When I first started this blog, I was still bewildered about the thought of pursuing a surgical residency. Embarrassing as it may be, I would binge watch Grey’s Anatomy and dream of the day I could hold out my hand as silence falls on the operative suite and say “scalpel”. A life as a surgical resident seemed so exciting. Imagine saving lives with an expertly placed Burr Hole (I see you Izzy Stevens) or being the intern to unravel a medical mystery and leave your colleagues in awe. Well, I hate to be the bearer of bad news, but medical TV shows aren’t exactly the most realistic representation of what life as a surgical resident is like. While there is plenty of excitement and nail biting moments of residency, no one prepares you for the mundane tasks that would never make air time.
0400: Time to wake up
This varies rotation to rotation, but in general most hospital’s first surgery of the day starts at 0730. Which means that the patient’s in pre-op have to be examined and consented at about 0700. In order to be free to see the pre-operative patients by 7am means that all the inpatients must be examined prior to 7am which means sleeping in and a surgical residency don’t mix. On particularly busy services There have been times I’ve gotten to the hospital at 430 to prepare for the day, and there are slower days where I can “show up late” at 6am.
0400-0530: Get my life in order
I am a morning person. There is something about being up before the rest of the world that really inspires carpe diem vibes. While I sometimes snooze away my extra time in the morning, if I have a big case that day I’ll use this time to review anatomy and procedural steps. If I’m preparing for a PT test I’ll go for an early morning jog or get in a quick ab work out. Being in surgery allows for a very low maintenance life style. As my hair is going to be tucked into a scrub cap all day I don’t have to worry about styling my hair, and I don’t bother wearing make up since I’ll be wearing a mask all day (even pre-pandemic). Being a military surgery resident makes outfit decisions easy because I go from my OCPs (the Air Force camouflage battle uniform) to hospital issued surgical scrubs. I chose to live within 10 minutes of the hospital and it is honestly one of the best decisions I have made since starting residency. I love that I don’t waste precious time in the morning commuting to work.
0600-0630: Chart Review
Chart review means reviewing any results or pertinent information regarding a patient. I start by looking at the vitals and make a note if any of them are abnormal or if it is something that is related to the plan of care (i.e. if a patient’s been febrile and they’re now back to a normal temperature after switching antibiotics). I then move on to review lab work, pathology, imaging and microbiology. For surgical patients I am usually most concerned with the white blood cell count (a sign of infection or stress), hemoglobin (indicates blood count), and a basic metabolic panel as any derangement in electrolytes could prolong an ileus (when the bowel doesn’t function as it should) or a rising creatinine could indicate an early kidney injury. I next look at any notes that may have been added since the previous day either from other specialties we’ve consulted, a nursing note which communicates a change overnight, or a social work update regarding a patient’s disposition. I repeat this process for all the patients I am assigned.
After chart reviewing each patient, I head to the inpatient floors. Our patient census varies depending on what specialty and which hospital we are rotating on but currently on my trauma rotation we have anywhere between 25-45 patients a day. On average I am responsible to see 5-10 patients a day. This is the time to ask patients how they’re feeling do a pertinent exam, and relay the plan for the day.
0700-0800: Sign out
This is when we discuss all the consults and changes that happened overnight. On this rotation this is time designated to sit down with all of the trauma attendings and residents who are on the service and discuss all the patients on the list. You agree upon a plan for the day and divy up tasks to be completed and surgeries to be covered.
Each work day varies. As an intern I spent a looooot of time in clinic, but now as I move up through the ranks more of my time is spent in the operating room and on the floor. I love the variety of being a surgical resident. Some days we have short 30 minute cases like chemoport placements or colonoscopies, other days we have 14 hour neck dissections with free flap cases. In addition to the scheduled surgeries for the day, we are on call and see consults for urgent or emergent add on surgeries. Despite being in clinic or in the operating room all day, we also juggle caring for the floor patients. The days are long but being busy makes them fly by. There are several days that its 4pm when I can finally sit down and have my first meal of the day.
1800-1900: Sign out
Sign out is where you hand over responsibility of your patient’s to the team that will be taking care of them overnight. We relay things that need to be followed up on (imaging or lab results) and things we may be concerned about (pain control, continued to bleed post operatively)
1900-2200: Be a normal human.
Surprisingly this portion of my day is actually the most stressful. I have a really hard time dividing my time between the things that have to be done (oil changes, running errands, grocery shopping) the things I should be doing (studying or working out) and the things that I would rather do (binge watch Netflix). I’d be lying if I feel like I could fit in everything I’d like to accomplish within a day. My boyfriend and I order take out to save time on cooking several times a week, my study schedule gets pushed to the weekend and sometimes chores pile up for the next day off. And you know what? Its okay! Being a resident in any specialty is a full time job. Heck! For most specialties its the equivalent of 2+ full time jobs. Its okay to spend an evening decompressing from a stressful day every once and a while.
Sleep is the one aspect of my life that is more “do as I say, not as I do” since I counsel my patients on good sleep hygiene. I aim for about 6 hours of sleep each night. In reality, there are several nights a week that I only get 4-5 hours due to phone calls from the hospital, or late nights at the hospital when cases run long. Its not ideal, but over time you get used to running off less sleep or being able to take power naps to get you through the day.
And there you have it. My not-made-for-TV version of a day in the life of as a surgical resident. Although it might not be as glamorous as a what I used to imagine, its even more rewarding and humbling than I could have ever anticipated.