This morning the three residents just starting on the service, as well as myself, had been told to meet in the chairman’s office. He gave the residents a long lecture on how to run things. It reminded me of Deputy Director Wither in That Hideous Strength. (No, I don’t like the chairman, how did you guess?) “On one hand you must demonstrate independence, and clinical decision-making capability. . . But on the other hand you should always call to check with us; we would always rather be called than not be called.” Or, when asked, since he emphasized the importance of the whole team rounding at least once, better twice, a day, he would like to round with us, he said, “That is certainly something I would like to do. But you would need to ask me. . . ” So the resident is supposed to petition, or invite, the attending to come round on his patients? Now we’re all sure of our ground!

To make it more complicated, some higher power decided to assign two fourth-year residents to this service, and one second-year. So instead of one fourth-year being the chief, in charge of a complicated service, and having a range of cases to do in order to fill his requirements, there are two fourth-years, trying not to step on each other’s toes, but still be directive to their junior and medical students, and having to share the desirable, needed cases with each other. They seem to like each other and are being polite, so far, but it looks like a tense kind of month.

Myself, I’m satisfied because, although the service is called slow, the two third year students will be leaving in a week, so for most of the month I’ll be the only student, and won’t have to compete with them.

Well, then the residents started rounding. First patient has a gastrocutaneous fistula, remaining from her gastric bypass surgery a year ago. The attending has seen fit to maintain a drain in the fistula. The residents were perplexed by this thinking, so quizzed the students on the mnemonic for fistulas. Only on surgery do they care that you know, not only the answer, but the mnemonic. Of course, I did not know the mnemonic, and neither did the third years. So we all stared at me, as the residents gradually produced the treasured words, and it was quite clear that the fourth year is responsible for knowing all mnemonics and all answers not known by the third years.

(I know you’re all desperate for information on fistulas [fistulae, actually], so here it is: his FRIEND: h high output; i intestinal destruction; s short segment fistula; F foreign body (ie drain, the reason for this discussion); R radiation; I infection; E epithelialization; N neoplasm; D distal obstruction. When we talked to him later, the attending had some train of reasoning for this drain, which didn’t make sense to me, and by the looks on their faces didn’t make much sense to the residents either. But it was too early in the team’s relationship to ask questions.)

Eventually we found the transplant surgeon, hereinafter Dr. Z (even his real name is far too complex for Englishers to pronounce), who had time to round with us. He did some transplants last night. He is very friendly and approachable, lets students touch sharp objects in the OR, and loves to teach. His ensuing lecture would have been great, except that I proceeded to get very sick and nauseated, tried the undignified approach of crouching against the wall so as not to either have to leave rounds, or faint during rounds. Didn’t help. I ducked around the corner and found a carpeted nook in the nurses’ station, where I collapsed hastily. (Sometime when there’s softer carpet and fewer spectators, I ought to find out what fainting feels like, since, like Anne of Green Gables, I’m curious. But surgeons always think of pregnancy when a woman faints, and I didn’t want to start that discussion.) After the team (large enough not to notice my absence) had gone on somewhere else, the alert nurses eventually noticed a person lying on their floor, and were very nice. Being nurses, they were not satisfied with my idea of letting me lie on the floor for half an hour, and insisted on calling someone. Eventually they paged some of the other medical students, who came and escorted me to the call rooms (opposite side of the hospital).

So I lay there for half an hour, feeling extremely disgusted with myself. Of all days – first day on the rotation. In the middle of rounds. And then the nurses insisted on paging the team. So who is going to want in their residency program a surgeon who faints – as far they know, every month? I swear it was a year and a half since I did this last – and it is definitely not going to happen again, if I have to actually consult a doctor in order to prevent it. But as I understand it, the residents have a vote and a fair amount of input on how applicants to the program get ranked. So first I don’t know an important mnemonic (I do now, I looked it up in Surgical Recall, but it’s too late), and then I have to faint. In the middle of rounds.

All may not be lost, though. I’m not going to give up on this program without giving it a good shot. Plan of action:
1. Never ever faint in the hospital again, and especially not on this rotation. (last half should be manageable)
2. Memorize every mnemonic in Surgical Recall.
3. Memorize every other fact in Surgical Recall.
4. Get a textbook on bariatric surgery, and at least learn the names of the procedures.
5. Get a textbook on transplant surgery, and get a vague idea of the complications.
6. Spend every spare minute, of which we seem to have a lot on this rotation, watching the surgery videos on WebSurg, a fantastic site. (Also important since the chairman recommended it.)

This weekend I think we have to come in every morning to round, but should get the rest of the day off. Not a bad schedule to start with. The third years are in class, the residents are writing orders, and I am studying.