Surgery grand rounds this morning was the first for the new school year. The topic was sleep-deprivation and fatigue, being a required topic. The residency director played a kitschy video on the subject. The residents roared with laughter, at the suggestion that one should nap precall, or sleep on days off, or that two days off a week is better than one, and so on. The part about recognizing fatigue – microsleep, falling asleep for brief seconds, or at a stoplight – also brought recognition and laughter. What’s to be done? I’m already exhausted, and I don’t work the hours or take the call that the residents do. I’m hoping it’ll trade off next year, more work, but a shorter commute.

Then, the director showed a graph to demonstrate that surgery residents are the most delinquent of all groups at the hospital as far as signing their old charts. Everyone erupted to point out that the most compliant people were psychiatry residents, and the reason the surgeons were behind is that they dictate far more notes and procedures than anyone else (and, they say, medical records loses their charts more often).

The group discussion for the morning (apparently next time they’ll get to real basic science) was: how to handle ethical conflicts: if you’re postcall, and there’s a Whipple scheduled (the quintessential humongous, ultimately desirable, extremely rare general surgery operation) (almost unanimous agreement: scrub the case unless you’re literally falling asleep); if you disagree with an attending’s action during a case (bring it up in a polite way, and then refuse to dictate the operation if you have serious concerns, so you don’t become too legally liable); what to do if a junior resident is disobeying the senior (shouldn’t happen; hierarchy, you know).

‘Nother lap Roux-en-Y this afternoon. Yesterday, it was the junior of the two bariatric attendings doing it. He let me drive the camera the whole time, and wouldn’t let his senior partner take it away from me when he scrubbed in at the end of the case. I love him, I love him, I love him. Today the schedule says both of them are scrubbing. I expect to be standing holding my hands at the end of the table. . .