Surgery was one of my top 3 initial interests for a career after graduation, however, I think the valuable first-hand experience I received over the last 4 weeks has given me much to consider if I want to pursue this in the long-term. However, I still enjoyed my time and the unparalleled lessons in anatomy that I received from fellow PAs and attending surgeons.

One of the most valuable lessons I learned was the power of efficient and effective teamwork. The surgical team encompasses scrub nurses, techs, students, residents, and attendings. Everyone has a very specific role to play, and they must adapt to the surgeon’s needs as quickly and safely as possible. The techs must have knowledge of the name and location of dozens of different surgical tools to hand off, the students will hold retractors and suctioning, and the residents/PAs will first assist and close up the wounds when finished. I saw first-hand that being experienced in a surgical technique means being able to anticipate and predict the tools that will be needed, which can drastically reduce the time that the patient spends under anesthesia. I also learned that patient care after the surgery is completed is essentially as important as the surgery itself, so being vigilant and monitoring for post-op complications like small bowel obstructions or fever is vital. One of the patients we operated on experienced a wound dehiscence and had to be brought back to the operating room, where an internal hernia was discovered and repaired. I followed that patient over several weeks and helped change his wound dressings, and got to establish a rapport with him. I learned the importance of bedside manner and making sure to introduce yourself to the patient before they are brought to the OR and after they wake up, so that they feel comfortable with seeing them in vulnerable positions. This will aid me in my future practice, as I became much more comfortable seeing and speaking to adult patients on my own after my previous rotations with psychiatry and pediatrics.

Despite my interest in anatomy and eagerness to scrub into surgical cases, a career with general surgery has a steep learning curve and lifestyle demand that may make it difficult pursue. Our day started at 6 AM, which meant being up at 4 AM and lasted for 12, or sometimes 13 hours, 5 days a week. Often it felt like I scarcely had time to do nothing but feed myself before immediately getting into bed and trying to stay ahead of my accumulating sleep debt. This may appeal to some who truly love the surgical field, but I personally found it hard to accommodate. This was in stark contrast to my week spent with orthopedic surgery, where I found a much better balance between work and personal life. I also loved being able to assist with some arthroplastic procedures, as I find the techniques and anatomy fascinating (despite nearly having a vasovagal syncopal episode during my first total knee replacement).  

I would love for my preceptor to recognize that I scrubbed into as many different cases as was possible to get the largest breadth of experience, and that I became better at taking the surgical history and doing physical exams during our outpatient clinic hours. Overall, I enjoyed surgery and especially orthopedics, I will look further into job opportunities closer to my graduation date.