How are the Days of the Surgeon

I wake up at around 4:45 AM and plan to get to the hospital at a quarter to six. Once I arrive, I put on my white coat, log my pager in, and head up to the surgical wing to meet up with my team. Our intern, who has arrived a bit earlier than the rest of us to get sign-out from the night team and prepare our rounding list, briefs us on overnight events. On rounds, we each have a separate task—while I’m examining a patient, one of the residents (or our PA) logs into a computer in the patient’s room and starts an electronic progress note.

Before moving on to the next room, the patient is given a tentative plan for the day. I tell one of our patients admitted with an SBO, that he may need to be taken to the OR if he fails his 24-hour water-soluble contrast trial, which we’ll know by 9 AM today.

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After rounds, if time permits, we head down to the cafeteria for a team breakfast. Today isn’t one of those days! Being a Thursday, one of our two main education days, we then head to the conference room where M&M (7-8 AM) and Grand Rounds (8-9 AM) are held. In the brief intermission, I run the list with our attendings and we come up with definitive plans for the day. Following Grand Rounds, we have journal club from 9-10 AM (other days we have lectures derived from the SCORE curriculum).

Afterwards, our team regroups. Our PA (who has been holding the service pager and taking care of floor work while we were in conference) gives us service updates, and we divide up the remaining floor work before heading to our OR and clinic assignments. Our SBO patient has failed his contrast trial. He’s been consented and added on to the OR schedule as the next case, bumping our elective cholecystectomy. I quickly change into scrubs and head down to the preoperative holding area to see the patient before he’s rolled into the OR. In the OR, I pull up his labs and imaging and talk to my attending about our operative plan. We choose to start off laparoscopically—after extensive treatment, we are both content that the patients pathology has been addressed. In between cases, I grab a quick bite to eat and touch base with the team, updating them on our intraoperative findings. Thirty minutes later, it’s time to head back the OR. Our PGY-2 and I will be performing the elective cholecystectomy together as a teaching case.

Our attending watches closely as we carefully expose the critical view—he gives us pointers throughout the way. After identifying the cystic artery and duct, we clip and cut the respective structures and remove the patient’s gallbladder. As the case has gone smoothly, I place post-op orders and prescriptions in the patient’s chart and plan for the patient to be discharged from the PACU. It’s now around 4 PM. Our team goes on afternoon rounds and does a couple of post-operative checks. All of our patients seem to be doing well. Since there’s a bit of time left in the workday, we take our medical students to the simulation lab and practice suturing and knot-tying with them (other days, we’ll take them through cases in a mock oral format). At 6 PM it is time to head home. The PGY-1 signs our service out to the covering night float resident and we make plans to round again at 6 AM tomorrow morning. My post-work routine is pretty variable. Some days residents will get together for dinner/drinks after work. Other days, many of us try to make it to the gym. Tonight, I plan to head straight home, have dinner, and prepare for tomorrow’s cases before catching up on the news/watching some TV. I then head to bed by 10:30 PM so that I’m well rested for tomorrow!