My blockmates  and I have been rotating as Surgery clerks for the  past month. We’re counting down our final days before we all move to Internal Medicine - one of the most demanding of all rotations — so I guess it’s just fitting that I chronicle how the past weeks have been for us.

Everyday, clerks are expected to be in the Clerks’ call room by 7 AM. There’s a log book in Ward 4 where you have to sign in to prove that you really were punctual for a particular day. If you fail to sign up before a resident grabs hold of the log book, you run the risk of being marked absent for the day. During the orientation, we were told that we should be prepared to everything and anything.

They weren’t kidding.

Well, outside of doing the illegal and the  lewd, clerks work like the worker ants of the Surgery ward colony. If papers need to be done, it’s the clerk’s duty to see to it that it gets accomplished at the soonest  possible time. To facilitate this better, each student is assigned a certain number of patients. He or  she then becomes  the student-in-charge for that particular case. Paperwork such as clinical abstracts, discharge summaries and referrals all fall squarely on the SIC’s shoulders. Every day, we are expected to browse through our patients’ charts to see if the residents or consultants have anything new to request - may it be in the form of a referral to certain department for co-management or additional laboratory work for diagnostics. If the patient goes to the operating room, it is also the responsibility of the SIC to assist in the operation.

There were sixteen of us and we were split up into the four services. Every week, each group of four would rotate into a new service. Each service has a specialized area of expertise and have a different composition of residents, consultants and fellows to work with.

General Surgery II (GS II) is mainly concerned with the operations of the distal bowel (i.e. the large intestines, rectum, anus etc.)

General Surgery III (GS III) deals with surgeries concerning the liver, pancreas and gall bladder.

General Surgery I  (GS I) covers just about everything else that the first two missed. Included in GS I are procedures involving the neck, face, breast, stomach and esophagus.

Every three days, GS clerks go on 24 hour duty. We spend 12 hours (6PM to 6AM the next day) in the Emergency Room to be the Surgeons-on-Duty. We are literally the first line for the Department of Surgery in the ER. It’s fun, exciting and highly educational but fatigue does set in real quickly. We are also called up to the ER whenever there’s a procedure. On average, a clerk on duty will be called for at least two procedures on any given duty night.

 

view from the second level bunk 

 

 During the day, we spend our days in the call room. We have activities like lectures, small group discussions and service rounds that interrupt our stay in this small holding chamber but nothing interrupts  like… THE RING.

Yup. The Ring scares most if not all clerks. It’s not a call room for nothing. Whenever the  phone rings, it usually means that there’s a procedure upstairs that  needs an assist. What does an assist do? Well, it can range from real back-breaking work to a relatively easy and quick task. It’s all in the luck of the draw. Those who are going to be on duty the next day (pre-duty) are first on deck when the first calls in the morning come in. Those who will be on duty that night are then sent up once the first four clerks have finished  their turn. Post-duty clerks are protected by the system. I mean, come on, how can you expect someone who hasn’t even had a decent amount of sleep to be able to hold retractors with ample effort?

 

By the end of the rotation, all of us would’ve been the first or second assist in more than 30 procedures ranging from appendectomies, cholecystectomies, herniorapphy and rare procedures like Whipple, gastroduodenectomy and cystectomy. That translates to hours upon hours of holding up folds of skin, pushing layers  of fat and muscle aside and unbearable moments of being unable to scratch your nose in fears of contaminating the so-called  sterile field.

With the end coming near, Surgery has proven to be nothing short of a blast. Amazing. If I had it my way, I’d love to be a surgeon.

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