Surgery Reflections: Week 1 of 6

I'm going to make a point of writing down the process of discernment regarding my future residency plans.

The evolution of my desired medical specialty by eras: 

• Pre-college years: Pediatrics  (heavily influenced by the fact that I had a great pediatrician/was myself a child)
• College years: Emergency medicine (heavily influence by the fact that I volunteered in an ER for 3 years) 
• M1: surgery (colored by my anatomy experience and penchant for things involving finger dexterity)
• M2: surgery 
• M3, start of clerkships: Definitely NOT pediatrics. Maybe Internal Medicine with Heme/Onc fellowship or GI fellowship.  Surgery.
• M3, currently: surgery....and actually maybe OB/gyn is sneaking in there too

I'm currently on Breast Surgery Clinic for two weeks. I chose it because the breast surgeons were some of my favorite professors, and they are all strong women with robust family lives. They are seriously my heroes, and becoming more so with every passing day.

Impressions so far on breast surgery:

• We deal primarily with breast cancer and the removal thereof--thus knowledge of cancer progression and pathology, radiation, and chemotherapy is required beyond just the technical aspects of surgery. It has been the most specialized and difficult terminology I've encountered so far.   
• Plastic Surgery takes care of reconstruction. We just go in and remove cancer with adequate margins while preserving the aesthetics and saving enough skin to have a good result 
• Breast cancer patients are understandably distraught beyond comforting, and it takes a compassionate heart and confident demeanor to satisfactorily address their suffering...something that I will forever strive for. For now, I am just terrified of saying the wrong thing. 
• The hours are relatively great. In that most breast surgeries are done as outpatient procedures or with 1 overnight admission. We haven't yet had more than three OR patient cases per day, even if they end up being long ones. This means I get to sleep until about 5:45am on most days.
• Much of breast surgery is clinic. We have clinic three days a week to evaluate new patients for surgery planning, follow up with past surgeries, and maintain prevention. I like clinic in general and like to think I have adequate people skills, but breast clinic takes a certain finesse. 
• The surgeries themselves are technical. Breast fellowship is a 1-year fellowship beyond the 5 years of general training. The resident I follow is a PGY-5/R3, and while he has excellent surgical skills, the attendings still say similar things to him as they do to me ("Pull tighter. You're going too thin. Go lateral." etc) 
• Breast surgery is relatively bloodless. I like that compared to C-sections and other OB surgery where things like amniotic sacs and placentas pop, gush, and flow.  
• Surgery notes are great. You do things that you would never do in other inpatient services, like copy and pasting H&Ps, and using incomplete sentences like "voiding without issue. appetite good. ambulating fine." Although I like writing for fun and personal use, I find clinical notewriting to be tedious because the prose-y writer in me tends to overthink ways to state something simple. 
• I have seen the ways that breast cancer patients regard their surgeons. The disease is a scary process that creates uncertainty and feeling like it's a death sentence, even if the 20-year survival is as promising as 99%. To have someone competent and compassionate holding your hand through it is necessary. It's also such an intimately female experience that has body image ramifications. There's psychology involved. 
• In conclusion, breast surgery has so far been the most multifaceted discipline I've had the privilege of working in.