Day 2 of General Surgery - Sean

So Dr. Yu felt it would be a good idea if I experienced the schedule of a general surgeon, so I was to report to the Surgery Ward at 6:30am to go on rounds with him. Since I was worried about being late I woke up at 5:30am, which wasn't too bad actually. Perhaps the jet lag was working in my favor. I was there before my preceptor, trying to prepare myself for my first opportunity to see what "going on rounds" was like.

Dr. Yu arrived and immediately went to access the patient database to gather status updates and information on his patients. One of his junior residents, Dr. Shing, also accompanied him. Although in Chinese, I was able to take notice of how detailed the patient records were. The organization system was impressive as Dr. Yu easily pulled up old labs, new labs, old scans, new scans, and vital updates. At times, it was a little bit difficult to keep up with his rapid clicking through all of the menus. Once he noted all the information he needed, it was off to see his patients.

Within the duration of the next 45 minutes, we ended up seeing 14 patients! I was surprised by how little time was spent interacting with each patient. That works out to just about 3 minutes a patient. Although some patients were there to be observed after their surgeries so not much was required for them, 3 minutes is still a short amount of time. It was also surprising to observe how much the patients liked Dr. Yu. I could tell that his patients trusted him a lot. He would often pat his patients on the shoulder, arm, or hand, and give them a smile. It was simply an example of amazing bedside manner.

Among the 14 patients, just a few of the interesting cases:

• The patient that received the Laparoscopic Cholecystectomy yesterday was there for follow up. Dr. Yu palpated the stitches to make sure it was everything would heal nicely. I found out that patients are usually kept for at least 2 days in the ward following that type of surgery.
• A patient who had a previous partial Hepatectomy was suffering from cirrhosis as well. This comorbidity had lead to ascites accumulation due to a leak. Another surgery would have to be performed to repair the source of the leak.
• The rest included a hernia patient to have surgery later today, another liver tumor patient who will require a hepatectomy, and a patient with gout, just to name a few.
  

After rounds, I was sent to a conference room where a lecture was given about the Tokyo Guidelines for diagnosing and treating acute cholangitis and cholecystitis. Did you know that a definite diagnosis for acute cholangitis is the presence of Charcot's Triad (fever and/or chills + jaundice + abdominal pain)? Me neither! The lecture was entirely in Mandarin, but luckily the powerpoint slides were in English, so I wasn't completely lost.

I then went to the OR afterwards. I was able to see 2 more hepatectomies today. Here's a picture of what the liver looks like inside an anesthetized patient after being skillfully exposed by the surgeon:

I was also able to observe a herniorrhaphy. It was pretty interesting to say the least that at the end of the surgery, the surgeon applied traction to the patient's testes. I later found out that because part of the repair requires suturing material to the inguinal ligament and other structures, it can sometimes cause the testes to be pulled upwards. Applying traction will prevent the slight chance of the testes ascending all the way into the abdominal cavity.

That was it for Day 2. I found out that the early start time was NOT just for today. I will be going in for rounds once again at 6:30am. I wonder if it will be harder to wake up? I guess we'll see...