January 2020
After 3 months on a busy orthopaedic trauma rotation in Queens, I walk into the Hospital for Special Surgery for the first day of a 6-week foot and ankle rotation. Having never been on a foot and ankle rotation before, I admittedly know as much about flatfoot reconstructions and bunion corrections as I know about cooking (which is to say, not much). Still, I am excited to learn something totally new.
The attending walks into the room, I introduce myself, and the day begins. On my first day of the rotation, I am scheduled to help with at least five cases, all with a nice mix of soft tissue and bony work. That’s five procedures I have never seen before. Big day!
Over the course of this year, I have been reminded that residency is a balance between service and learning. As residents, we help the system run. As learners, we try to leverage our clinical duties to help us gain knowledge. Some days, service and learning happen equally and simultaneously. But on others—like my first day on the foot and ankle rotation—when the balance shifts heavily toward learning, it feels pretty darn good.
February 2020
The 6 weeks on foot and ankle pass quickly, and it’s back to Queens for another 3-month stretch of trauma. Half of our second year is spent on the orthopaedic trauma service there, for several reasons: lots of operative experience, graduated surgical autonomy, a wide breadth of cases, and excellent teaching both from chief residents and attendings. The rotation has a service component—we take turns taking trauma call and covering orthopaedic inpatients—but there is educational value in that as well.
Today was a very full day. We started out with a humeral nail, followed by a hip hemiarthroplasty, a cephalomedullary nail, a bimalleolar ankle ORIF, and a bicondylar tibial plateau ORIF. I find myself becoming increasingly comfortable with some of these—the hip procedures in particular—though “increasingly” remains the key word. With the hips, I try to stay ahead of my chief and attending in terms of asking for the instruments and knowing what comes next. With the other procedures, I focus on improving my technique, taking steps methodically, internalizing feedback, and trying to demonstrate what I’ve learned with each repetition in the operating room.
It strikes me that it’s all about the details, and about how each interaction gives me a chance to catch more of them. My attending shows me how he uses curved Mayo scissors to avoid cutting the labrum when making the hip capsulotomy during the posterior approach. My chief resident teaches me how to orient the pointed reduction clamps to reduce an oblique distal fibula fracture with one turn of the wrist. Later, during the tibial plateau ORIF, he shows me how he uses a periosteal elevator to gauge the depth of the articular depression through the submeniscal arthrotomy. In the moment, I make mental notes; each evening, I log these details so that I can use them for next time.
March 2020
Trauma call again. The balance has shifted dramatically toward service. Our hospital in Queens has become one of the main hospitals at the epicenter of the COVID-19 pandemic.
As I write this in late March, almost all of the hospital’s inpatients are COVID+. The orthopaedic floor was the last floor in the hospital to be non-COVID, but that too is now filled with patients who are COVID+. There are no more ventilators. The emergency room is almost unrecognizable. The pediatric Emergency Department, with its colorful painted walls, is full of adults struggling to breathe. Personal protective equipment is being rationed so that it lasts through the days to come. The mood in the hospital is somber but determined; overhead calls for rapid responses seem to never end.
On the orthopaedic service, we’re trying to minimize exposures without sacrificing patient care. Most nonemergency consults are managed by phone, and most patients with injuries we plan to treat surgically are sent directly to the floor to decrease their time in the COVID-filled Emergency Department.
I sympathize with the patients, who are helpless in the face of this terrible storm. An elderly man with a hip fracture arrives on the floor. He is frightened, and for good reason. The hospital no longer allows visitors, so he is totally alone. Every provider he sees is hidden behind a mask, goggles, gloves, and gown. I let him know that I spoke to his family about our plans to treat his hip, and that I will check on him again in a few hours. “We’ll take good care of you,” I promise him, and that seems to calm him down.
Footnotes
A note from the Editor-in-Chief: I am pleased to present to readers of Clinical Orthopaedics and Related Research® the next installment of “Residency Diary.” Drake LeBrun MD, MPH, is a second-year orthopaedic surgery resident at the Hospital for Special Surgery in New York, NY, USA. In this quarterly column, our readers will have the chance to follow Dr. LeBrun as he chronicles his transition from medical school to residency, as well as events and interactions that have made an impression on him. We welcome reader feedback on all of our columns and articles; please send your comments to eic@clinorthop.org.
The author certifies that neither he, nor any members of his immediate family, have any commercial associations (such as consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article.
All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research® editors and board members are on file with the publication and can be viewed on request.
The opinions expressed are those of the writers, and do not reflect the opinion or policy of Clinical Orthopaedics and Related Research® or The Association of Bone and Joint Surgeons®.