What’s up, party people? How’s it going?
It is Saturday afternoon almost. Yeah, it’s 12:01. It’s my day off! I was working for two weeks straight. Last night, or yesterday, I was on general surgery. It was a Friday.
Sometimes I do just trauma call, and sometimes I do general surgery and trauma call. I usually never do just general surgery by itself, but a lot of times the trauma is light in the hospital. And so it’s not that really big of a deal.
I was on for two weeks straight, and yesterday was general surgery. And I had no operations. It was a really light week, and I got really lucky. And so I took it easy.
Always the last day. I don’t know why this happens. Always the last (bleep)ing day of your string of call. You get destroyed. Nothing really happened yesterday, and I went to bed last night…
One of the mentors I work with a lot said, “It’s all about expectation management, okay?”
If you go to bed and expect to sleep all night and you get woken up five times, you’re gonna be pissed off. But if you go to bed and you’re like, “You know what? I got really (bleep)ing lucky this week and, probably, that’s not going to continue overnight.”
I went to bed, and I actually did sleep. But I got woken up at 5:30, and my shift – two weeks – ends at 7:00 am, right? And I get, at 5:30, an emergent operation. I was like, “(Bleep)!”
Because I went to bed really expecting to get woken up, I was like, “You know what? It’s been all week. I haven’t really…I had a light week. That’s not that big of a deal.”
Anyway, so I went in at 5:00, 5:30. I got there at about 6:00. I got a call at about 5:30, I got there at 6:00. Saw the patient and was like, “Yep. Need an operation.”
It was a strangulated incisional hernia, so patient had previous abdominal operations. And the small bowel had herniated through the bottom portion of the incision, so it’s an upper midline incision from the xiphoid down to the umbilicus.
I swear to God I’m gonna get to the actual video.
The hernia was about that big of a hole, and so the small bowels had come through that.
There’s different types of hernia. There’s sliding hernia where the bowels or whatever goes in and out and then there’s incarcerated where they go out, and they don’t come back in the abdomen. You can’t push them back in, and there’s strangulated, which is basically incarcerated plus they don’t have a good blood supply. So they’re compromised. Vascular flow is compromised, and they could become ischemic and die. So that is a true emergency. You have to operate as soon as you can.
How I knew that, I got a pretty good look at the small bowel. And there was a little bit of fluid. Some rattiness under on the CAT scan. You’ll understand that if you look at CAT scans. If you don’t, you have no idea what I’m talking about. But you will.
Oh, (bleep). What the (bleep) was that? Oh my God. A transformer just blew up. I think I hit my (bleep)ing car. That was crazy. Transformer exploded as I was driving underneath it. Oh my God. That scared the (bleep) out of me. What was that?
When it’s a strangulated hernia, the bowels come out. They get trapped. The vascular supply gets compromised. They can die, so it’s a true emergency. So I took the patient to the OR. Did a laparotomy, and then you basically release the bowels. They come out. There’s a hole in your abdomen. The bowels come out like this. Not like this but like this, and then they get caught. And so you have to release all the fascia of the abdominal wall and put the bowels back in and all that stuff, and so that was a two-hour operation because of just all the adhesions. The patient had a lot of abdominal operations before, and so it took a lot of time to get the bowels separated from everything around them without cutting into the bowels.
Because this patient had multiple holes and actually needed an abdominal wall reconstruction, which is a bigger deal and one of the things- I don’t really do those anymore. I have done quite a few of them, but it’s not just something I do regularly. The patient had a lot of comorbidities, and it’s an emergent operation. So I just closed it primarily, and then he can come back later and get elective abdominal wall reconstruction at another date.
Sometimes you have to do, what we call, damage control surgery. And that is just fix the emergent thing, and even though there’s some other problems going on that need to be taken care of, you don’t want to do that and extend that during an – especially an emergent operation. Especially with someon with lots of comorbidities because they can have problems like heart attack, stroke. Higher chance for infections and stuff like that. Quit while you’re ahead kind of deal.
I did that, so what I wanna talk about today is something that I am seeing a lot of people ask me about. It’s okay, but I don’t want people to go off on the wrong path. Things like, “What is my car? What is that watch? How much did that cost? Can you buy a Ferrari?”
Questions like this lead me to believe a lot of people are becoming, or thinking about, being a doctor because they think it’s a good way to make a lot of money. It is, and it isn’t. What I want to impress upon you is that there are lots of ways to make a lot of money, and even though you can make good money – over $200,000 a year for most physicians. Surgeons, higher.
When you guys start asking me about the cars and the watches and things like that, what I want you to understand is that those things should be only a by-product of your work. If you’re going into medicine for the money, you will not be that happy. You’ll be disappointed.
Even though you can make upwards of $500,000, some surgeons make over a million dollars. Not a ton, but they’re there. And if that’s your main goal, of course you’re not.
I think a good way to look at these things is that your primary focus is doing a really good job being a doctor or a surgeon. When you do a really good job at that and you’re an excellent doctor or surgeon, then that money will come. And it’ll be exponential.
When you have exponential growth in your income, you can afford all those things that you’re talking about because they no longer stress you when you purchase them.
I was talking about this, actually, on Instagram. What you want to make sure happens is that when you buy a car or a watch or an expensive pair of shoes or whatever you guys are talking about, that purchase does not even phase you. It doesn’t matter that you spent that money. That’s where you want your income.
My example is that my mortgage on my house is less than one-tenth of my monthly income. That house no longer stresses me, and that house actually is…I love my house. It becomes more of a sanctuary and a great place to spend time because I never look at it as this burden that I have to keep up, and I have to keep working for. And I don’t get angry that I have to go to work to pay for my house because it’s such a low percentage of my monthly income, and that’s how you should look at your cars and your watches and all the other expenses. That is just a good way to have nice things, but it’s a by-product of your work and your primary focus, which is being an awesome doctor and surgeon.
That’s all for today! That’s all I have. Just a little comment. Turned out to be a long video. I don’t know why. Oh, because I ramble like a mother(bleep)er.
Hey, you guys. Thanks for watching these videos. I’ll talk to you later. Subscribe, like, share, all that good stuff. And I’ll see you in the next one.
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