At some point in the last week I learned: Surgery is not for me. As with all of my rotations, I tried to start with an open mind. There was a time during first-year anatomy that I seriously considered a career in surgery. It's cool to be good as something physical as well as cerebral and I was no slouch with a scalpel/clamp. Surgery also provides fairly instant gratification. One day the patient has a problem, you cut them, the next day the problem is fixed (most of the time, and ignoring any problems you caused). Simple.
However, there are so many reasons not to do surgery. The lifestyle is horrible, at least through training. Recent changes have limited resident shifts to 16 hours, but many see this as worse than the previous 30 hour limit because it is harder to see all of your required cases and you could be forced out of the hospital when an important emergent procedure There is a proud tradition of hostility up and down the hierarchy of surgeons. An OR is an understandably tense place, but sadly a lot of the tension is due to the surgeons (both attendings and residents), who have learned that efficiency and kindness are mutually exclusive. My current team is actually very nice, by surgery standards, but they're still surgeons and there's never enough space for my admittedly sizable ego amid a roomful of theirs.
All of that aside though, I just don't enjoy the job. I find surgery tedious. Once you get past the whoa-we're-cutting-a-person's-body thing, there is just too much standing in a room and poking around in a very cramped space. The biggest issue for me is the lack of patient interaction. The surgeon meets the patient beforehand and follows up with them afterward, but every other specialty in which I have trained has had more (conscious) patient care. I like talking with patients. All medical activities are stressful for most people and the one thing that has consistently made me thankful for getting to pursue a career in medicine is putting patients and families at ease. I can do that in surgery, and I have built a raport with every patient whose case I've observed. But that I'm looked at as a weirdo for spending so much time with the patients, just puts a bad taste in my mouth.
I'm sure my views will evolve more as the weeks progress and as I see other areas of surgery apart from the vascular team I'm on right now. But these are today's thoughts.
MondayIL: It generally takes the near occlusion of two of the three major splanchnic aortic vessels to cause symptomatic intestinal ischemia. I'll try to break that sentence down a bit: there are three main blood vessels that supply the small and large intestines. The areas supplied by these vessels overlap, but if two of them get clogged, the intestine loses blood flow and start to hurt. The upper two blood vessels (the celiac trunk and SMA) have such good connections downstream from their blocked trunks that research has showed similar results for opening both vessels or just the SMA.
TuesdayIL: An 80% occlusion of the carotid artery is generally considered the cut-off for corrective surgery in an asymptomatic patient. For a symptomatic patient the cutoff is usually 70%.
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