Plastic surgery is much more than cosmetics. Here's a typical day:
4:45 am wake up SSS
5:30 leave for the hospital
6am rounds
6:30 lecture/rounds
7:30 finish rounds/go to M&M or grand rounds or Or
8:00/8:30 OR time / Clinic Time
See new consults on the floor
See consults in the ER
More OR time
See new consults on the floor
See consults in the ER
More OR time
9-10pm leave
Notice there isn't any lunch in there.... and that goes into some nuggets of wisdom I picked up there
Rule #1 Eat When You Can
You will never be paged and told that you haven't eaten that day and should get a bite.
Rule #2 Sleep When You Can
You will never be paged and told that you haven't slept that day and should get a nap in.
Rule #3 Never F**K with the Pancreas
Seriously, it is like frozen cottage cheese and there is rarely a good outcome.
I have seen some amazing things. I can't tell you how many skin grafts we have done. I think I could do them on my own now. They are surprisingly easy to do. Flaps are AMAZING and very time consuming.
Observations
Good Nurses Keep Medical Machine In Motion. Bad Nurses Keep Patients in the Hospital Longer and Make Doctors Angry.
Coming from a background in Nursing, I am very sympathetic toward nurses. I will cut them a lot of slack and do my very best to work with them as a team in the care of patients. Stupid or lazy nurses, however, seriously piss me off. There has yet to be a day were I have not discovered serious neglect on the part of the nursing staff for at least one patient. Skin assessment is exceptionally lacking. I also used to wonder why orders were written: ACCURATE I&Os. I no longer wonder why. Some nurses have obviously made them up. While many of my colleagues and I would hemorrhage from the eyes at the thought of doing such a thing, others have demonstrated that they have no such feelings.
Good Surgical Techs are Worth Their Weight in Gold. Bad Surgical Techs are Worse Than Doing it all on Your Own.
When the techs are actively engaged in the surgery, there is a harmonious flow of instruments and the procedure is both efficient and expedient. When they stand there staring off into space with their thumbs up their asses (which does in fact break the sterile field) and are uncertain what their instruments are, the symphony that is the surgery comes to a grinding halt. Fortunately, the vast majority of surgical techs that I have worked with are exceptiopnally skilled professionals. The 1% that were not made.... an impression.
Flaps Are Amazing
I had the good fortune to participate in a DIEP flap proceedure. There is an excellent write up of the proceedure at www.microsurgeon.org/diep.html that explains the basics. We were able to reconstruct the breast of a woman the same day that she had her mastectomy. She was very pleased with the result and it was exceptionaly rewarding. I suppose you could call it a "boob job" but it is unlike anything I have ever had the honor of participating in.
Many Old School Docs think Many New Docs are Whiners
There have been extensive discussions about the 80 hour week that was mandated for residents. The consensus of the older staff docs is that it is crap, and that anyone for it is more or less a whiner and a sissy that supports a shorter work week. It is anathema to speak in favor of better working conditions in front of the attendings. When they are out of the room, however, the true feelings are shared. FYI today is the first day that I have not violated the 10 hours between shifts rule this week.
Sutures are Fun
Most medical students are either retractor bitch or suture cutting bitch. Also you will never retract in the correct spot with the appropriate amount of tension and your suture tails will be slightly too long or too short. Once you accept this you can move on to actully being useful. If you show that you are reasonably competent, you can do a surprising number of things. Interestingly enough, I have managed to convince the fellows and attendings that I am marginally intelligent and that there is a low probability that I will kill or disfigure our patients. Suturing is a lot like mowing grass, you can really tell that you have done something when you are done and it is very satisfying.
More to come as I decompress from the previous 2 weeks of material.
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