Surgery was a rotation that I was scared of the most, but surprisingly ended up enjoying it. I did my surgery rotation in Metropolitain hospital. I will be honest and say that the 1.5 hour commutes one way and the 5:30am start time were very exhausting and draining, but once I was in the OR I saw how interesting surgery really was. At this hospital we were exposed to both the OR side and the clinical side of surgery, in which we got to work with PAs, so it gave a good overall look at this field. We did 2 weeks of general surgery in which we were there from 5:30am-6:00pm doing OR cased the first half the day and clinic the last half, then one week in clinic, and one week in a specific specialty (I chose urology). This was definitely a very different rotation, because I got to be very hands on. I also was able to practice my H&P skills and my SOAP note skills.  

In the general surgery weeks, I was able to experience the OR environment and how to treat a patient from pre-op, operative, and post-operative stages. We would start our mornings by doing rounds on the patients and following up with them and seeing if there were any changes over night. I really liked this because it showed continuity of care, as we were able to continuously keep updated with patient stats. We then signed up for different cases to go into. I was able to scrub into a Lap cholecystectomy, a flex sigmoidoscopy, a mastectomy, a amputation, an open indirect inguinal hernia repair, a Fine needle aspiration of a thyroid nodule, and a skin graft. I am very glad I got to see a wide variety of cases and work with different doctors. For every case I would prepare for it the night before, which allowed me to really study my anatomy again in preparation for questions during the operation. During the surgery the Doctors would allow to be very involved by holding the camera for the lap chole, suctioning, suturing, and retracting. I also really liked how they would teach us throughout the surgery, about certain anatomical landmarks, why we do one thing over another, etc. My two favorite surgeries I saw were the skin graft and the mastectomy. In the skin graft, I was following the patient throughout the week so it was nice to have the continuity of care. He had a gaping 25 cm necrotizing fasciitis of his left thigh, which we treated by doing multiple debridements and vacuum suction, and then by making a skin graft of his right thigh to place on the left. This was so amazing to me as I got to see the process of taking the surface layer of the skin and making it into a mesh. We then got to follow this patient in the ICU, and I was able to see how he was healing. My other favorite case was the mastectomy, as my mother had breast cancer last year and was treated with a lumpectomy, so this was a very personal and interesting case for me. I got to see the important nerves and vasculature in the breast, and the axillary structure as well. Overall this was an amazing experience, and it taught me how the anatomy looks so different in each person, and how creative you have to be in this field. It also taught me a lot of patient, as being in the OR one has to be very careful and still and sometimes roadblocks can happen, but its important to be flexible and remain calm. 

In my clinic week we were able to work with a lot of the Surgery PAs, and follow them through different clinics. In Metro, we have a wide variety of clinics each day such as ENT, vascular, plastics, ortho, wound clinic, breast clinic, etc. Here I was able to be more hands on, as I was taking my own histories and writing my own patient charts that I would present and send to the providers. I learned how difficult it is to take histories on follow up patients as seeing them for the first time we have no idea what they are here for. I learned how to look through old charts and pick through important information that was relevant to that particular visit. Another challenge here was that in this area, not a lot of patients spoke English. So we would use the interpreter system, which at times would be difficult and made the visits seem less personal. But I was very impressed at how involved I was here, I would always volunteer to do the physical first, and help with would dressing changes and ulcer debridement. I learned the proper ways to dress certain wounds and see the various stages of healing. I learned the important of certain dressings and when they are applicable such as unna boot, E2 oxygen dressing, and simple kerlex and coban. I liked this week because I got to see a wide variety of patients, and even saw certain patients whose surgeries I scrubbed in for, here for follow up.  

In my urology week, I was able to scrub into cases such as cystoscopes, vasectomies, and lithotripsy, and also go to urology clinic. It was interesting to be in the OR in this week, as I got to work with the PAs in the OR who were first assist in the urology cases. I really enjoyed seeing what PAs can do and not do in this field, because I learned that there is a lot of opportunities for PAs in surgery. We also then got to clinic, in  which we were able to follow these patients, and also do medicine management and adjustment.  

Overall as exhausting and drained as I am at the end of this rotation, I learned a lot about medicine and myself. I was able to refresh on my anatomy, and basically review the whole body as the cases were so diverse. I also am proud of how involved I was in this rotation, as I got to practice my suturing, wound changes, catheter placement, etc. I wanted to make sure I was getting the most out of this rotation, by asking alot of questions and participating in whatever I could. I learned that I have a lot more endurance and stamina then I thought, as these 13 hour work days were like running a marathon, with no breaks in between. One thing that I thought I needed improvement on and will try to better myself in the following rotations in taking a focused history on a revisit patient. As trying to look up their past info and why and who referred them, without missing any information or making the patient frustrated by asking repetitive questions, is very difficult especially if this is your first time seeing this patient.  

I really did find being scrubbed in the OR such a unique and rewarding experience. Being able to stand next to such professionals who work so eloquently in treating the human body with their skill set, was truly very motivating.