The Bovie pencil is in your hand. The attending says, "Go ahead." You have three seconds before the room realizes you don't know what you're doing, and another two to decide what comes out of your mouth. Post 10 in the Cut to the Chase Surgery Survival Series: how medical students and interns handle unfamiliar surgical instruments, energy devices, staplers, and knots without faking fluency, plus the one sentence that keeps the case safe.

The wound looks good until day three. That's when the nurse calls. The edges are raised, she says. A little dusky. You walk to the bedside, pull back the dressing, and see it — sutures biting in like a wire tie around a garden hose. The tissue is telling you something it tried to tell you in the OR.

You practiced last night on a bedpost. The knot held. Then the attending hands you the needle driver, your second throw slides, and your hands belong to someone else. An attending's take on why surgical knots slip in the OR — granny knots, unseated first throws, and the moment a mechanical task becomes a public one. For MS4s and surgery interns. From Cut to the Chase: General Surgery Survival Series.

Someone hands you the camera. The scope goes in, the monitor lights up, and within five seconds the gallbladder is drifting toward the corner of the screen — and nobody has said anything yet. This is what your job actually is, and how to stop making the picture lie.

We're at the scrub sink. Case starts in four minutes. I ask how your patient is doing — and what comes next will determine whether I can find what I actually need before I walk into the OR. Here's how to sort before you speak.

Colorectal cancer is now the #1 cause of cancer death in adults under 50 — seven years ahead of projections. A colorectal surgeon breaks down every screening option, explains why colonoscopy remains the gold standard, and addresses the misconceptions that keep patients from getting screened.

Four hours on a retractor isn't filler — it's your first real anatomy lesson from the inside. Dr. Aden Davis explains what surgical trainees actually learn by observing, staying present, and holding the field when the novelty wears off.

Surgical intensity isn't personal — it's pressure. A veteran surgeon explains what's actually happening in a tense OR, how to read the room correctly, and the difference between intensity that serves patients and intensity that serves ego.

From the other side of the drapes: what surgical teams are actually evaluating in the first few days on rotation — and why trust matters more than brilliance.

I'm a colorectal surgeon, and I want to say something that might sound strange: I hope you never need me. Not for this. Colorectal cancer is now the leading cause of cancer death in Americans under 50 — seven years earlier than researchers projected. One in five diagnoses today involves someone under 55. As a surgeon who has operated on patients in their thirties with metastatic disease, I have one ask this March: stop putting it off.

Scrub in like you belong. Attending guide walks med students through sink technique, gowning/gloving, what to say if you contaminate ("I'm not sterile"), sterile field rules (no reaching across surgeon), and fainting prevention. From hyper-aware hands at the sink to Surgical Prayer—what the OR team actually wants from you.

The night before your surgery rotation starts, you're not afraid of the anatomy. You're afraid of not knowing the rules — and nobody thought to write them down. Until now.

End-of-life conversations in the ICU are among the hardest skills trainees learn. This attending-level guide offers practical frameworks, coaching strategies, and emotional normalization to help residents lead family meetings with clarity, confidence, and compassion.

If you spend enough time in the ICU, you will miss lines. That doesn’t mean you’re bad at procedures—it means you’re learning. This attending’s guide shows how setup, mindset, and recovery turn hard attempts into confidence.

ICU nutrition is active therapy, not an afterthought. This attending-level guide teaches medical students and residents how to assess nutrition risk, start feeds safely, know when to initiate TPN, and present nutrition clearly on rounds.

RRT doesn’t require you to be a nephrologist—it requires a system. Written to help trainees, this guide helps students and residents understand when dialysis is needed, how to choose the right modality, what orders to write, and how to tell if therapy is actually helping at the bedside.

I wrote about this a couple years ago as an "Emerging Crisis" and presented information on this last year. Those words no longer fit. Early-onset colorectal cancer is no longer "Emerging". It is here! Once relegated to the realm of later life, colorectal cancer (CRC) now casts a growing shadow over younger generations. Its insidious rise among individuals under 50 demands urgent attention, a shift in clinical paradigms, and a deeper understanding of the unique biological land

A high-yield ABG teaching guide for medical students and residents using the CLEAR framework, bedside shortcuts, and worked ICU cases to simplify acid–base interpretation and avoid missed mixed disorders.

VTE is a leading cause of preventable hospital death. Effective prophylaxis requires more than "checking the box"; it demands tailoring orders to patient physiology. For medical patients with renal failure, switch from Enoxaparin to Heparin 5,000 units TID. Trauma patients often require aggressive 40 mg BID dosing due to high metabolism, while neuro-trauma requires 30 mg BID. For obesity, use weight-based dosing (0.5 mg/kg) and consider Anti-Xa monitoring to ensure safety.

One of the most common questions that seems to always come up on rounds is, "Does this patient need GI prophylaxis?" Depending on who's rounding, the day or the experience, a different answer will come. Why is this? Maybe training or experience play a role in this. We can look at the recommendations based on training. Comparing Surgical Guidelines, SCCM/ASHP Recommendations, and the REVISE Trial Stress ulcer prophylaxis (SUP) in critically ill patients has been a standard