Surgery rotations can be intimidating. In my experience (six months), the myth of surgery has grown from a decades-long game of “whisper down the alley” into something that scares many students and discourages them from going into the specialty. Legends of surgeons throwing instruments, residents trying to make students cry, scrub nurses screaming, and weeks without sleep have grown to rival the legend of Paul Bunion. Most of the stories are not true, except the sleep thing…that one is all too real.
My goal in this post is to review a few quick tips to help you look like a rock star on your surgery rotation.
The note. A surgery note is very different from medicine note. A good surgery note is less than a page, and there is no need to write medications or previous days labs. Remember that your resident and attending both need to co-sign your note, so leave enough room at the bottom for them to do so.
Surgeons like things short and to-the-point. There is no need to write your dissertation every morning. Using abbreviations such as +BM in not only expected, it is preferred. Every morning, for every post-op patient, you want to ask certain questions on surgery: Did you have a bowel movement/flatus? Did you tolerate your diet? Did you get up and out of bed? How is your pain? These four questions are your best friend.
Remember to document output from drains and always comment on the wound. Remember that dressings are clean, dry, and intact (C/D/I); wounds, on the other hand, are approximated without erythema or exudates.
The McDonald’s sign. When asked to do a consult in the ED, situations often come down to “does this person need to go to surgery right now?” On a general surgery service, this is often the question of an acute abdomen. It may take feeling a few abdomens before you can tell if the patient is rigid and distended or simply obese.
The McDonald’s sign (your hospital may call it something else) is a beginner’s way to spot an abdomen that is not acute. Simply ask the patient if he is hungry. If the patient complains that he has not eaten in hours and is starving, chances are he is not headed to the OR.
Remember, acute abdominal patients are in distress, usually vomiting, and often curled into the fetal position because lying flat is too painful.
The OR. Many students have never been in an OR before their surgery rotation. The entire process can be very intimidating. My best advice is to eat breakfast and try to stay hydrated. Many students are afraid to eat or drink anything because they worry they will have to go to the bathroom. But dehydration is a sure way to guarantee that you pass out during a surgery. OR lights are warm and you are there in a thick gown with your hands, mouth, and head covered.
If you start to feel lightheaded, step away and scrub out. Don’t try to hang in there. The OR table is made of steel – not the most forgiving substance. If you start to feel like you are overheating and the scrub tech is not busy, ask her to put water on your hands; it will help you cool down.
Have fun with your surgery rotation. Even if you have no plans on ever being in the OR again, take the time to watch as many procedures as you can. Laparoscopic procedures are great for observing because everything is on the screen. For many people, this is the first and last time they will ever be in the OR, so take advantage of it. There is something to learn from every case.