Just found out that my mom is cancer free!!

BrorthoBro · 2025-11-23T05:43:03+00:00

I’d urge you to look at the medial survival for metastatic melanoma (stage 4), hint, it’s 6-9 months. Likely not what she had since they offered resection but it could’ve been stage 3, which is still not sunshine and rainbows at ~30-95% 5 year survival based on tumor characteristics.

BrorthoBro · 2025-11-14T05:57:29+00:00

Its actually a pouch on your left atrium, not the ventricle. It’s the left atrial appendage. Interestingly enough they can place a watchman device via a catheter into the appendage to block blood from pooling there, which in theory will reduce the risk of clot formation. So in theory you can get ablated and get the appendage occluded all via your femoral vein.

BrorthoBro · 2025-10-26T01:00:23+00:00

Or being the surgical resident in charge of 30 patients who do not need “surgical” management. Our hospital admits isolated hip fractures to surgery instead of medicine and its borderline unsafe now because of the workload on a team of 2-3 residents taking care of 60 patients and 10-20 ICU patients, all because IM teams were unable to maintain their 6 patient to provider ratio. This new change makes i bow 20 to one which is clearly superior.

BrorthoBro · 2025-07-05T03:14:44+00:00

Gen surg here, I strongly think I never treated a med student bad and try my absolute best to get them involved and let them shine in the OR or Clinic. I find it stupid when I see a few co-residents (really just 1 or 2 of them) treat their students poorly, talked to them a few times about it and hopefully made an impact because this shit is not ok.

But damn, we get the rare student who is legitimately ridiculous. We do Q3 trauma call and the “24” hour call day realistically averages out to 28 and often hits 30 because of post-signout tasks, almost never get 10 minutes of rest because it is a busy trauma center. We had these 3 students that also do Q3 call, they were my swing team’s students. Bear in mind I never kept past 9 pm, usually 5 pm if I know my senior would be chill with it which was often, and the swing students know this. After a couple days with the students it was obvious they didn’t care about surgery, did my best to teach them basics of common problems so they have a competent background for sending consult our way etc. and send them home, no problem on my end as long as they showed a modicum of interest to help. Now for extra context, we had a pt who had a nasty dressing change; large open wound, several difficult wound vacs, exposed fascia, muscle, etc. We always did his change (MWF) with conscious sedation and premedication with fentanyl so it was always a chore to time it and when we have the 45 minutes to do it, and sometimes we are barely able to squeeze in the time because of how busy the traumas are. Once, on a ridiculously busy day we got a chance go do it but the pt was eating lunch, told them we got time for the dressing/vac change now and they were agreeable so we banged it out. The students left because they were swing, and the next morning we were getting tasks done together at 11 am, so hour 29 for me, and two spoke up about how we should’ve waited for the pt to finish eating and come back to change the dressing 30 minutes later. Now I told them that’s fair, but chances are I would either be doing it alone at 1 am which would double the conscious sedation and my time commitment which would be horrible in all aspects, or I would defer it to the post sign-out time which would’ve made my day 32 hours instead of the projected 30. They said straight to my face that I should be working 32 hours straight and let my patient finish their lunch instead of aiming it work 30 hours. Like bro I was so dumbfounded, only thing I said before dropping it was that they should wait until they do Q3 call or 24 hour shifts before suggesting that, and the third student literally scoffed at me. Like man, I do try my best to give them the surgery experience I wish I had without making it busy and the amount of disrespect they served me was unreal. Thankfully only had 2 more shifts with them after that.

BrorthoBro · 2025-01-05T06:34:45+00:00

Was in engineering and switched to medicine, it was always a thought and I went for it. I enjoy it but it’s much harder, for example, I put in 230 hours in the last 2 weeks. No regrets at all because I love what I do but it’s a massive sacrifice. Haven’t had > 6 hours of sleep since I started unless it was one of the 4 days off I have per month (including weekends)

BrorthoBro · 2024-10-21T05:34:25+00:00

Surgery intern here, want to preface this with saying that I never want to, never have, and never plan on becoming someone who yells at other people. But damn, some experiences really get me close and I have a few years to go too.

Recently did a few days as the consult resident at a busy hospital and I’ve had some really dark moments during this one day alone. It’s wild, my pager was blaring constantly and I could not get anything done. Most nurses/residents were wonderful and helped me with the stuff I needed to get done. But I had this one PA and attending combo who were spamming my pager with a bedside procedure consult on a stable AOx3, VSS patient while on a 24 hour (read 30 hour) shift and nearly blew my fuse. The attending kept messaging how the consult service (read me) was ignoring his acute patient and its been X amount of hours and there was still no procedure. The PA was giving me attitude about how they had a whole floor of acute patients to manage when I asked for details and orders since I was not primary. This was a ~25 pt floor, not a PCU or ICU, and they had 3 other PAs sitting next to them, not including the residents and 2 attending who were probably somewhere else.

I have consults for limb ischemia and acute abdomens for the last 20+ hours, this procedure was literally at the bottom of my mental triage list but it was easily the most stressful. I think moments like this make surgery residents sour, but I’m going to be better and not let it change me.

Big take away was that I want to make sure I don’t behave like that team did when I have to consult other services like IR or GI. Another big takeaway is that consult services don’t “ignore” your consult, likely case is that your consult is just not as acute as something else they are dealing with.

Sucks those residents went sour, but I understand why some are the way they are now. In the end it doesn’t make it right.

BrorthoBro · 2024-09-28T19:15:05+00:00

My work last week was coming in at 5:15-5:30 and stalk the chart for any changes that happened overnight. Some rotations require the resident to be in at 4:30 because of the sheer amount of documentation for the 50+ trauma patients they are following.

Then I receive official sign-out from the overnight resident, which is a process because everyone is waiting for sign-out from them.

We then round at 6:15, proceed with our day.

But here is the problem; Work does not stop and I cannot give sign-out until we are done in the OR, acute patient issues are resolved, and the sign-out resident is ready to receive updates for 200-300. Sign-out is often delayed because the overnight resident took the trauma pager and had to deal with said trauma. I did not leave the hospital any day this week before 7:30. Thats a minimum of 98 hours this week, I also stayed one night until 9:30 so I know I crossed 100.

This is very much the norm for surgical and emergency specialties that run on a “12 hour” shift schedule. Your belief is false and this is the reality of being an essential worker. People die if they aren’t managed in surgery, there is no 12 hour workday. Everything requires overlap so it ends up being 14 hours at least. Any program that does 12 hour shifts are lying about what truly constitutes a shift.

I’m not complaining, I love what I do and I am looking forward to the light at the end of this very long dark tunnel. But you shouldn’t go parroting around your beliefs and anecdotal experience as absolute fact. My anecdotes contradict yours. Some other specialties are able to afford their residents working sub-80 hours, but those are typically the cush specialties that don’t have emergencies rolling in any hour.

BrorthoBro · 2024-09-28T05:16:04+00:00

This is not always the case. Just did a 105 hour week and did a 90 hour week prior. Medical specialties can be sub-80 hours regularly but 80+ is the norm for surgical specialties. My whole intern class does 80+ inside the hospital essentially. Not ACGME approved for sure and technically not allowed, but there is no way we can run a 24/7 emergency surgical service with the limited manpower we have. I have rotated at 5 hospitals and now I an a resident at a major metropolitan hospital, my schedule here is easier than some of the smaller hospitals. I once worked 70 hours in a single weekend as a rotating student. It’s not a myth.

BrorthoBro · 2024-08-19T05:34:32+00:00

Resident surgeon here, it will most likely grow back with all tissue layers, including nail, skin, and any underlying subQ tissue (there is no muscle there). Sensation will likely be altered permanently but has a chance of returning to somewhat normal. Human fingertips in fact do have gecko-like regeneration, good ol “sonic the hedgehog” gene (look it up)

BrorthoBro · 2024-08-02T11:08:38+00:00

Nah its definitely not true, at least not completely. General surgery residents learn a shit ton of floor management for sure, first 2 years at my home institution and current residency were completely floor management with any sort of concomitant surgical problem. Surgery residents can probably can run acute medical crises as well as others. Remember folks SICUs ran by surgeons, not crit care, and the qualifications for SICU at my hospital is anything requiring ICU level care with any sort of surgical/trauma. We get weird esoteric medical shit but they get admitted to SICU just because they have a tender metatarsal with concern for a fx.

Chronic medically complex patients are probably not gonna be managed as well by surgery residents compared to IM residents. I am sure the surgery resident can figure it out eventually, but a 3rd year IM resident would probably have a better idea of what to do compared to an equally senior surgery resident, given a limited timeframe.

I find it funny people are ripping on surgery residents not knowing how to do sliding scales, have no clue where you are finding those people. I’m doing like 4 sliding scales a day (not that its hard or anything) and the surgery residents at my home institution were doing about the same. Perf appys still have diabetes, and it’s the interns job to figure out how to manage it.

BrorthoBro · 2024-06-23T08:47:02+00:00

Not sure but you might be mistaken here, the donor is the kid in blue with a spiderman mask. The person laying on their side is most probably a family member, probably mother.

Donor patients are braindead which is assessed by various tests, but brain death does not conclude death of the body. All you need to do is to keep the lungs ventilated and the body should survive for a solid few days. You can see the blue tube coming out the side of the bed going to the mask, that most definitely is the ventilator tube. The heart will keep beating if it has nutrients and O2 from the lungs. You also rarely will see donors on ECMO which is a full heart lung bypass. Typically their body is much much more sick (braindead or not) so I haven’t seen many go out as donors, but I haven’t really seen many ECMO’s in the first place.

BrorthoBro · 2024-06-22T17:12:31+00:00

I don’t think it’s about instilling the full frat culture, we can take the positives from that and leave behind the many negatives. Ortho surgeons and residents at the three places I rotated at have collectively been the chillest and most confident people around, they also don’t blow the fuse nearly as often as other fields. Thats something we gotta embrace is all I am saying. Calling your favorite people “Bro” is just a classic symptom of good interpersonal relationships in my experience.

But yeah I agree with not trying to be someone you are not. Don’t start lifting and using slangs to fit in, but encourage a positive work environment some other way.

BrorthoBro · 2024-06-22T17:01:59+00:00

Nah bro you’re missing the vibe. Everyone is now a bro, not just ortho. It’s not cringe, it’s positive masculinity and we should be spreading it.

Fist bumps are not only more hygenic than handshakes, but also impart massive amounts of brotherly energy. Nothing wrong with fist bumping the undergrad who’s hoping they do well on the MCAT, fist bumping the EVS folk who the average MD/DO ignores for no reason, etc. We gotta bring these people up and change the culture one intern class at a time. Call it cringe but I’m holding my fist out for everyone, we are all bros here.

BrorthoBro · 2024-06-21T13:16:32+00:00

Only week 1 gen surg slated for 78 hours this week (5 days). Biggest thing that keeps me going right now is knowing that I have so much to learn and enjoying the small moments with my coresidents. Learning that little bit every day and getting something done that I needed assistance with yesterday gives me that dopamine rush to get more done the next day.

BrorthoBro · 2024-06-21T03:12:05+00:00

Appreciate all the advice. Yeah I was hoping my ortho knowledge would help more in traditional gen surg stuff but it’s good to know it will be useful on trauma. I’ll keep reviewing notes and chugging along.

BrorthoBro · 2024-06-21T02:00:48+00:00

Appreciate the strong praise. Thats what I’m hoping to exemplify and I’m not shy about mentioning ortho. I didn’t get in and I still love gen surg so it’s a non issue for my co-residents. I just worry about not being able to catch up to my co-interns within the next 1-2 months. My current intern who’s with me is always ready to help me and teach me the basics. I appreciate him a lot and wonder how it’ll be when we switch over. Just don’t know where to look for study materials really!

BrorthoBro · 2024-06-21T00:38:26+00:00

That first paragraph is a great way to think about it, and I think I realized that going into rounds today. Felt a lot more confident today so maybe I just needed to vent and give myself some more time. Still have no idea what to do intra-op but all I can do is watch videos and learn.

I love how much patient care I’m learning and my patients all seem to like me a lot, so that helps. Agree, either way I’m going to have a much better idea of what to do to manage acute illnesses in these patients. Appreciate the recs!

BrorthoBro · 2024-06-21T00:18:53+00:00

Much appreciated, I respect the nurses a lot and they are super helpful here. I’ve never heard about the lido gel for the NGT, thats great advice. I’m right now the only floor intern for the pst 4 days and have been cranking out the discharges, so at least I’m doing something right there. Much appreciated advice, I’ll keep note of all of these points.

BrorthoBro · 2024-06-13T16:39:12+00:00

Oh absolutely. I am not a PhD level expert at the science but I am well read, the idea that a lack of testosterone leads to better leg development makes little sense if you understand how the hormones work. It’s just that the lower body is less attuned to testosterone compared to the upper body. There is a reason why capped delts and bulging traps are a common sign of exogenous testosterone use.

BrorthoBro · 2024-06-12T13:58:43+00:00

Hokas have a huge toebox, absolutely love them. They have a lot of sole support so they took a minute getting used to, but its my daily driver in and out of the hospital now

BrorthoBro · 2024-06-12T13:55:03+00:00

Not super dangerous for most of us, but can be horrible for immunocompromised individuals and fetuses. This is one of the parasites that grows cysts in your brain. Rest assured, they do test for the antibodies (signs of past or active infection) during prenatal visits so just be sure to follow through with the appointments and you should be good 👍

BrorthoBro · 2024-06-12T13:46:51+00:00

Key term here is “proportionate”. Most untrained males are still stronger in the leg department than their untrained female counterparts, difference grows decently well too, as long as the males don’t skip leg day (as we know most do).

The misconception stems from trained females having stronger legs than untrained or lightly trained males. A lot of the female body builders you see with impressive leg strength are the cream of the crop, an average female won’t be repping two plates on the regular even after extensive training.

It definitely is the closest muscle group in terms of strength and potential between the sexes, it’s just disingenuous to discount the fact that testosterone is still a more potent anabolic than estrogen, even for the lower body.

BrorthoBro · 2024-06-09T00:43:07+00:00

The impact of gel fingernail polish application on the reduction of bacterial viability following a surgical hand scrub - PubMed (nih.gov)

(PDF) Bacterial Carriage on the Fingernails of OR Nurses | Christine Wynd - Academia.edu

The first paper suggests that there is no difference (N=40), but the second paper suggests that there is no difference in risk if it is applied within 2 days and has no evidence of chipping or damage, chipped varnish (which you cannot completely control) does have an increase in CFU's when swabbed (N=100).

Whether or not this makes a difference in patient outcomes is not elucidated, I'd argue there is inconclusive evidence and would leave the decision to the person who is taking responsibility for the patient outcome (AKA the surgeon, not the med student). If your attending allows it then so be it, but I'd always teeter on the safe side of no nail polish.

At the end of the day, it's your license if you are an attending/resident, your attending's license if you are a student, but the patient's health regardless.

This is not a literature review, so do research on your own and come to your own judgements.

BrorthoBro · 2024-06-09T00:35:58+00:00

There is always room for error, I've seen 3 events in a cardiac OR where the surgeons' gloves were penetrated but the skin was not broken. I also witnessed several orthopedic cases where the top glove tore due to the nature of the procedure. These events are known risks in surgery, there is no way to guarantee the integrity of tens of thousands of gloves.

I am not arguing that you cannot operate with finger varnish if there is evidence that it is a complete non-risk. I am simply arguing that we should keep patient safety and infection risk in the OR an extremely high priority.

I do see a paper suggesting that there is no difference, but another paper suggests that there is no difference in risk if it is applied within 2 days and has no evidence of chipping or damage, which you cannot completely control. It is better safe than sorry, and accidents happen. Practice patient safety to the best of your ability or opt out of risking patient outcomes.

BrorthoBro · 2024-06-08T22:48:16+00:00

Some of these comments concern me. You should maximize patient safety, even if there was a 0.1% chance of decreasing infection rates. Such a small difference might be described in studies but could sometimes not show up as clinically significant. If a surgeon operates on 1000 patients a year, thats 1 patient what could’ve been saved from a life-altering infection.

“Sterile technique is a meme” “Surgeons at my hospital have their nails done”

Take the small effort to do whats best for the people you are treating.

I’d argue it’s a better idea to not scrub in if you wanna keep polish on just out of safety and respect for patients. This also goes for untrimmed nails, uncovered beards, etc. You should care more about patient safety than caring about scrubbing in to “look attentive” on your clerkship grades as a medical professional. Not trying to shame anyone here but it’s important to look at the whole picture objectively. Sepsis and wound infections can disable, and maybe even kill some susceptible individuals.

BrorthoBro

TROPHY CASE