Surg Rotation Reflection

     Surgery was one of the most special rotations of the entire clinical year. There’s no words to explain how much it inspired me as it showed me how much I still have to learn. The five weeks we have allocated for it is nearly not enough to even scratch the surface of learning what’s possible in this field.

Starting day one, I got to scrub in on five cases. Everyone in the operating room was very supportive and willing to teach and show me appropriate techniques for scrubbing, suturing, keeping an upright posture and neutral hand positioning.

     Interpersonal challenges I’ve experienced were with some surgeons who did not acknowledge me once they found out I was a PA student and not a resident. By asking appropriate questions, researching patient history and, most importantly, surgery indications, in advance, and knowing my anatomy, I have gained their attention and inclination to teach as I expressed desire to go into surgery and showed passion and willingness to learn. I learned how to access OR schedule, asked my preceptors if there was a student scheduled on the procedures I had interest in and, that way, ended up scrubbing into more cases than I was scheduled for. At NYPQ education is geared towards the residents so making sure I get the experience I want was my job. However, my efforts were greeted with warmth from my preceptors and the chief resident making the schedule thus granting me access to plastic surgery cases which PA students normally don’t have.

     Patients I found challenging to deal with were those with terminal disease undergoing extensive palliative instrumentation as seeing their families pray with them before operation and joining the prayer really brought tears to my eyes. A memorable patient encounter I will carry was with the patient who had to undergo a massive palliative robotic abdominoperineal resection for rectal cancer by three different teams that lasted over 16 hours. In the OR he needed an epidural placement which was done while he was still awake and it took the anesthesiologist over 20 minutes to establish access. Patient was sitting upright and a PA was holding his head to keep his spine flexed. After some time patient, while in tears from pain and fear, relaxed and placed his head on PAs chest and the way PA embraced him was almost father-son like. That moment I realized we have almost a spiritual obligation to take care of our patients in the OR as it is an outermost privilege and honor to be in the room while they are unconscious and paralyzed under anesthesia and we have access to the inside of their bodies. That realization made me understand the reason why this is the most rigorous of all the specialties and why the surgeons are so unapologetic when they see incompetency as the stakes in surgery are high as ever.

     With that said, I exercised my best ethics introducing myself to every patient preop and staying with them until the handoff to the stepdown or recovery. I treated every patient as if they were my family.

     I got to close the skin of almost every case I scrubbed in on (of course, after asking for it and telling the surgeon I know how to do it – and they asked which technique and suture I was planning to use, so making a plan in advance was helpful). One of the surgeons, before allowing me to close patient’s breast and areola – a cosmetically important area – told me “close it like she was your mother” and I thought to myself “that’s exactly how I was planning to do it”.

     I have learned how to properly take a patient history since there were areas of improvement – being on a surgery team we care a lot about surgical history and I&Os – not the first thing that used to come into my mind when evaluating non-surgical patients. After being corrected on it, this skill will become an integral part of my HPI taking from now on.

     I have learned about myself that I don’t imagine myself working anywhere else outside of the OR (well, preop and postop areas of course) and that surgery inspires me more than any other specialty despite exhausting hours and all the rigors of the specialty. When you are excited and looking forward to a day at work, waking up at 3 am is not a problem. One of the pillars of PA profession is excellence and growth, and for me surgery is a perfect field to execute both. A Surgical Physician Assistant is surgeon’s best instrument and I am looking forward to becoming it.

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