This month is flying by. I’m staying busy enough that I’m finally understanding the sensation of “not another case – it’s after noon!” The surgery center, with its motivated staff and fast turnover, is one thing, but in the main OR, things drag and drag, and even a short list of three cases can end up stretching out to the point that one single add-on seems an imposition. Not that I’m complaining; this is also now enough time spent continuously in the OR that I’m more comfortable with all kinds of small routines, even as small as making an incision (yes, ok, major failing for a would-be surgeon, but cutting on people takes a little determination to actually get into something, and not just scratch the surface).

Hernias, especially. I know I still need to do another hundred (literally) to really understand what’s happening. But in the past few weeks I’ve done enough, often enough, with the same attending, that I’m at least starting not to be surprised when certain structures show up in the same place over and over. Today, on an athletic young patient, I even recognized the conjoined tendon (in elderly patients this area where tendons run together can be so attenuated that the “conjoinedness” is more theoretical than actual). This is an important procedure for me, because if I plan to be a community general surgeon, this is going to be a major part of my practice. Right now I can’t quite picture sorting out all the different layers by myself; but we’ll get there.