Tyler Chesney

July 2018

University of Toronto

Q1) It is your Chief year! Did you ever believe this year would come? How would you reflect on the journey overall thus-far?
Wow! It is quite impressive how quickly this has all gone by. It seems both like a short time and a long time. The days have been long and tough, but so rewarding. I am awed by how formative these years are not just as a surgeon and a professional, but as a person. I have transitioned from quiet and acquiescent to a bold advocate and capable surgeon. I viewed residency as an immersive process to develop into a safe and competent surgeon. I have gained this and much more. My mentors and colleagues, and many friends along the way, have been truly inspiring. On reflection, there are three global lessons that stick with me. First, this is a hard job, but it’s a great job! Second, complaining constructively to the right listener with data and ideas for solutions can make for real change. Third, precise and thoughtful communication is one of our most important interventions; with this, we can turn chaos into clarity.

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 am so honoured to have been selected for the Surgical Oncology Fellowship training program at the University of Toronto. I am thrilled to spend two more years of focused training on the care of patients with complex cancer problems with some of my greatest mentors.  

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

While I am happy to move on, there are many things I will miss. Most I will miss the camaraderie and inspiring mentors and colleagues. It has been such a privilege to work with so many truly incredible people. I have met some of my best friends. We have been through good, bad, and great. I have been lucky to be influenced by such talented colleagues that have inspired me to become a very different person and doctor than I ever expected. I am proud to be amongst them, and it will be hard to say goodbye.

 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 have wanted to be a general surgeon since I was a child. I first learned about surgery when my brother needed an operation, and I was fascinated. I have never been able to shake it. Throughout medical school at McMaster I tried to convince myself I didn’t want to be a surgeon, but it just didn’t work. I loved everything about general surgery then, and I still do now. This is a great job!

Q5) 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 Peterborough. I went to Queen’s for my undergrad and then Master’s in Neuroscience. I worked with older adults, worked in dementia clinics and volunteered with patients with dementia, and studied cognitive aging. I also worked in a Hospice for a summer. Studying cognitive neuroscience was fascinating, and the experiences I had in working in these settings stick with me now. As I pursue further training in surgical oncology, I remain engaged with the challenge of caring for older adults and those with poor prognosis.

I learned to cook with my mom and grandmother. I love to cook, and have always wanted to cook in a restaurant. I love going to restaurants that have a passion for food. Exploring the food scene in Toronto can keep one busy. When travelling, I always book a local cooking class. There is no better way to learn about the local culture, local food, some language, and what’s good to eat! Exploring the World’s 50 Best Restaurants list has brought several unforgettable delights.

I also love music. I play the flute and used to be in several bands. More recently I began learning the piano, and I find practicing very relaxing. I attend the symphony whenever I can, and the Toronto Symphony Orchestra has a great listing every year.

More recently I have been inspired by the Department of Surgery Book Club to re-explore literary fiction. This may prove somewhat distracting as I study for the Royal College exam!

 Q6) What is the most memorable thing that you have done outside of surgery in the last five years?
Although residency is busy and intense at times, I have been fortunate to travel to some interesting locations on vacation. Finally, with designated vacation time I was able to explore new locations and cultures. Cheese, bread, and champagne in Paris. Historic finds in Berlin. Beaches in Brazil. Local food of Thailand. Gardens of Tokyo. Villas in rural Italy. Sand dunes in Morocco. Hiking the rice paddies of northern Vietnam.

Q7) What was your most memorable night on call?
My most memorable night on call was as a PGY1. We had 14 traumas come in overnight, and this was my first night on trauma call! My senior was in the OR doing a AAA most of the night. Luckily, I had a great TTL who showed me the ropes. It was also the first hot weekend of the summer too, so mostly all motocyle and boating traumas. If that wasn’t enough, I saw 6 gen surg, 2 vascular, and 1 thoracics consult too. If I hadn’t learned efficiency yet, I learned it then!

Q8) What was the absolute funniest moment during your residency?
We were in a long oncology case, we had a very keen elective medical student on our service. They of course were trying to impress our staff, and were doing a pretty good job. We had made reasonable progress on the dissection of a very large tumor requiring multivisceral resection. The elective student had been entrusted with the suction. The dissection was slowing somewhat, and we had been operating for several hours. The student then places the suction straight onto the tumor with a big “shhhhhhhluuuurp”. The staff saw this and suddenly grabbed the suction and in a diabolic breathy voice whispered “don’t ever suck the tumor”. We all paused silently, until we all burst into laughter about how utterly terrifying this was.

Q9) How about the scariest moment during your residency?
The scariest moment was during my first solo case with staff outside the room. It was a straightforward laparoscopic right hemicolectomy. The junior and I were doing the case, which was going surprisingly well. We were aiming for a high ligation of the ileocolic pedicle. We divided the vessel and blood started to well up in the central abdomen. I felt like I had never seen so much blood. I must have divided the SMA. I thought as I imagined the entire bowel becoming ischemic. Instead, after a deep breath I grabbed the suction and realized that only a small ooze from the mesenteric fat was causing the bleeding and could be easily cauterized… perspective is everything!

Q10) Do you have any call superstitions or routines?
I like to plan dinner early so that I know something is in the works. Nothing like finally getting a chance to eat and realizing nothing is open! Otherwise, efficiency is the key.

Q11) 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?
Really, my main piece of advice would be to enjoy the process. Give of yourself to this work because it truly is a privilege, and it can be a lot of fun. Come to work everyday with passion and enthusiasm. Reflect on your personal and professional development. The end will come much more quickly that you expect. If you do this, you will find what works for you.

Q12) Rapid fire
What do you listen to in the OR?
Usually whatever the staff picks; otherwise my current favourite Spotify playlist

What is the operation you dislike the most?
Laparoscopic ventral hernia repair

What is the operation you like the most?
Low anterior resection (open, lap, transanal are all good!), or a nice multivisceral right hemicolectomy

What is your favourite medical TV show?

What is your go-to surgery textbook?
Scientific American Surgery for real clinical practice, Cameron’s for a quick overview

Favourite post-call activity?
Sitting in a cozy chair with a big delicious latte

What is your favourite “go-to” food on call?
Really anything from UberEats        

White coat or hoodie?
White coat

Single glove or double glove?

Dry scrub or wet scrub?
Dry, but a meditative wet scrub is nice every once in a while

Trauma laparotomy or elective Whipple?

Inexperienced junior resident or inexperienced ER staff?
Inexperienced junior resident – they are keen and sponge-like

Open inguinal hernia repair or laparoscopic?

Monocryl or skin staples?
A nice subcuticular with Monocryl in the right situation is loved by patients

Perianal abscess I+D or ingrown toenail?
Perianal abscess I+D by far!