discuss in the next chapter). They are Medicine, General Surgery, Pediatrics, Obstetrics and Gynecology, Neurology and Neurosurgery, Ophthalmology (eyes), Psychiatry, Radiology, Orthopedics, Ear, Nose and Throat (Otorhinolaryngology), Anesthesia, Preventive Medicine, and Urology. Additional studies for the fourth year may include Prenatal Obstetrics, Ambulatory Surgery, Emergency Room Medicine, Geriatrics, and Primary Care.
And you graduate and get your M.D. degrees to the sounds of “gaudeamus igitur” and all that stuff, and usually someone reads the Hippocratic Oath, and now you're a doctor. Unfortunately, those are just the very basics, which don’t really prepare you for much because you haven't had enough clinical experience. Most United States medical students take the National Board Examinations before they get their degree, and this helps them to get licenses in states other than where they went to medical school. But in most cases the new doctors go on to get further training in a specialty of their choice, such as Family Practice, Emergency Room Medicine, Radiology, or a host of other interesting areas. We will discuss the surgical specialties in Chapter IV.
Oh! You might reflect on the fact, that while you are sweating away in medical school, most of your college buddies are well established in some business, making a living, and raising a family. (Some medical students are married, but it creates a great stress on the family, and the husband or wife usually needs to support the student for many years.) It's a difficult period to go through and yet, for the individual fascinated by medicine and intent on helping others, it never becomes tedious or boring. After these four years, the new physician may opt for additional training, so that many doctors don't even start their own practices until they are almost thirty years old!
Chapter 4
INTRODUCTION TO SURGICAL SPECIALTIES
When I was young in college, to feel good I had to lie,
To other guys who often seemed much cleverer than I
So I went off to med school, and determined I would find
A specialty that I could use to give me peace of mind.
And after four hard years I found my niche in general surgery
Where I could talk to patients and not be accused of perjury.
And when I meet old college pals (on benches in the park)
I can truly say I always have the final cutting remark.
When the physician has completed his studies for an M.D. degree, he may decide that he wants to go on into a surgical specialty. This will require him to enter into a postgraduate training program called a residency (sometimes including a first year called an internship) and may spend as many as six to eight more years expanding his knowledge and experience. He is generally taken on as a special resident physician at a university hospital, clinic, or private hospital and paid a meager salary during this period of time. Depending on the specialty, he may be on duty thirty-six hours and off twelve hours, including weekends, or may just have an eight-hour day and be available for emergencies.
In Part II of this book, we will discuss the various specialties and each major procedure in more detail. At this time I just want to familiarize you with the main fields of surgery and outline for you the types of procedures they do.
First is general surgery, my own specialty. At one time, about a hundred years ago, this encompassed all the areas of surgery, and the general surgeon could handle all surgical procedures, including the chest, heart, orthopedics, and pediatrics. Over the years each specialty has advanced to the point where one individual cannot have an expertise in all areas, and young surgeons have learned to choose which area is most interesting for them.
General Surgery encompasses Abdominal Surgery (stomach, intestines, colon, appendix and rectum, pancreas, liver, spleen, gallbladder, and adhesions), skin, breast, thyroid, parathyroid, hemorrhoids, pilonidal disease, esophagus, hernias in the abdomen, abscesses, “Lumps and Bumps,” and a diverse selection of cancers throughout the body. Although this is not a complete list, it includes most of the procedures which the practicing general surgeon does today. For this he is usually required to take an internship for one year and four to six years of residency training. In some programs, such as the one I went through, the resident does research in an area of his interest and may write a thesis and get a Masters of Science in Surgery Degree.
The second area I want to address is Peripheral Vascular Surgery. This usually requires a surgeon to take an additional one to two years of training after the general surgical residency, although some comprehensive programs combine the general and vascular surgery in one training program. Vascular surgery includes suturing, repairing or replacing the major blood vessels of the body, such as the aorta in the chest and abdomen down to the smallest one-millimeter vessels in the hands and feet which can be approached surgically. In the arms and legs, the arteries are considered medium-sized and are much more amenable to repair than the tiny vessels of the hands and feet. Vascular surgeons are the ones who sew arteries and veins together for use during dialysis for kidney failure, and place all kinds of artificial shunts and bypasses, either to get around blocked vessels or for dialysis access, as we will explain in a later chapter. This specialty also corrects problems of the carotid artery (which supplies blood to the brain narrowing may cause a stroke), renal (kidney) arteries narrowing of which may cause hypertension (high blood pressure), and vein problems (varicose veins and venous ulcers). The most recent advances in vascular procedures are in the field of endovascular surgery, where a trained specialist can repair an artery using balloons and special devices placed in the damaged arteries through tiny incisions, obviating the need for major vascular surgery.
Urology is the surgical sub-specialty which includes kidney, ureters, bladder, prostate, testicles and internal and external genitalia. In this field we have the kidney, ureteral and bladder stones, prostate enlargement, and various types of cancers specific to this area.
Orthopedics (which literally means “straighten the child”) is the medical and surgical treatment of bones and joints, including the spine (which is shared with the neurosurgeons) and all types of trauma involving the bones and joints. These surgeons handle back pain and joint pain, amputations, and endoscopic surgery on the joints. Some orthopedists go on to further specialize in complex back and spinal surgery or hand surgery, including procedures which require microsurgery (using special magnifying lenses to repair tiny vessels in the hand). A whole field of re-implantation surgery has developed for severed limbs, which requires further expertise and training.
Gynecological surgery centers on the female reproductive organs, the vagina, cervix, uterus, tubes, and ovaries, including hysterectomy (removal of the uterus), salpingectomy (removal of the fallopian tubes) and oophorectomy (removal of the ovary). These surgeons also may do diagnostic or therapeutic laparoscopy (using a small incision and placing a small camera in the abdomen to avoid large incisions), such as tubal ligation or identification of pelvic infections or other problems. A whole advanced field of Gynecologic Oncology has developed requiring two to four additional years of training to learn how to remove all cancers involving female organs.
Next we move on to Neurosurgery, the specialty focusing on diseases involving the brain, spinal cord and nerves. It requires two years of additional training after the general surgery residency, and the neurosurgeon must be well versed in the diagnostic abilities of a neurologist to identify the problems in brain function. We will go much more into detail about neurosurgery in later chapters.
Thoracic surgeons, not surprisingly, operate on the thorax or chest cavity, which includes the esophagus, lungs, ribs, and chest wall. They remove lung cancer and other tumors, benign and malignant, and do surgical procedures for infections in the chest, called empyemas and lung collapse secondary to trauma or emphysema (a disease where the lungs contain abnormal air pockets that may rupture).
