Day in the life of a general surgery resident

Hey readers.

I thought I'd start writing a series chronicling a typical day of a resident in each type of service to help you all decide what kind of medicine to go into.

Many surgery interns have a different experience, as each program differs from institution to institution.  For example, ortho residents may have to do general surgery months during intern year, but they may have ortho months as well, while a general surgery resident would just have general surgery months that have a different amount of vascular, paediatric, trauma, plastics, and general surgery months.

Usually residents will get in at 530-600am and start rounding on patients in a meeting room, like going over a list with other residents and the medical students to discuss urine output and amount of bowel movements, as well as the volume of fluids a patient got, post-op concerns, acute events overnight.

Then the patients are physically rounded on, usually rounds are done by 7-8am depending on how big the patient census is.

Then it's the OR for the rest of the day.  Post-op visits are 4 hours after each surgery.

 If the surgery occurred at 5pm and lasted until 9pm, you will have to wait 4 hours in the hospital to post-op check (if there isn't a resident on nights).  Work hours are less defined for people in their 2nd year of surgery residency (though they average somewhere around 30 hours at a time).

I'd say a general surgery resident's morale takes a dive at least once a week and a lot of specialties with better hours have a lot of former surgery residents.

Then it might look like you're ready to go home, but there are add-on cases.  This means there is a surgery that has been literally added onto the schedule of surgeries for that day.  Usually there has been an opening in the schedule, or there's an emergent case.

If your an intern, the max you'll be working is 16 hours straight due to ACGME regulations as of the time of writing this post.  Junior residents usually get 1 day off per week as time off, but it becomes less as you get higher in rank, sometimes 2 weeks without a day off.  Upper level residents in general surgery are usually working 30 hours at a time, checking on their own patients, and checking on the junior residents to make sure they are doing well and that the patients are safe.

General surgery cases usually range from 30 minutes to 12+ hours for gall bladder surgeries and Whipple procedures, respectively.  Whipples are the longest cases I've been in on during a general surgery case.  More often than not, multiple surgeries are performed on the same patient in a series before they leave the OR (bilateral hernia repair with cholecystectomy, plus a biopsy for example).

It's a good amount of work, and that's not even touching vascular surgery or plastic surgery cases, which are a lot more delicate and tedious.  Transplant surgery is notorious for the worst hours, because of the unpredictable nature of organs becoming available, and the harvest and actual transplant itself.

Surgical oncology can be very demanding as well because tumours can encircle arteries or major veins.

To be a happy surgery resident (if there is such a thing), you have to dream about the colon and pancreas, and find abscesses fascinating and a thing of beauty and wonder.

I was also enlightened to the fact that not everyone gets cured after surgery like I thought was the case.  Often, patients with Crohn's disease keep having strictures of their small intestine removed and have a lot of resections over time.  Also, many ulcerative colitis patients require that their colon be removed.  Surgery might seem to have more victories in it than internal medicine for example, but there are many patients who still suffer.

It's not for me, but if you love it, chase after it with all your heart.

Fellowships after general surgery include:
1. Vascular surgery
2. Surgical oncology
3. Paediatric surgery
4. Cardiothoracic surgery
5. Trauma surgery
6. Plastic surgery
7. Transplant surgery