I enjoyed my surgery rotation at Woodhull even though it was challenging and involved a lot of long days. It was slightly different than what I was expecting but still very interesting and educational, I feel that I learned a lot during the 4 week rotation. I had some experience doing procedures at previous rotations but that did not compare to scrubbing into surgeries that took anywhere from 2-5 hours. 3 weeks were spent with the general surgery team and 1 week was with specialists including orthopedics and urology.

During my time with the general surgery team I was exposed to the surgical floor, the operating room, and the clinic. The team involved attending physicians, interns, residents, PAs, NPs, and medical students. Most of the day was spent with the interns, residents, and other students. The most time I spent with the attending physicians was during surgeries.  Every morning I would start before 6 am in order to see patients before rounds started. Presenting surgical patients was slightly different than what I had done at other rotations. A lot of the focus was on acute events that occurred overnight, other things we focused on included post operative recovery including pain at surgical site, activity, refeeding, bowel movement, urination. We would care for surgical wounds and change the dressings. During rounds we would evaluate whether patients required surgery or could be managed conservatively. We also evaluated the need for further care such as need for debridement of necrotic tissue, arterial lines, central lines. There was a patient that stood out where I assisted when we debrided necrotic tissue at the bedside in the gluteal region, this patient stood out because I was able to palpate the patient’s ischium during the debridement. The clinic was more familiar for me. We would see patients in an outpatient environment and follow them after or before their procedures. This also involved pre operative evaluation and wound care. I was able to place Unna boots for patients with venous stasis ulcers. It was a great experience to be able to scrub in and assist with procedures including but not limited to various hernia repairs, laparoscopic cholecystectomy, laparoscopic appendectomy, lipoma removal. One patient that I will not forget started out as a hernia repair. Things were going smoothly as the surgeon opened up the patient and reduced the hernia, however the patient still had a large mass within the scrotum. The surgeon previously suspected that the scrotal mass was bowel from the hernia. The routine hernia repair turned into an excision of a large (10 cm), round, firm scrotal mass. The mass was sent for pathology however the results did not return before the rotation ended.

During my week with specialty surgery I was exposed to orthopedic clinic, orthopedic surgery, and urology clinic. The orthopedic surgeries made the general surgeries feel easy by comparison. The procedures I scrubbed in and assisted with included hip replacements, ORIF of tibial plateau fracture, and bilateral quadriceps tendon repair. The surgeries were much longer and often used imaging during the procedure which meant we had to wear lead vests for the duration of the surgery. The most laborious procedure was a patient that had a re-fracture of their hip 2 months after hip replacement. This procedure took more than 5 hours and required placement of 5 cables to stabilize the femur before fitting the patient for new hip hardware. It was amazing to watch the surgeons use the specialized tools during orthopedic surgeries.

I hope that the teams I worked with noticed how hard I was working to see as many patients as possible and participate in surgeries in order to learn throughout the rotation. As mentioned earlier, this rotation involved long hours and a lot of activity before, during, and after surgeries. Many parts of the pertinent history, physical exam, labs, monitoring, procedures were very unique compared to how I had done it during other rotations.

My next rotation is long term care with the internal medicine team at NYPQ. This will be our first 5 week rotation. I am looking forward to this rotation as some of it will be familiar for me since I previously did my IM rotation at QHC, I am interested to compare how things are done at a different facility. I heard from my classmates that there are a lot of PAs working IM at NYPQ that I will be able to work with and learn from which I am excited about since my previous IM rotation involved interns, residents, attending physicians, and medical students.

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