I’ve studied so much the last couple days I feel like I’m bursting. Apparently I’ve discovered the secret to studying at the hospital: don’t bring any other books in, and have nothing of the slightest interest occurring in the world, so that reading news sites and commentary is more boring than reading a textbook. Actually the surgery books are fascinating, especially since I asked the chief for some recommendations. I’ve now discovered a book I clearly should have been reading since the beginning of the year, Chassin’s Operative Strategy for General Surgery, which explains how to think about operations, and all kinds of details of practice that I’ve learned exist, by stumbling against them, but never really heard why they are that way. And then of course the usual assortment of gigantic textbooks, in one or two or three volumes, which are certainly not boring, but can be very discouraging: flip through any one at random, and there are nearly 2,000 pages of dense information that I ought to know and would like to know – and it takes forever to read any one chapter.

At least I finally figured out that nowadays one operates on acute cholecystitis within the first few days. (Yes, I told you I was a bad surgery intern; it took me nine months to figure that out. My only excuse is that this is the first month that I’ve spent much time with plain old general surgery – except August, and I wasn’t conscious then.) Somehow I had gotten the impression in medical school that one operated urgently on small bowel obstructions, and tried to wait six weeks before operating on cholecystitis (infection of the gallbladder, usually due to stones blocking the cystic duct) and biliary pancreatitis (inflammation of the pancreas due to gallstones getting stuck in the common bile duct), so I kept being puzzled when the surgeons here operated a lot sooner. My current program isn’t the most innovative, but apparently it’s a generation ahead of my medical school program, because all the current literature (it wasn’t even hard to find) says that it’s best to operate immediately, before too much scar tissue and other complications develop. (And for biliary pancreatitis within a few days, as soon as the pancreatitis seems to resolve, because it will likely recur if you wait much longer.) (And you should wait a few days to see if a small bowel obstruction will resolve on its own – more than 80% do – and only rush to surgery if the patient is toxic on presentation. That I did figure out a while ago.) So very slowly, I’m learning a couple of key concepts. (This kind of information you won’t find in the textbooks, which are a couple of years behind recent research, and also, for all of the data that they cram into those books, they still don’t seem to have much application to daily life on a surgery service. Obviously I need to read some more, till I get to the relevant part.

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