My General Surgery rotation at NYPQ was both exhilarating and exhausting. Prior to starting my rotation, I was unsure if Surgery was something I would consider in my future. I can confidently say that this educational experience has awoken a curiosity in me about potentially exploring General Surgery, or other surgical subspecialties, in the future.

This rotation was drastically different than my previous rotation in Emergency Medicine. Getting used to morning rounds and the presentation style certainly took practice. I learned early on during my rotation that when presenting General Surgery patients, it is of utmost importance to include I&Os, particularly drain output (most often Jackson-Pratt drains). I learned to present my patients in a concise fashion, focusing on their overnight events, their pertinent positive and negative subjective and physical exam findings, and giving report on the appropriate lab exams. One thing that was challenging for me was learning about the assessment and plan for surgical patients, particularly in regard to their diet requirements (including when to advance their diet), learning when to discontinue their Foley catheters/Flexi-SEAL, or when to transition from PCA to oral analgesia. I was also exposed to new techniques in the operating room. These techniques included improving dexterity when using surgical instruments.

One skill that I will continue to improve upon throughout all of my rotations is the presentation of a concise SOAP note, particularly during rounds. I am actively seeking to improve in this area by seeking out constructive criticism from my colleagues and learning from their presentation styles.

I had several experiences with patients with intellectual disabilities during this rotation. Several of these patients were unable to make their needs or concerns known. This proved to be challenging for me as a provider, particularly to understand if they were in pain, were hungry, etc. My preceptors and the surgical residents that were a part of my team helped me to learn how to assess pain in these patients (most often accomplished by looking for grimacing during physical exam and vocalizing).

One memorable experience that I will carry with me is, unfortunately, the death of my first patient. Our patient had been diagnosed many years ago with a rare, unresectable neuroendocrine tumor of the gastrointestinal tract. I had scrubbed in for his exploratory laparotomy and I will always remember the deliberation that went into deciding what, if any intervention, could be accomplished for the patient. During the operation, we ended performing a diverting loop ileostomy as a palliative measure. The patient was transferred to the Surgical ICU and died two days later after palliative extubation. Prior to the palliative extubation, I was able to observe the conversation between the team and the patient’s family about what the patient’s prognosis was and what they wished to do going forward. It was very emotional and ultimately ended in the patient changing their perspective from “doing everything” to palliative extubation.

The knowledge I’ve gained during this rotation will certainly be applicable in other rotations/disciplines. This includes the emotional and conversational learning I have done throughout this experience. Additionally, it includes learning to formulate assessment and plans which include considerations about diet, pain control, etc. This will be particularly important as I am set to begin my Internal Medicine rotation at Saint Francis Hospital in a few days.

One thing I would want the preceptor or my other colleagues to notice about my work in this rotation is the fact that I was constantly seeking out opportunities to perform procedures, observe procedures, be a part of SICU rounds, scrub into cases from other disciplines (like CT surgery, OB/GYN, etc.) I would want for my preceptor and my other colleagues to recognize that I often stayed late, sometimes getting out of cases at 9:30PM or 10PM, not because I felt like I had to, but rather because I was interested in learning and fully immersing myself in General Surgery.

Things that I wish to improve upon in the following rotations include giving more concise presentations and writing more H&P/SOAP notes/Orders. I can accomplish the above by requesting the constructive criticism of my peers and learning from their examples. Additionally, I can speak to my preceptor and team about whether I could write down orders (on a piece of paper) and have them review them (to help me improve in this regard).

During this rotation, I learned that I can push myself out of my comfort zone (particularly my sleep comfort zone!). As I previously mentioned, I was unsure if surgery was something I would consider in the future, but given this positive experience, I am keeping my mind open.

Surgery was appealing to me for a multitude of reasons. These included the amazing experience to visualize the anatomy, seeing patients improve following surgical procedures, and seeing how team-oriented the surgical teams truly are. During the last day of my rotation, my preceptor and I had a discussion about how welcome I felt during my time at NYPQ. We specifically spoke about how my colleagues treated me respectfully and seemed to truly value my help. She told me that there were many reasons that she has stayed with NYPQ for so long, and this was just one of them. In my experience, and in hers, the surgical team recognizes how important each member’s individual contribution is, and egotistical, hierarchical friction is nonexistent.