Q1) It is your Chief year! Did you ever believe this year would come? How would you reflect on the journey overall thus far?
“The days are long but the years are short.” What a phenomenal journey. I’m currently on a rotation that I last did in the first month of the first year of residency, and I can’t believe how fast things have gone. Surgical residency has been of course grueling and intense, but there is nothing else I would enjoy doing more. The best part about being a chief is that you literally know everyone in the hospital, the staff surgeons all know you, and you just start to hit this learning curve where you just feel like you are getting better and better. There are these magical moments where you just feel like finally things are clicking. There’s just the matter of the little quiz that we have to deal with…
The real sacrifice was made by wife and 3 kids who have had to put up with me being away so often – I’m blessed to have such an amazing family.
Q2) So what is next? Where are you off to in July? Have you already lined up a job or a fellowship or are you still keeping your options open?
I’m absolutely delighted to be going to a colorectal fellowship in Vancouver at St. Paul’s Hospital. They have such a great group with high volume colorectal surgery and they are the cutting edge of colorectal surgery with taTME. It doesn’t hurt that when you stand on the 9th floor where the general surgery ward is you can see the English Bay! I can’t wait.
Q3) What are you going to miss the most about residency?
I did my masters in Boston, and one of my co-residents came to do a research elective for a month while I was there. When I met up with her for coffee, I thought I had a glimpse of what it was like for veterans from the war to meet each other after a long period apart. We traded “war” stories and reminisced about crazy cases and funny situations.
There’s no question that I’m going to hugely miss my fellow residents. As Alfred Tennyson said, “My mariners/souls that have toiled and wrought, and thought with me-/that ever with a frolic welcome/took the thunder and sunshine, and opposed.” Some of the most profound discussions I have ever had have been with other residents at 3 am after a long night of consults and operating. Our group loves joking, talking, and spending time with each other, and we all rely on each other when we are having a tough time. I will really miss everyone.
Q4) Where did you go to medical school and how did you come about the decision to specialize in General Surgery? Was it something you gradually got into or is there an “aha” moment from your background or training?
I went to medical school at the University of Alberta. My dad is a general surgeon in a small city just outside Edmonton (Fort Saskatchewan). Funnily enough, he suggested to me that I should NOT do general surgery, mainly because of the lifestyle. I knew since childhood that I wanted to do something with my hands, so I knew going into medical school that I wanted to surgery, but because of my dad’s advice, I tried shadowing every other surgical specialty besides general surgery. However, I just found that there wasn’t any other surgical specialty that had the same ability to manage patients both medically and surgically. The day I really knew I wanted to do general surgery was when on elective the general surgeon handed me knife and said, “Ok, today is your first laparotomy.” I was hooked. I wish I had a better story, like, “I was draining a perianal abscess and I just loved it,” but I think it was the accumulation of many experiences.
Q5) What is the most memorable thing that you have done outside of surgery in the last five years?
I somehow managed to have 3 kids in the last 5 years…maybe not the smartest thing I’ve done (especially having a 3rd child in my chief year!) but definitely the absolute best part of my life. I still have moments of disbelief when I see these 3 living creatures that share 23 of my chromosomes. There is nothing like coming home and having my children rush to the front door and bowl me over. My long-suffering wife and children keep me grounded and really help me to keep my priorities straight.
Q6) What was your most memorable night on call?
The most memorable call I’ve ever had was when I was on vascular. When we do vascular, we do call for the entire weekend, which is usually quite manageable. This particular weekend was the worst weekend of call I’ve ever done. We got a patient from a remote hospital with a massive iliac artery aneurysm. By the time they got to us it was 3 in the morning. My staff thought it would be best to do an endovascular repair of the aneurysm. We spent all night doing the repair. In the morning, we ate breakfast and went back to the OR to fix a traumatic forearm AVF on a 15 year old. Immediately we started having problems figuring out the anatomy and we had to call a plastic surgeon to help us. During the middle of that OR I got a STAT page from the ward that the iliac aneurysm patient had coded. It was the first time I ever really saw someone being wheeled into an elevator while having CPR, just like the movies. We crashed the patient back into the OR. My staff starting doing a cut down on one side and in my hurry to do my side, I got into the femoral vein, and had to fix that. We called in another vascular surgeon and we got a pulse back and it was clear that the multiple grafts had lost their seal and the patient was freely bleeding into the aneurysm. We managed to fix the problem and sent the patient to the ICU. I still hadn’t finished rounding, and kept rounding till around 10 pm, having not slept the entire night. I finally went to sleep, and slept through multiple pages from the ICU saying that the patients was unable to move their legs. My staff did bilateral fasciotomies in the ICU by himself, and I finally woke up and ran to the ICU, only to see him leaving the room, his sneakers covered in blood.
After all that….the ICU withdrew care on the patient the next morning. We did 3 operations on the same patient in 24 hrs only to have the patient die. I definitely learned a lot about my own resilience, and the importance of staying cool under pressure.
Q7) What was the absolute funniest moment during your residency?
As an R1, I had finished a long night of call with an elective medical student, Evan Nelson (who later went on to become a resident in our program). We were all tired but internally satisfied with a night of hard work well done. I took Evan and one of the other R1s for breakfast and told them to buy whatever they wanted and that I would pay for breakfast. They both got a full breakfast and I was happy to pay for it. However, in my post call delirium, I had forgotten one key detail…I didn’t have my wallet! Needless to say, Evan has never let me forget it.
Q8) How about the scariest moment during your residency?
We had an elective end ileostomy closure requiring mobilization of the right colon who bled post op. Her bleed wasn’t recognized initially and we didn’t take her back till the next morning, when she was already in DIC. She had a liver injury and she had bad venous bleeding. The sinking feeling in my stomach of helplessness was something I will never forget. Despite calling in 2 HPB surgeons, and packing the liver, the patient eventually died 3 days later. I learned a lot about how to handle complications from my staff, as well as the importance of recognizing issues early.
Q9) Do you have any call superstitions or routines?
I try not let myself get too superstitious about anything. The only thing I really try to routinely do during call is to have a fresh pair of underwear, socks, and to take a shower, even if I’ve been up all night. It makes me feel like a new person, and is also helpful for anyone I have to scrub with the next day.
Q10) If you could give some words of wisdom to new Residents starting General Surgery (or to your past self on the first day of residency) in the light of everything we’re facing these days across Canada (limited jobs, duty hour restrictions, more and more specialization), what would it be?
One of the R5s (Erin Martin) and I recently gave a talk to the new incoming residents. I really liked the advice Erin had for the new residents: come prepared to the OR, own your patients, be curious and be safe, and take feedback with grace.
On a more philosophical level, having been a patient myself during residency, I would remind residents that it is an incredible privilege to be able to take care of patients and cure them of their disease. Finally, I think it’s important to enjoy the journey. I think most senior surgeons look back on residency fondly as a time when they really develop not just as surgeons, but also as people.
Q11) What would your juniors say is the best thing about you?
I think I try to approach things with a lot of humor and see the funny parts about life in the hospital. There’s a lot of laughter when I’m on call.
Also I have a secret super power…I know where all the popsicles in the hospital are!
Q12) Rapid fire:
- What do you listen to in the OR? Unfortunately I have to listen to a lot of very questionable music choices in the OR (country!!!!). I do have some eclectic taste in music, but if I had a choice I’d listen to rap (Kendrick Lamar, J Cole etc)
- What is the operation you dislike the most? anything breast
- What is the operation you like the most? laparoscopic right hemicolectomy. that operation was made for a left handed surgeon!
- What is your favourite medical TV show? I haven’t even ever watched any other medical TV show other than scrubs! which is the best!
- What is your go-to surgery textbook? Camerons
- What is your post-call ritual? workout and play with my kids
- What is your favourite “go-to” food on call? this is bad…I love burgers on call
- White coat or hoodie? white coat simply because I get way too hot in hoodies.
- Single or double glove? hey it’s 2019…double glove, everytime
- Dry scrub or wet scrub? dry. my skin gets cracked
- Trauma laparotomy or elective Whipple? elective whipple, such cool anatomy, and you need some attention to detail
- Open inguinal hernia repair or laparoscopic? hmm I would have said open before for sure but lap is starting to grow on me. I think I still have to say open
- Monocryl or skin staples? monocryl
- Perianal abscess I+D or ingrown toenail? I’ve been religiously reading the other scrubs off for the other previous graduating chiefs, and I really can’t understand the people who said ingrown toenails. really. I can’t.????