Clinical Year: Surgery


Surgery was by far my favorite rotation while I was in PA school.  I had already been exposed to a bit of surgery in OB/GYN where I learned I could see blood and invasive surgeries without passing out, so I was excited and ready to go for my surgery rotation.  

The surgeon I worked with was a general surgeon, but he specializes in breast cancer.  He is seriously just a great person.  He is kind to his office and surgical staff, spends time with his patients and truly loves them, and awesome at what he does.  That probably was part of why I loved this rotation so much.  And he helped me get the job I have now!

While surgery was my favorite overall, it was also one of my busiest rotations and during the 12-hour days I would rarely sit down.  Maybe for 30 minutes total out of the whole day.   After the first week, I was feeling like my body just wasn't going to make it.  This rotation is where I learned it is important to wear good shoes and compression socks and that it will actually make a difference.  Danskos are a good option, but if you can't bring yourself to look like a little dutch girl, a good pair of tennis shoes with supportive insoles will work too.  I went to The Walking Company for some shoes, and then got some Dr. Scholl's inserts at the fancy machine at Bed, Bath, and Beyond that tells you what kind you need.   Compression socks take a little getting used to, but I wear them daily still.  VIM & VIGR are my favorites right now because they have some patterned ones, but also they give good compression and really maintain it throughout multiple washes.  I have 3 pairs I've been rotating through for the past year, and they are all still doing great.  

Before this rotation, I did not have much knowledge of breast cancer.  No one close to me has ever had breast cancer, and the few lectures we had during the didactic year were a little over my head for where we were at the time.  Dr. C did a great job of explaining the different types of breast cancer, how hormones play a role, and surgical options when breast cancer is found. 

I became very proficient in breast exams during this rotation, and I realized the importance of women doing self-exams.  It was very interesting seeing a case from start to finish, and all of the emotions involved.   I actually really like getting to help patients through that process, and it's something I still get to do in dermatology.  One case that sticks with me was a 35 year old woman who happened to notice a lump while on vacation.  Mammograms are not recommended (or covered by insurance) until age 40, so she had never had one.  (This is something that insurance companies are trying to change to make the recommended age older, by the way.)  She came in and we did an ultrasound first.  Typically a dark shadow that blocks the waves completely and shows nothing underneath it means the tissue is thicker and not doing what it is supposed to be doing.  Then a fine needle aspiration was done, and I learned early that if the tissue sinks in the specimen cup, that is also not a good sign.  The surgeon told me that he can usually tell by how the tissue feels during the biopsy if it is cancerous, and I can confirm that's true after working in derm.  When I biopsy a basal cell or squamous cell carcinoma, the tissue seems to almost fall apart and it is very friable.  

Anyways, this patient had both of those signs, and Dr. C told her his suspicions.  It is hard to watch someone receive that news, but everyone reacts differently.  Some people are ready to know what's next and how to fight it, while others start throwing up and need some time to come to terms with the disease in their body.  Whenever a patient is diagnosed with breast cancer, Dr. C would bring them in for a "talk" to go over the diagnosis and discuss options.  

In the OR, we did a lot of lumpectomies and mastectomies, with a few gall bladder and lipoma removals and hernia repairs as well.  I love the OR setting.  I was able to make incisions, suction, help remove tissue, and suture.  This rotation is where I really learned to suture and got a ton of practice, which I am so thankful for.  

The worst day was when the air was broken in one of the ORs, so it was about 80 degrees.  When there are a lot of hot tools being used and you're wearing scrubs and a gown and mask, it can get pretty hot.  That was the only time I almost passed out while in the OR.  

Here is a blog post of an interview with a PA who works in orthopedic surgery.  Broken bones are not my thing, so if you can set a fracture without passing out, then more power to you!

Here is a blog post of an interview with a PA who works in neurosurgery, so check it out if that is a field that interests you.  

Surgery is interesting because you have to be ready for complications, and be able to think through problems.  I really enjoyed it, but it's not for everyone.  Let me know if you have any questions! 

Some other posts or articles that pertain to working in surgery: