Week 8

My final week on surgery was an abbreviated one. We only had clinical duties on Monday and Tuesday (along with rounding over the weekend). Other than taking care of the same burn patients, I was in a couple hand surgeries. On my last day of the rotation, they let me use a scalpel! (Actually, I had used one to put in a chest tube, now that I think of it). A young man had a pyogenic granuloma on the finger, a ping-pong sized erythematous friable (red, easily bleeding) mass forming at a site of prior trauma (he had hit his finger with a hammer). He was put under conscious sedation and I carefully cut it off. The second case was a carpal tunnel release, a quick but good procedure to see. In clinic, I saw a few standard plastic surgery cases: a thumb crushed in a car door, a breast reduction.

Tuesday evening, I drove back from Fresno to San Francisco. It's really good to be back; October is a beautiful month in the city. We had two days to study for our shelf exam on Friday. Our evaluations in this clerkship have a few objective components; we had to do an observed abdominal exam with a faculty member and present a couple annotated researched H&P's to our preceptor. But the looming menace was the shelf, which has a reputation of being quite tough. Along with a tight time constraint, the surgery exam tests aspects of orthopedics, neurosurgery, urology, and pediatric surgery, which we have to review outside of our rotation. A lot of it (surprisingly) is medical management: how to work up abnormal electrolytes or decreased urine output or post-operative fever. In any case, it was an intense exam but it went fine and marked the end of my third rotation and, more frighteningly, the half-way point of my third year.