Andrew Giles

February 2019

It is your Chief year! Did you ever believe this year would come? How would you reflect on the journey overall thus far? 

My wife and I share a running joke that it’s only going to be “5 more years!” So although there is further fellowship training to come, the maturation that has come in my chief year has been gratifying. I appreciated the mentoring as a junior resident, seeing my skill and knowledge improve as my seniors and staff invested in me, and it’s been great coming to a point where I can share some of what I’ve learned with my juniors while gaining mastery of the knowledge and technical elements required of me.

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?

In July I’ll be headed to Winnipeg to train in Thoracic Surgery. McMaster General Surgery has been wonderful and I’ve enjoyed every aspect of my time here, but I’m even more excited about focusing in this area and working with the team at UofM. My wife and our newborn will be joining me, so it will be a busy and exciting transition!

What are you going to miss the most about residency?

I’ll miss the relationships that have developed over my time at McMaster and the community that I’ve been immersed in. It’s always nice to recognize the specialist you’re calling because you’ve shared patients or worked with them on an off-service rotation.

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 Queen’s for medical school. It was a fantastic experience, I had a great class, and I got to do a lot as a clerk. I knew from the start that I wanted to do surgery. I’ve always liked working with my hands, and as a “fixer”, surgery leant itself well to my inclinations. After a brief tryst with orthopedics I realized that I preferred dealing with the life-and-death aspects of medicine, in the acute setting (traumas, ER presentations, postop decompensations) and non-acute (oncology). More importantly, I found that I “fit” best with the compassionate and thoughtful, but action-oriented, culture I found in general surgery. I had some wonderful mentors in Canada (Dr. Dath deserves special mention) and abroad (Dr. Foster in Angola) who also inspired this decision. In the end I chose Thoracics as my subspecialty for all the same reasons – similar mix of acute and non-acute with a focus on oncology, while dealing with a wide range of anatomic/physiologic systems, and a wonderful mature culture.

Where did you grow up and what did you do in your life before medicine? Not just professionally, but did you have any hobbies or passions that you still pursue?

I grew up in Oakville, but left home to go to boarding school in South Korea when I was 15. My parents had both been raised in other countries, my father in Ethiopia and my mother in India, and we traveled extensively when I was a child. After high school I enrolled in a Korean university for a semester and then spent 3 months volunteering in south China. There I was more directly exposed to medicine and it sparked my interest. When I came back to begin university in Canada I had been out of the system for a while and did not believe I could achieve the grades required for a med school application. I applied for a transfer into nursing school and was denied (a fact that my wife, an ICU nurse, makes sure I don’t forget!). Evidently I eventually managed to get into med school, and despite the challenges incurred by some of these adventures, they have also shaped my worldview and my mission in life. Travel remains one of my major passions (I’m currently writing this in the Hong Kong airport on my way home from Australia). More importantly, this led to further work in the impoverished nation of Angola and a MPH in global health. My desire is to use these combined experiences and skills to work with training programs in low-income settings to improve their trainee output and quality of training.

What is the most memorable thing that you have done outside of surgery in the last five years?

My wife and I drove through the deserts of Namibia in a 4×4 truck and hiked the Sosussvlei sand dunes at sunrise. I loved the solitude and geography of the country and would go back in a heartbeat.

What was your most memorable night on call?

In my fourth year on call at the trauma centre we received a thoracoabdominal penetrating injury. The injury pattern was bizarre, and even stranger was the fistfuls of of semi-chewed fruit we pulled out of the chest! The staff let me lead on the case and it was one of those moments where I felt everything clicking – the general surgery skillset, my feeling of excitement about the thoracic component, the ability to take on a big case and problem solve. It’s one of the most interesting cases I’ve been involved in, and I every time I look back on that night I feel the satisfaction that I think we all feel knowing we are in the right specialty.

What was the absolute funniest moment during your residency?

I was inserting a chest tube for a patient with esophageal perforation in a cramped resuscitation bay. The moment the tube went in all sorts of semi-digested nastiness poured out on my scrubs. As I was securing the tube I felt my back become progressively wetter and was puzzled how the enteric contents got all the way up there. I finished the procedure and turned around to find out I was backed against a wall-mounted automatic hand sanitizer dispenser, which had been dispensing alcohol rub down my back the entire time!

How about the scariest moment during your residency?

There are a few of these. I’d have to say the scariest was operating on a child with a metal foreign body in his airway. Bronchoscopy had failed and we had to do a thoracotomy. After making a right main bronchotomy the endotracheal tube somehow fell out and anesthesia couldn’t re-establish an airway since he was in decubitus. With sats plummeting we doused an endotracheal tube and vent line in poviodine and inubated trans-thoracic via the right main bronchotomy! Eventually they got an oral ETT back in place and we wrapped up, and the child did fine. Goes to show the value of a flexible approach!

Do you have any call superstitions or routines?

No superstitions. I have noticed that the nurses tend to remember what they need from you about 5 minutes after you leave, so I joke about this when leaving the ward to try to jog their memory ahead of time!

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?

Five years will go quickly. Look at this time as part of your career progression. Yes, work hour restrictions mean less exposure, but it also means you can live your life now. Take advantage of that, and take (or make) every opportunity given in your clinical hours. Don’t be afraid to do something outside of the typical residency progression. The year I took off to do a Master’s in Boston was an incomparable year for personal and professional development. It doesn’t have to be the anticipated research degree either – figure out what you want to do and go after that.

As far as jobs – pursue your passion. Job availability can’t be counted on – they may be available now and not when you’re done, or vice versa. If you invest in your area of interest you will eventually figure the rest out.

And finally, be a good person! Just as you like working with others who treat you well, be that for others. This will serve you well with colleagues and current/prospective bosses. It’s also the main thing that patients remember – not the specific medical actions you performed on their behalf but how you made them feel.

Rapid fire:

1. What do you listen to in the OR?

Tropical house. Or whatever makes everyone else happy – a cooperative working environment is better than my preferred music.

2. What is the operation you dislike the most?

Sentinel lymph node biopsy. So finicky and unsatisfying.

3. What is the operation you like the most?

Laparoscopic LOA, especially when it’s a single band obstruction. I actually like LOA in any form… so I’d take open as well.

4. What is your favourite medical TV show?

Scrubs! I also haven’t watched any of the other ones.

5. What is your go-to surgery textbook?

Top Knife. Not very academic but you can’t beat the Mattox wisdom and witty style.

6. Favourite post-call activity?

Besides sleep? Coffee then gym.

7. What is your favourite “go-to” food on call?

Cesar salad with chicken. Makes me feel healthy (probably isn’t) and usually available in some form most places.

8. White coat or hoodie?

White coat.

9. Single or double glove?

Always double.

10. Dry scrub or wet scrub?

Dry usually. Wet scrub when I need a moment to clear my head and think about the case.

11. Trauma laparotomy or elective Whipple?

Trauma lap.

12. Inexperienced junior resident or inexperienced ER staff?

Inexperienced junior resident. It’s a learning opportunity rather than an inconvenience.

13. Open inguinal hernia repair or laparoscopic?

Open.

14. Monocryl or skin staples?

Monocryl for short incisions, staples for long or re-do incisions.

15. Perianal abscess I+D or ingrown toenail?????

I’ll take perianal abscess. Pus is kinda fun!