Mornings:  Up at 0700 and be ready for breakfast around 0720 – There is a shower in the room.  Breakfast is served (usually coffee, oatmeal, eggs, or cheese sandwich).  You leave for the hospital about 7:30.

OR Schedule:

The OR schedule is posted just outside the locker room in the OR area by around 2pm everyday.  It can also be found in Dr. Cuduco’s office by noon.

Typical OR schedule

Case Load:

About 35% of cases are obstetrics and gynecology, 25% general surgery, 15% orthopaedic, 10% pediatric, 3% endocrine, 3% trauma, and others including urologic and maxillo-facial surgery.  You may choose to scrub on any cases that you wish.  Monday, Wednesday, and Friday are when most of the general surgery cases are performed.  On Thursday afternoon, Dr. Valdez of neurosurgery usually has 2 cases; he appreciates your help.  Thursday is also a big orthopaedics day in the operating room.  There are multiple cesareans every day to scrub on, especially in the afternoon.   There will be occasional trauma cases through the ER as well as acute cholecystitis and appendicitis. 

Clothing:  Most attendings wear casual clothing (men: pants and a collared shirt – no tie).  It is 80-90s everyday.  It usually rains once a day and clears up within 30minutes.  In the operating room you get scrubs and can change in the locker room (co-ed).  The family does the laundry at their house on Saturday.  At least one tee-shirt has been lost, torn up, and used for rags in the kitchen, so if there are any items you are particular about, try to keep all your items together on the same line and try to hang the clothes out on one line yourself.

Work: The OR starts at 8 am and all cases usually finishes by 1pm.  Only one surgeon takes call or “service” and one gynecologist remain in the hospital to cover emergency cases. You will have the option of participating in general, gynecology, orthopaedic, urologic, neuro, and pediatric surgery.  There is surgery clinic 3 times a week, which you may participate in.  To pick up emergency cases, visit the emergency room and the obstetrics ward in the afternoons around 3-5 P.M.; also keep an eye on the OR doors, because if they are open, that means an emergency case is going and you should scrub.

Operative Experience: Please keep your daily operative log on the excel file that appears on the desktop.  Save a copy of it for yourself and also keep saving copies onto the desktop.  That way, we will be able to tabulate a cumulative experience and not have to compile those of each individual resident.  Make sure you save the file at the end of the month and bring it back with you, since you will leave the computer here.   

Scrubbing:  There is a scrub sink in the OR area on the left.  Turn the water on by hand, there is Chlorhexidine soap in old soap bottles on the shelf, and there is a bucket of scrub brushes which are reused.  When finished, turn the water off with your elbow.  Some days there is no running water; there are buckets of water on the floor which you can use a separate bucket to retrieve water and have someone pour it on your hands.  Some days there is no chlorhexadine (liquid soap); there will be a soap bar available at the sink.

 Scrub Area

After entering the room, there will be a table with instruments and folded gowns.  You’ve already opened up your gloves onto a corner of the sterile field.  Use the hand towel first, then put the gown on, the nurse will tie the back.  Next place your gloves on by yourself; now you are ready to set up the instrument table.  First place the sterile sheet on the instrument table, then place the instruments that you will use on the table.  There are usually 4 lap pads (“compressors”) and a bunch of 4x4s (“gassa”).  The nurse will first prep, then you will prep and drape.

Call Room: 

The call room is located in the adjacent building in the rear of the complex.  Dr. Cuduco has the keys (one for the gate to the building, one for the gate at the door, and one for the door).  The call room has a bathroom, shower, bed, fridge, alarm clock, windows, and a cabinet. 

 Hospital Call Room

   Call room bathroom

Items in call room (some may be stored in Dr. Cuduco’s house): 8 pairs of scrubs, mosquito net, paper, desk, bed, cabinet, refrigerator, air conditioner, soap, toilet paper, cleaning products, umbrella, alarm clock.

The water goes off several times a day throughout the hospital and may stay off for several hours or days.  The power too may go out for several minutes.  The call room is located in a separate part of the hospital.  Starting around 4pm, there is extra security and one of the main doors to the call room is locked.  We have keys to this area.  Tell the guard that we have a call room there and that it was set up by Dr. Cuduco.  Always maintain caution when going to the call room at night as this part of the hospital is closed and no one else is there.

Day Example:

7:00 AM alarm

7:20 Breakfast

7:30 Leave for the hospital with Dr. Cuduco and children

8:00 Get scrubs from nurse, change in locker room, start first case

12:30 Usually finished all elective cases

12:40 Home with Dr. Cuduco for lunch, you can call him when you are done or around 12:30

2:00   Take a cab back to hospital or go back with Dr. Cuduco (he sometimes has clinic).  There are usually cesareans, deliveries, or emergency cases all afternoon.  Dr. Valdez, neurosurgery, usually operates on Thursday afternoon.  Call the attending on call and let them know that you will be available if anything comes up.  You can afternoon round on your patients.

5pm – 8pm Take a taxi home.  Usually a light dinner.  Work on presentations, take call from home, take a walk, watch tv, go out in town, read, write, go out for a drink, relax, scrub with the gynecologists, take call, stop by the emergency room.

Presentations:  We are expected to present at least once during the month to the medical students regarding surgery.  Make a schedule with Dr. Cuduco and/or Dr. Chahin.  Tuesday and Thursday are light OR days.  The LCD projector and laptop are located in our room at the Cuduco’s, and there is a conference room in the hospital where you can project the slides up onto the wall.

Call:  We are expected to take call with Dr. Nina, one of the younger general surgeons who takes call about 2-5 times/week.  He often takes call for other surgeons, so ends up taking call quite frequently.  We take call from home, and take a taxi in when an emergency case goes in the middle of the night.

If you are not on call, but wish to be called for emergency cases of any kind, let the surgeon on call know and tell him to call you if he has a case.  There is a call schedule posted in the OR and in Dr. Cuduco’s office which lists the names of the surgeons followed by a series of numbers (i.e. Nina 2,3, 7, 14,15…) which are the dates Dr. Nina is taking call; however, often times surgeons will cover for oneanother, so don’t be surprised if the schedule changes.