Surviving on Crackers

I was once told by an anesthesiologist that he made his way through residency by surviving on saltines and water. When I heard this, I did not entirely believe him. But the more I think I about it and having spent 3 weeks on surgery, I can see the truth in his statement.

My daily diet (when I'm in the hospital) has been mostly consisting of two things- saltine crackers or graham crackers (and if I'm lucky- a whole wheat bagel with peanut butter). With ice water. Very appetizing.

While in the hospital, you sometimes go hours without really eating or thinking about stopping to eat. Between pre-rounding and rounding early in the morning, meeting patients before the case, prepping the patient for surgery, scrubbing in on the case and accompanying patients back to the PACU to write orders- you are left to scavenge for bites of food in the few minutes you have before the next case starts. And your body gets used to it. This is why dinner has become my favorite meal. I can actually sit and chew my food.

There a few things I have come to appreciate while being on surgery.

1. There is nothing like breathing air. By that I mean, being able to take a deep breath in and out without a mask on your face. It never felt so good.
2. Sitting- it's a wonderful thing. Wow, what a different it makes for your back, legs and achy feet.
3. Medical students do have a useful job on surgery. We are glorified supply cabinets. Need four by fours, gauze, tape, saline, suture removal kits? Don't worry- we got it on our person, or know how to get some.
4. I think my patients think I am preoccupied with bowel habits. Because every morning I ask the same questions- "have you passed any gas? Had any bowel movements yet?"

With three weeks down, I can truthfully say that surgery has consumed my life, taking up most hours of my days. There has very little time to see friends, sleep, study and exercise (although I think standing all day and running around rounds qualifies as exercise). I leave my apartment when it's dark and return home when it's dark. The only glimpse of sunlight I get is when we round on our patients, I can sometimes catch a view of the sun setting on the city. Even when I'm not in the OR or hospital, I am thinking about my patients and their diseases, the surgeries of the day, the suturing techniques I have learned, and the hospital course of my new patients.

The hours are long. And you work hard. Despite the challenges (namely lack of hours in the day to sleep and study), I feel lucky to be actively involved in my patient's care. There is something very special about taking care of the patients you have operated on. By performing surgery, you not only become acquainted with your patient's anatomy, but you are also able to use your hands to fix a problem, whether it is a hernia or enterocutaneous fistula or excision of a mass or a bowel resection. Postoperatively, you see how your patient regains bowel function, has improved pain, and starts eating food. The transition can be rewarding, when you see your patient discharged in good condition. It can also be frustrating, when your patient does not improve and remains hospitalized and you are left to wonder what went wrong.

I spent Friday night taking trauma call at SF General Hospital. The motto for SFGH is "It's as real as it gets." The SFGH Emergency Department serves as the only Level-One Trauma Center for the City and County of San Francisco and northern San Mateo. With over 58,000 visits annually, the Emergency Department serves both critically injured patients, as well as a large underserved and urban population.

The night was fairly mellow. We had a couple of 900 emergent pages (a gunshot victim and motor vehicle accident), which upon further evaluation did not require surgical intervention. We also had some patients with acute appendicitis, a patient with pneumothorax requiring chest tube placement, and a patient with an abscess. I performed my first incision and drainage on this woman's abscess. In doing so, her pain was improved and she was able to go home.

My first overnight call (with 2 hours of sleep) done. I left at 10 AM the next morning, completely exhausted and hungry- looking for some crackers.