Jacky Lai

  My surgical internship started in September.  It is so obvious that I might have a very difficult September for my Blog remained silent in the past two months.  I began the course with General surgery, which is the toughest course in surgery.  The house officer is one of my uncles classmates, who is a very respectable professor.  He is always enthusiastic in teaching and cautious about managing his patients.  And I began to learn how to take care of 24 patients without burning myself out.  As days went by, I finally knew the keypoint in taking care of surgical patients.

  Following the general surgery, traumatic surgery is one of the courses that I shall never forget.  There, I took care of 25~30 patients, which not only broke the regulation of upper limit of intern loading, but also set up a new record of caring amounts of our class.  Patients in this field all come from emergent department.  As a matter of fact, traumatic surgery is a relay of ER and Home.  About half of our patients suffer from gall stones, whereas half of the other half have acute appendicitis.  The rest of our patients show a great variability in this field.  We have liver abscess, hemothorax, pneumothorax, acute pancreatitis, pancreatic cancer, psychoses, and even pregnant patients.  "Thanks" to the variability of our patients, I have to read a lot more to know how to handle these patients so different.  To be quite honest, it aint easy at all.  First of all, "25~30" is already killing me.  How could I memorize every single patient in detail with a 3-page-patient-list?  Moreover, as our house officer so busy replying consultation sheets from ER, and the resident stuck in the OR, I am the only one who can access the ward.  Fortunately, I was pretty confident with my previous training, making it looks easy taking care of all these patients.  In the second week, two surgical clerks joined our team, and I began to realize why senior residents are sick of supervising these youngsters.  Our resident don't even have much time to talk with me, and with my work almost overloading, I seldom have time to teach them something.  As a matter of fact, our house officer's ward round is the only time I counld teach them without being bothered my nurses.  Leading them towards the bedside, the house officer will make a brief introduction of the patient.  And I tell them what our planning gonna be and the indication of surgery.  At this time, the house officer will give them some little pop-quizes that they seldom respond correctly, exactly how I looked like last year.  It is so interesting how internship helps in the maturation of a doctor.  Seeing them anxious, nervous, and not knowing what to answer, I slowly, patiently told them the answer and began to think, "when did I learn those things?"  I didn't recall "touching" my textbook recently;  I was a straight C student in the past six years.  But why? Why did I know all the answers?  Actually, it's pretty simple.  In my clerkship, I only took care of no more than 3 patients at the same time.  i.e., I would learn no more than 3 common diseases in each course.  I had to ask for the opportunities to perform some invasive procedures: inserting Foley cath, N-G tube, artery puncture, central line.  For an intern, these are the procedures that we could find no chance to avoid.  That's the major difference of a clerk and an intern, and that's why I always want those kids to learn more by doing.