For my seventh rotation, I had the pleasure of working in Surgery at Queens Hospital Center. This rotation was probably one of my most challenging rotations. While I don’t think the work was necessarily any harder from any of my other rotations, it did require a lot of hours on site; it was one of my first experiences being “on-call” for 24 hours. The long hours on site did provide me with the opportunity to see a variety of cases. I really learned a lot about surgery and surgical management.

One of the things I learned during this rotation is how to do deep dermal sutures. For our program, we were ever only required to know how to perform simple interrupted, vertical mattress, and horizontal mattress sutures, so I was very nervous when asked to do these types of sutures. It was more challenging than I thought, being that I believe I am skilled at suturing, however, I accepted the challenge and gave it my best shot. I believe the most nerve-racking part about it is that everyone is waiting on you to close to be done with the surgery, so it was a lot of pressure. From this experience, I have learned to be a little more proactive in terms of teaching myself about different techniques that might be used in the field. I did take time aside to practice when I wasn’t in the operating room, but the skin pads aren’t the same as suturing actual skin. At this time, I will continue to practice my suturing techniques in the case that I ever decide to go into surgery. 

Another thing I learned about is different landmarks that need to be identified during surgical procedures. For example, for a laparoscopic cholecystectomy you need to identify the critical view to be able to dissect the gallbladder. The critical view consists of the cystic duct, cystic artery, and the inferior edge of the liver. Learning about surgical procedures forced me to review my anatomy, and it is critical to be familiar with in surgery. However, anatomy is important for all fields in medicine. Anatomy comes in handy even when thinking about differentials when patients come in with specific complaints. For example, if someone comes in with right upper quadrant pain, you must think about all the organs in the area or in proximity that could be causing the pain. Moving forward with my clinical year, I plan to keep reviewing my anatomy as it will help me as a provider in the long run. 

On this rotation, I also learned a lot about dealing with difficult patients. While I was in the breast clinic, I had a patient who had an abnormal mammogram, and it was recommended that she have a biopsy done for that breast. However, the patient was not amenable to having the biopsy because of a prior experience with a painful breast biopsy that turned out to be negative. The PA and I tried to explain the risk and benefits of having the biopsy, reiterating the fact that if she doesn’t get the biopsy, there is a chance that we may miss something malignant. The patient refused the biopsy because this same recommendation was given in the past and her biopsy returned negative results. Since the PA couldn’t convince her, he decided to talk with the attending to see if she could get the patient to change her mind, but to no avail. The solution we came up with was to continue surveillance and repeat her mammogram in 6 months. This case was interesting because it can be unsettling as a provider to deal with the idea that something malignant can be missed; however, the patient always has self-autonomy to refuse treatment or testing. I am sure I will come across this type of patient in the future, and I will be sure to explain the risk, benefits and alternatives to my patient, with the understanding that he or she may choose to do as they please. 

Overall, I learned a lot while on this rotation. I believe that I put in a lot of effort into preparing for surgeries and was proactive about asking for help when needed. I’d like my preceptor to know that I went into every case ready to learn and that I was very receptive to constructive feedback. There were times I became frustrated, but I never let the frustration affect my work as a student.