Jake Hiebert

September 2019

 

Q1) It is your Chief year! Did you ever believe this year would come? How would you reflect on the journey overall thus far? 

July is a pat leave month for me as we just had our third child, so it is actually hard to believe that I am a chief. The saying “the days are long but the years are fast” expresses the feeling quite well. It’s been a bit of a rollercoaster, but overall each year of training has been progressively more enjoyable.

 

Q2) So what is next?  Where are you off to in July? 

Next up is a community job that I have accepted here in BC where I will have a broad general surgery practice with an amazing group of colleagues. I always wanted to go out to the community for broad practice, as the breadth of general surgery was one of the things that drew me to the specialty. Also, my poor kids no longer know where home is from all the moving around for rotations, I need to plant them down ASAP, haha.

 

Q3) What are you going to miss the most about residency?

As I think all (or most) of the previous interviewees for SCO have answered, I’ll reiterate: relationships forged in the trenches.

There are so many experiences in residency that can only be truly appreciated by those going through the same grind. My (incredible, superstar) wife, family, and non-medical friends have been an amazing support (and I wouldn’t have gotten to this point without them), but no matter how hard you try to explain an experience to someone, the only people who can truly empathize in the highs and lows are your fellow residents.

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?

A BC boy from the beginning, I went to UBC for med.

I framed houses in high school and the year after graduation. During that year on a trip to Australia, a friend kept trying to convince me to pursue medicine – I kept saying no because I loved working with my hands in a team environment. One day he countered “well then become a surgeon”; that was my “aha” moment, and I wrote in a journal that night that I would become a surgeon. Knowing I wanted to practice in the community setting I did the community clerkship option for 3rd year med (ICC) where I found out how awesome gen surg was, and how it stood out amongst the other surgical specialties as being a career where, within the same day, you could relieve significant suffering, cure a cancer or two (or 3, or 4), and rescue someone from the brink of death. It also is a specialty that is needed at essentially any functioning hospital and lends itself to overseas work, something I hope to be involved in.

Q5) What is the most memorable thing that you have done outside of surgery in the last five years?

Besides fathering (and delivering) 3 gorgeous children with my beautiful wife, I built a small cabin for my crew during vacation weeks/long weekends. When framing houses, my goal was to one day frame a house for my wife and I – this is a (very) small version of fulfilling that goal. (It still needs some work, and a proper deck)

Q6) What was your most memorable night on call?

There are many memorable call shifts, many for good reasons but more for stressful circumstances.

As an R1, a crashing patient was in ED (previous liver transplant) with rapidly expanding abdomen on >100 levo, and ICU staff poked abdo with a needle and it rocketed full of bright red blood. I called all gen surg staff in the hospital but all were already operating, so I booked an E0 with no staff surgeon, and two ICU staff pleading with me to do something. I then decided to call vascular staff, who came to the patient’s (and my) rescue when I was already in the OR with the patient. We did a REBOA before getting into the abdomen to find the celiac access had ruptured off of big-red from a mycotic aneurysm. After more than a hundred units of blood products, blood on the OR ceiling, and a saphenous vein graft from Ao – Celiac, blood was coming from everywhere but nowhere, we vac’d but the canister filled so fast I cut a hole in the vac tape and put cell saver through the vac to give him back his own blood as it continued to pour out. We warmed him and corrected coagulopathy with ROTEM in the OR because we couldn’t move him to ICU.

I’ll never forget that image of blood leaking from everywhere but nowhere.

 

Q7) What was the absolute funniest moment during your residency?

The moment that immediately comes to mind may not translate into a hilarious story on paper, but I cannot recall another time where I have repeatedly entered into uncontrollable laughing fits throughout an entire day.

This was during CRASH (a month long series of lectures and courses for first year surgical residents), when another resident and I decided that we would use our late start time of 8am to get in shape. There’s an outdoor gym near VGH with chin-up bars, dip-bars, and a bench with a bar to hook your feet under for sit-ups (such that you can go back past horizontal for a very extended sit-up), and there’s a track there that is just under 1 kilometre per lap. Our game plan was to meet up at 6:30, run to the gym, run a lap around, do chin-ups, dips, and sit-ups, run a lap and repeat several times. This was our time to get physically prepared for the grind that would be the next 5 years.

Day 1: a struggle. We were both fine with the running aspect, but neither of us had a great deal of chin-up/dip/sit-up ability. After the second round of sit-ups we were both feeling like we would vomit, and decided at that time to limp/jog home.

Day 2: I got a morning text saying it wouldn’t work to meet for our exercise, which was fine by me as I could barely sit up to get out of bed. When I arrived for our morning lecture I saw my buddy walking down the hallway… Very slowly, limping, and his legs were approximately 4 inches further apart than would be socially acceptable. Limping a bit myself, I burst out laughing at how little exercise we could tolerate, thinking initially he just had sore muscles like – he cracked a weak smile but did not share in the laughter. He told me it was a bit more than that, and looked somewhat concerned. We then sat beside each other in the lecture where, through serious whispers, I learned that his left set of abs had blown up compared to the right and his scrotum had expanded to the size of a cantaloupe. In the quiet lecture hall we both burst out laughing, and the entire day we were sent into fits of uncontrollable laughter any time we made eye-contact. That rectus sheath hematoma was the beginning and the end of attempt to get in shape.

 

Q8) How about the scariest moment during your residency?

Coming home after a stretch of lots of call and super long hours and all I wanted was a hug from my wife and daughter (this was R1 so I only had one daughter at that time) – my daughter ran away from me, into the arms of my wife crying… the way she did with people she didn’t know… She won’t remember that at all, thank goodness, but I will. That was heartbreaking, but also scared me to my core. Now I am pretty good about taking my post-call days, and calling or FaceTiming even if for 2 minutes while on call, even if busy – even on the busiest of shifts, you can find 2 minutes (even if your mouth is full of food, or if you’re friends with OR nurses they can call while your scrubbed to let them know you’re busy and say goodnight for you).

Q9) Do you have any call superstitions or routines?

I’m not superstitious at all, so you can say “it’s quiet” all you want when on call with me. As for routines, if things are busy I stop in ED to get cups of water for my team and I to sip on while we review consults. The busier it gets, the more water I drink, which stems back from R1 on ACS after I did a couple call shifts where I didn’t drink any water and realized my urine output was worse than my patient with a wicked AKI.

 

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?

  • When with loved ones be present; spend extra time if needed before seeing them to finish what needs finishing – then give them the pure attention they deserve.
  • Your attitude shapes your experience in residency, and the experience of those around you: when getting a 3am consult for someone with abdo pain NYD, try to think, “this is a good ED doc who is having trouble figuring this one out”, and try to think “this patient is in a ton of pain, and there’s a possibility I could be the one to help them”. Take a moment to find out how your patient’s biliary colic or hernia affects their life before doing the OR. I think this mentality helps with your resilience (and that of your colleagues), as it is easy to grumble about consults, or get your sense of accomplishment by adding one more gall-bag to your T-res log, instead of getting it from the fact that you really improved someone’s quality of life or added years to it.
  • Be kind to all and politely refrain from participating in hospital gossip. It’s a tempting but “cheap” way of getting along with hospital staff, and contributes to a toxic environment. Change the subject to asking about their family or what they would be doing if they had the day off.

 

Q11) What would your juniors say is the best thing about you?

This question is a classic brag about yourself trap – that I refuse to fall into.
Ask me what they think the worst things about me are and I’ll give you a list (too humble, care too much, too nice, perfectionist, things always too easy for me, etc etc etc).


Q12) Rapid fire:

  1. What do you listen to in the OR? I like to poll the team to see what people are feeling. But I do my best to veto country music, which I feel belongs only in a truck while on a hunting or fishing trip.
  2. What is the operation you dislike the most? Self-inflicted stuff (stab wounds excluded), ex: rectal FB
  3. What is the operation you like the most? This is constantly changing, right now I would say MIS adrenals/spleens – nice quick clean cases, and cool anatomic relationships, and some vessels that keep you on your toes.
  4. What is your favourite medical TV show? Scrubs
  5. What is your go-to surgery textbook? Seeing Sabiston’s is sitting open beside me at this moment… but it’s a hate>love relationship I have with it.
  6. What is your post-call ritual? Often a run of some sort (home from hospital, or around the sea wall), a power nap, then spend some quality family time in the afternoon on the couch reading books or at the park.
  7. What is your favourite “go-to” food on call? I always bring leftovers from home. But if I’m feeling generous (to myself), I’ll find a coffee shop and get a coffee and white chocolate macadamia nut cookie
  8. White coat or hoodie? We have general surgery vests that I like, occasionally I’ll have a hoodie on underneath it.
  9. Single or double glove? Double
  10. Dry scrub or wet scrub? Dry
  11. Trauma laparotomy or elective Whipple? Trauma (…Trauma whipple?)
  12. Open inguinal hernia repair or laparoscopic? First repair open, redo/bilat lap – love both
  13. Monocryl or skin staples? Staples, unless there’s an MSI/junior that needs to learn to suture.
  14. Perianal abscess I+D or ingrown toenail????? Abscess for sure. Just pretend that every abscess you drain will progress to Fournier’s if you don’t show it who’s boss.