Semester 12 - Surgery (RETROSPECTIVE POST)

My Surgery Rotation was done at another Hospital. I had the privilege of shadowing a senior General Surgeon, and was allowed to scrub into a few of his Surgeries.

On the Surgical Wards, the majority of patients on the Unit I was attached to, were admitted for Cholecystectomies (Gallbladder Removal), Thyroidectomies (Thyroid Removal), Hernia Repairs, Skin Cancer Excisions and Mastectomies. I didn’t get to do many Venepunctures, as the Pathology Nurse was strictly supposed to do the morning Orders. I also didn’t like how Butterfly Needles for taking blood (easier to maneuver IMHO) were scarce, with only Straight Needles being available. I really liked the Ward Rounds coz they felt very quick. As Inpatient Stay was much shorter than Medical, the Patient Histories were very abbreviated, as was the History and Physical Exam. It all seemed more succinct. The Intern and Registrar got into the Rhythm of asking about Abdo Pain, Flatus, Bowel Movements, inspecting the Sutures, and palpating the surgically operated area (typically Abdomen). Ward Rounds probably took about half the time for the same number of Patients in Med.

Scrubbing into Theatre was exciting. Perhaps it was coz I’ve never scrubbed in before (apart from 2 Operations in O&G, of which I didn’t really assist). For some reason, the senior Surgeon performed a lot of Mastectomies and Skin Cancer Excisions but no Thyroidectomies (I had to shadow another Surgeon to observe that). In the Mastectomies, I initially assisted by massaging the (unconscious) Patients’ breasts in a circular Manner to help distribute the injected Radioactive Dye (which eventually gets concentrated in lymph nodes, making it easier to identify for Biopsy), which was a surprisingly enjoyable experience. The Surgeon also suggested I palpate the Breast Cancer, which I felt to be lumpier than the regular Breast Tissue. In the actual Operation, I later got to hold the Retractors which lifted the Skin Flaps so the underlying Tissue could be excised off. The Surgeon used this Tool which created small Electrical Sparks when a Button was pushed, which burned off whatever it got into Contact with. I felt REALLY awkward when I actually enjoyed the smell of burnt Human Tissue, reminiscent of a smoky BBQ. I also had the opportunity to use this Tool, in which I zapped his Forceps that were in direct Contact with the Tissue. Thankfully both of us were wearing sterile Gloves so we didn’t get electrocuted. It was actually an enjoyable process coz every time I zapped it, the affected Tissue would fizzle and turn black. I was internally very pleased to eventually see that mass of fatty Breast Tissue get excised and “released”, revealing the Pectoral Muscles underneath.

I experienced a similar Pleasure watching the Left Thyroid get “released”, but due to my lack of any Involvement, found the Surgery more tedious to observe. I found that I had difficulty standing in one Spot for long periods of time, and was impatiently alternating between left and right of the Operating Table every 15 - 20 Minutes. I’m not sure if the other Surgeon got annoyed by that Frequency, but perhaps they tolerated it coz I wanted to change Positions to alter my View. It took about 3 Hours for the Left Thyroid to be carefully excised, revealing a large red fleshy Gland. We were allowed to Palpate it, and my, it felt warm and fleshy, but nearly the same Texture than the Placenta. It fit into my Palms, I could squeeze it like a Stress Ball!

Ironically (or not Ironically), my most stressful bits in this Rotation was the Mini-CEX. We had to pass 2 Mini-CEX’es for each of the Semester 12 Rotations. Though granted we were with a seemingly lenient Surgeon, I still felt Pressure to perform at an appropriate Level. My first Mini-CEX involved performing an Abdo Exam on a Patient and describing the Findings, in which I did so-so. The second Mini-CEX was taking a History from a Patient, followed by presenting the Information with a basic Management Plan. The second Mini-CEX felt very much like an OSCE, but in full View of my Classmates. I recall being very Algorithmic / “Robotic” when taking the History, but fortunately the Patient didn’t find it weird or offensive, and answered all my Questions. Our Conversation felt very much like a Table-Tennis Session, with responses rapidly bouncing between us. I was so mentally exhausted when the 10 Minutes was up, but the Patient and her Partner were very impressed by my History Taking. When articulating the Management Plan, I talked a lot slower coz I haven’t adequately prepared this before (verbally) + I was exhausted, but the Surgeon didn’t seem fazed. Thankfully I passed this.

I wonder that if I get drained just from just 10 Minutes of Clerking, how will I cope with Internship? Perhaps it was the Context in which I was being observed by multiple People which added to my Nervousness. It’ll probably become easier with more Experience. I realized a few more of my Weaknesses, which was in explaining Procedures and some Medical Concepts. I’ll have to work on this, or at least memorize the Explanations that are comprehensible to Laymen. The Surgeon also said that it also helps to draw Diagrams (particularly Anatomical) to aid Patient Comprehension and to get them engaged, so I’ll look into that too.

I think Surgery (along with O&G) is one of those Specialties that most People love or hate, particularly due to the long Hours. I conceptually love the Notion of Surgery, in that you’re making a Physical Difference from the Operations (removing or repairing something), which appealed to my Concrete / Black & White - Thinking Traits. However I just didn’t think I’d have the Patience to deal with the Duration of each Operation. Too much Standing, and whilst I have a strong Eye for Detail, I didn’t think the latter (along with the shorter Ward Rounds) was enough to tolerate the Former. 3 Hours just to remove the Left Thyroid. If I waited to observe the Right Thyroid being excised too, that’d be another 3 Hours in which case I’ll miss Dinner!!!

In the Past, I was even more Black & White, in that whilst I intellectually knew that an Operation wasn’t an instant Process like “Order Thyroidectomy --> BOOM --> Voila it’s gone!”, I academically treated it as such, and was unable to adequately appreciate how Rigorous and Time-Consuming Surgery was until this Rotation. I suppose if you’re the Surgeon, and if you’re very engaged and interested in the Surgery, the time may “Fly by” or be more tolerable. I can see how Surgery would appeal to a Person with Concrete Thinking, and anecdotally a lot of Surgeons in the Past (particularly Neurosurgeons) had Aspie Traits. I respect the Surgeons’ Efforts to work in this Specialty, but for me, no thanks. I want to have a Life outside Medicine. Somebody else can pursue Surgery instead, and good on them for their Ambitions. Besides, I’m currently more interested in the Diagnostics Process of Medicine of which Pathology (and perhaps even GP) is more encompassing of that.