ATLS is a tremendous improvement on ACLS. For one thing, you know that 90% of the time, the answer to a test question written by a surgeon will be either “immediate operation” or “consult a surgeon.” LOL. Some of the ER interns did not immediately grasp this principle.

 The lecturers are all doctors, so we respect their opinions a lot more, and they treat us as colleagues – very junior, but colleagues; which is an amazing sensation. Also, the hospital produced a good lunch for us – also impressive.

And finally, the afternoon was spent practicing procedures on anesthetized pigs. There was a brief opportunity offered for anyone to back out if they had ethical objections . . . I would be far more concerned about trying to do there procedures on a human without having taken the chance to practice on a non-human first. All six of us in the group put in chest tubes (on one side, after a thoracotomy had been done by the enthusiastic attending to check on the placement of a curiously-positioned pericardiocentesis needle!). I was one of two who seized the chance to do DPL (diagnostic peritoneal lavage) (less space for this in the pig’s weird anatomy). It felt like real surgery – making an incision, clearing down to the fascia, carefully picking up the peritoneum before nicking it open. Probably the closest I’ll get for several months.

 During the discussion groups, one of the trauma attendings zeroed in on the fact that I was the only surgery intern in the group. So he directed most of his questions at me, and seemed to expect me to have the right answer when the others were lost. Part of the time I did, and part of the time I spouted some of the dumbest guesses you can imagine. Pimping is no-win. If you get the question right, you just earn a harder one. I can barely imagine what his opinion of his new intern is now.

 More fun tomorrow. By all reports, this test is going to be more difficult, and the practicals more complicated, with a slight but real chance for failure.