Hi there folks,
I wanted to write a little about the factors that went into my choice of General Surgery for a career:
After I made the decision to apply to medical school and give up my wonderful career in teaching and bench research, I started to give some thought to choosing a specialty. I had been a Pediatric/Perinatal Critical Care Respiratory Therapist so I had the most exposure and experience in Pediatrics. I loved treating Pediatric patients which had propelled me to specialize in their care during my Respiratory Therapy training. Even my personal statement for AMCAS detailed a pediatric case, that stays with me forever. One of my best friends is Chief of Pediatric Critical Care Medicine at INOVA Fairfax Hospital, one of the best in the country. I was sure that being a Pediatrician would be my natural calling and an extension of my previous training.
I suffered through First and Second years of medical school, along with my colleagues. At Howard, our first clinical rotation is done first semester during freshman year. I elected to rotate through Emergency Medicine for experience and exposure. What did I learn from that experience? Emergency Medicine for me was essentially performing outpatient clinic medicine for 97% of the time. Those 3% of adrenalin-rush cases got turned over to the Trauma Surgeons and I was left behind in the ER, wishing to get into the OR, to see what what actually there. 
During Third Year, required clerkships, I started with Pediatrics. After getting over the fear of making a mistake, my Pediatric Respiratory Therapy personna took over and I felt natural in the role of medical student Pediatrician. I loved my patients and enjoyed everything about the rotation. At the end, I scored very high on the Pre-Board and oral exam and received Honors in the rotation. I was on my way! 
I headed through Psychiatry (Honors) and Family Practice (High Pass) with a very high degree of comfort treating both adults and children. I was still happily pursuing my Pediatric career. Then came winter and General Surgery.
Here I stood, about to scrub in on my first case. I had pre-OPed the patient, an 80-year-old lady with diverticulosis and massive rectal bleeding. I had made sure here hemoglobin and hematocrit were adequate, her electrolytes were optimal especially potassium, her bowel prep adequate. I had carefully screened her for cardiac risk factors. I had read up on total abdomial coletomy and post-operative complications. I had studied my anatomical landmarks. I wasn’t going to look like an idiot in the OR in front of the attending.
I scrubbed and quickly noticed that four females were going to perform this operation. All during the case, I was facinated by the precise choreography and fun of being a third-assistant. I hardly noticed that three and one half hours had passed. My chief resident let me do some ties on the bowel that was to be resected. I explored the liver with my hand. We talked about the latest fashion in shoes too! 
I was hooked. I couldn’t wait to do my next case.
I didn’t have any problems getting my colleagues to let me take their cases. I knew from that moment on, that I had to do General Surgery. I also loved Cardiothoracic Anesthisia but I really loved General Surgery more. After I came back from Mayo, I knew I had to do General Surgery and nothing else would satisfy my love of operating. I will do as much scut as I can if it ends with me in the OR performing a case.
I know that the next year is going to be physically and mentally demanding but I know that I am going to be the best and safest surgeon that I can be. When the Code Yellow call goes off, I was in the Trauma bay before anyone else. I don’t know what being tired is, as long as I get to go to the OR.
IIRC, you were at one time interested in Critical Care Medicine as a end sub-specialty - I'm wondering how that ties in with your fervor for procedures and being in the O.R. - ISTM that these are mutually exclusive practices - can you enlighten me on the aspects of CCM that allow for plenty of O.R. procedures - or am I mixing thing up in my remembrance of your ambitions and future goals?
Lisa
Hi there,
Critical Care Medicine fellowships can be entered after residency in Internal Medicine i.e. Pulmonary and Critical Care, Anesthesia - Critical Care, and General Surgery - Trauma and Critical Care. The longest route into Critical Care is through General Surgery.
Many General surgeons will cover Trauma call but the gold standard for me, is to do the Trauma and Critical Care fellowship. Trauma Surgery typically covers thoracic, general and vascular procedures along with their care in the Surgical Intensive Care Unit after surgery. My mentors are Edward Cornwell, III, Chief of Trauma Surgery at Johns Hopkins and Haile Mezghebe, Critical Care and Trauma at Howard.
I eagerly anticipate adding more mentors as I head to University of Virginia in a couple of months. They have an outstanding Trauma and Critical Care Division. 
aha, so from the Gen Surgery track, it is generally Trauma Surgery + SICU, as opposed to SICU only.
I was thinking it would be SICU intensivist only without any surgery schedule.
I assume from I.M. you'd be in ICU or CICU and from peds the PICU (NICU is a separate fellowship I think). From anesthesia, I'd assume ICU or SICU w/out surgery, possible CICU or PICU with specialized fellowship.
Is that right?
| Quote (LisaS @ April 01 2002,14:23) |
| aha, so from the Gen Surgery track, it is generally Trauma Surgery + SICU, as opposed to SICU only. I was thinking it would be SICU *intensivist* only without any surgery schedule. I assume from I.M. you'd be in ICU or CICU and from peds the PICU (NICU is a separate fellowship I think). From anesthesia, I'd assume ICU or SICU w/out surgery, possible CICU or PICU with specialized fellowship. Is that right? |
Hi there,
From General Surgery: Fellowship is Trauma and Critical Care Surgery. You operate (like a beast) and you manage patients in Intensive Care. This may be (Surgical ICU) SICU, Burn Unit or Cardiovascular Surgical Intensive Care (CVICU). After fellowship in Cardiothoracic Surgery, you may also manage patients in SICU or CVIVU.
From Pediatrics: You can do a fellowship in Pediatric Critical Care or Neonatal Intensive Care. You do not perform surgery but you manage critical care pediatric patients in PICU and after neonatal fellowship (NICU).
From Emergency Medicine: You can do a fellowship in Pediatric Emergency Medicine which will enable you to manage patients in a PICU setting but not NICU.
From Internal Medicine: You can do a fellowship in Pulmonary and Critical Care Medicine or Cardiology. Both will enable you to manage patients in MICU or CCU but not SICU, PICU or CVICU but you may not perform surgery.
From Anesthesia: You may do a fellowship in Cardiovascular Anesthesia and Critical Care. You may manage patients in SICU or CVICU but you do not perform surgery. You may also do a fellowship in Pediatric Anesthesia after which, you may manage patients in PICU.
There are lots of options for doing critical care medicine but only after a surgical or surgical specialty residency or fellowship may you operate. All of the above will use the title "Intensivist" which is a generic term for any physician who is qualified by fellowship to manage ICU patients. Cardiologists usually hate this term and prefer to be called a cardiologist.
Most folks with the fellowships tend to practice at large, university-based medical centers that are generally located in urban settings. If you plan to practice in a smaller hospital or in a rural setting, the ICU may be a combined MICU/SICU/CCU where internists manage most of the patients except where surgery is involved. My uncle, the cardiologist, was one of three intensive care physicians at his small rural hospital (less than 120 beds) who covered the combined ICU and called in the General Surgeons as he deemed necessary.
Hey Nat,
I was just reading your post and thinking how similar it was to what I’m going through. I was a firefighter/paramedic and came to medical school thinking emergency medicine all the way. Then I did (am doing actually) my surgery rotation. I started out at Children’s Hospital doing pediatric surgery (the last true general surgeons) and I LOVED it despite sleeping about 30 minutes a night on call. Now I’m on the trauma service and I’m thinking…hhhhmmmmmm this surgery stuff is pretty darn cool. The only time I have my doubts is when my alarm clock goes off at 4
0 am 
When I’m in the OR, I look up at the clock and think, I can’t believe I’ve already been here for 4 hours
| Quote (tonem @ April 01 2002,19:28) |
| Hey Nat, I was just reading your post and thinking how similar it was to what I'm going through. I was a firefighter/paramedic and came to medical school thinking emergency medicine all the way. Then I did (am doing actually) my surgery rotation. I started out at Children's Hospital doing pediatric surgery (the last true general surgeons) and I LOVED it despite sleeping about 30 minutes a night on call. Now I'm on the trauma service and I'm thinking...hhhhmmmmmm this surgery stuff is pretty darn cool. The only time I have my doubts is when my alarm clock goes off at 4 0 am When I'm in the OR, I look up at the clock and think, I can't believe I've already been here for 4 hours |
Sounds like a surgeon to me!
Hi Folks,
I am one month into my first rotation on my General Surgery internship and I wanted to re-visit why I wanted to do surgery in the first place. Since I started out with vascular surgery, the most grueling and the sickest patients of General surgery, I have come to realize that I LOVE, I repeat, I LOVE what I am doing. I am in a rhythm that starts when I hit the hospital door. When I first encounter a patient in the clinic, my mind starts to think about risk factors, about how far the patient can walk, why the patient was referred to us etc. When I get a new post op admission, I start to think about what complications could arise and how I will handle them. This is especially true with carotid endarectomy patients. If the surgeon has been operating around the carotid bulb, I know that the patients blood pressures are going to be all over the globe. Sometimes I have to put the patient on a nitroglycerin drip for pressure control. Three weeks ago, that would have struck terror in my mind but now, it is just part of the post op plan.
Yesterday, I really got into the OR for a AAA. I was scared of the pimping from my fellow but I enjoyed myself. We are really beginning to gel as a team. It’s a good thing because I get another month of vascular with Chris, my fellow. He is a very large Texan who cracks me up in rounds on a regular basis. I am even getting used to some of the attendings but that discussion is worth a whole post within itself.
I am working hard to change the image of surgeons being nasty folks. Most of the nurses that I have encountered at UVA have been very nice folks and very helpful to me. I don’t want this to change so I go out of my way to be helpful. When they call in the middle of the night, I really try to have a smile in my voice even if one has just paged me an hour before with the same question.
I have discovered that I make a correct decision during fourth year, to take electives that would make me a better resident. It really helps that I know how to read my own radiographs. I have the assistance of a radiology resident in the ER but having some basic knowledge is a good thing. I am glad that I did gastroenterology too. This elective has come in handy more than one time.
When I look at the third year medical students and listen to what they want in medicine. It is amazing how much they don’t know about the real world. If anything, Howard provides the best preparation for real world medicine. My Family Practice elective was an excellent choice for a budding surgeon.
Finally, I haven’t found anything about surgery that I do not love. When I step into the OR, I am in the zone. This is the coolest thing that anyone can do. Sure there is a mystique about the whole process but I totally enjoy it. Vascular surgery can be some the most technically challenging procedures especially when you have the aorta cross-clamped and the kidneys are not liking the low blood flow state. I know I am in for hell post op when this happens. Chris is a great technical surgeon and I watch his every move with great attention. Every stroke is not wasted and he is only five years ahead of me.
The sacrifice and long hours are worth every moment that I get to spend doing this. The most difficult thing about this internship so far, has been trying to get my fellow intern to pull his weight. Just one week to go and off to breast surgery!