowledge in human anatomy because you do not know what is inside the body you’re operation on until you started to incise the skin with a scalpel. 

My first rotation in surgery was surgical subspecialty which includes pediatric surgery, plastic surgery, urology and neurosurgery. It is a one week rotation including 2 duty days and 3 preduty. There were only few patients admitted in our time because most of the patients in surgery were under general surgery. In my tour of rotation in subspecialty, I only had 3 admitted patient. My first patient is a 15 years old, female, service patient who had cleft lip and cleft palate who underwent palatoplasty. Since the surgical field was small, I was not able to scrub in the procedure but only observed. It was only a 2 hours procedure and I was amazed on how the plastic surgeon reconstruct the palate and the lips of the patient. Although, the ideal age for palatoplasty in between 6 months to 12 months old or before the patient begins to speak, due to financial concern, the patient wasn’t able to undergo the procedure earlier. My second patient was a 1 month old child diagnosed with intussusception. Patient was for emergency surgical reduction. However, while waiting in the emergency room, patient underwent hydrostatic reduction of intussusception and his surgical reduction was cancelled. He was admitted for observation of recurrence of intussusception but eventually discharged.  My last patient in subspec was a 5 years old child with acute appendicitis. It was my first time to have a case of appendicitis and you will really see the classic signs of fever, periumbilical pain which eventually transfer to RLQ pain, rebound tenderness, nausea and vomiting. In his case, his appendix were not yet ruptured but only inflamed. The procedure lasted only for 3 hours and the patient tolerated the procedure well. 

My second rotation in surgery was anesthesia rotation for one week. I learned a lot skills during my one week rotation in anesthesia. We were thought how to intubate a patient, put an indwelling catheter, ECG, and nasogastric tube. They also thought us about different anesthetic drugs and their actions, they also allowed us to do epidural anesthesia with their supervision although I was not able to insert it properly. They also informed us how to calculate medications, the importance of preoperative and postoperative monitoring of the patient, giving morphine push to postoperative patients, identifying the adverse effects of anesthetics drugs and manipulating the anesthesia machine. At first, I thought that it was boring since you were just observing and you were just at the head part of the patient, it was still interesting since you were able to observe different kinds of surgical operations not just in department of surgery but also orthopedic surgery, head and neck surgery and OB-Gyne cases. 

My third rotation in surgery was 2 weeks rotation on the wards wherein you were in charge of all non-subspecialty cases admitted in the whole hospital. It was the most tiring rotation ever happened to me since we were only 4 on duty and you were in charge to the whole hospital. We have multiple wound care, many unstable patients that we need to monitor every hour and we had a lot of admission that we need to attend the surgical procedure and monitor them in the recovery room. We also need to rounds all the patient and prepare their charts before the residents have their rounds because they were sometimes asking us about the case of each patients. Although it was tiring, I enjoyed my rotation in the wards since I handled and assist a lot of general surgeries. I assisted mastectomy, appendectomy, wound debridement, exploratory laparoscopy, and cholecystectomy. I experienced to eat late and had many sleepless nights monitoring for each patients. Sometimes, I’m the only one left in the wards since 3 of my groupmates were in the operating room assisting in a procedure. At the end, I was blessed since our residents gave us an eight hours merit for all our hardworks and good patient care.

         My last rotation in surgery was 15 days rotation in Out-patient department of surgery. It was the chilliest rotation since you were always in preduty status and our patient per day was 15 in the morning and 15 in the afternoon divided in 12 clerks rotating in OPD. We have 2-3 patients: clerk’s ratio per day. Most of the cases in the OPD were post-operative check-ups, patients with breast mass, hernias and different kind of benign masses like epidermal inclusion cysts.  Because of a lot of break time in OPD, we were able to study for our written exam and OSCE. Also, I was able to prepare for our CMC with Dr. Matic which we discussed linitis plastica, a rare case of gastric carcinoma.

I realized by the end of our rotation that I don’t want to be a surgeon in the future since it was hard for me to handle long surgeries and I don’t have a fine hand in handling delicate structures and organs in the body and I don’t have the strength and knowledge to handle emergency traumatic patients. It has a lot of stress in surgery and you have 5 years of residency program to finish it. I admire my residents and consultants who pursued and finished surgery since they were the best and they were one of a kind. We are many doctors but only few of us can perform surgery and save lives.