Hi everyone. First, I would like to apologize for not keeping up with more regular updates. I have to admit that the beginning of residency has been far more strenuous then I could have imagined. It’s not that residency in general is like that, I feel it might just be my personal experience. I think my current rotation, current hospital site, and residency program itself are all aligned for maximum workload right now. I know this because speaking with many of my friends, our experiences have been quite different these past two weeks. That’s all good though. I will still try and provide some updates!
As a first year resident on a surgical team your role is different than most would expect. Beginning your surgical residency you have this expectation that you will be in the OR, first assist, breezing through cases and provided with opportunities at every turn to participate in the procedure. Sadly, this is not the case. In reality, it is the senior residents who do the majority of the operating, as they are preparing to embark on their own practices as fully trained surgeons. It is the junior resident’s role to take care of absolutely everything else so that the senior residents can operate. This is called “scut work”
When I was a medical student I thought I knew what scut work was. Basically round on your patients, write a few orders, and maybe see a consult or two during the day. All the while, you have a resident to bounce ideas off of and to tell you the management plan for each patient. While this is true to some extent, I’ve discovered that medical students are actually sheltered from quite a lot of the busy-work. For example, as a medical student my pager probably went off a grand total of 10-20 times ever. Now I get more than 20 pages a day from nurses, other residents, staff doctors, the emergency department, the regional bed transfer service, etc. Some pages are about routine questions or updates about patients, others are consult requests or patient transfers. There have been more than a few occasions where I will be on the hospital phone answering a page, while simultaneously texting my team about an issue, and also having my pager going off again – all at the same time. I never had this experience as a medical student.
At the end of the day when the team meets for afternoon rounds everyone expects all of the ward work to be done. Patients that were planned to be discharged should be gone, scans from radiology should be reviewed, bloodwork should be finished, consults seen. There is so much to do that I don’t even think about operating right now.
Today I had my first chance to be first assist on an endoscopic laser procedure. We passed a $20 000 camera up a women’s urethra, into ureter, and all the way up into her kidney. Then we fed a fiber through the scope and used a holmium laser to blast away her kidney stones. Finally, we used a nitinol basket to collect the fragments and pull them out of the kidney. Pretty cool stuff. My job was mostly to use the basket to grab stones, which was definitely fun. But, during the whole case all I could think about was how many pages would be listed on my pager when I un-scrubbed and all the pending ward work and consults I had to do.
It’s a difficult position, because on one hand you’re there to learn to be a surgeon but on the other hand your team is expecting you to make sure everything is taken care of. You don’t want to let the team down. I guess at this point I’m staying positive and acknowledging that it is important to learn how to do scut work as it teaches you how to manage patients, and maybe most importantly, how to be the epitome of efficiency.
Slice of Life 