I'm coming to the end of a chapter in my life. The last five years I will no doubt recall with some fondness, though it will only be because memory always seems to make grueling and painful things more rosy simply because they're past. This year has been the culmination of my surgical training, my chief resident year.

The surgical chiefs are, by all rights, the kings (and queens) of the hospital. Like few other specialties, general surgery chiefs have earned their distinction as "the one who you call when the s*** hits the fan". For five or more years of residency, these individuals spend day and night in or near the hospital. If a junior resident or a medical specialist is at their wit's end with a terribly ill patient, you can bet a chief has been called to that bedside. If there is bleeding that can't be controlled, that's who you call. Those bags under my eyes, the thinning hair, the 2-day stubble on my face, the ghostly look that says "I haven't seen sunlight in weeks," these are all the scout-badges that say "Yep. I'm the guy to call."

I learned much of what I know from my chief residents along the way, starting with Larry, my chief at UVa. I then try to pass on to my junior residents and medical students those same lessons, the ones they don't teach in books. "Always order a chest X-ray after inserting a central line." "Be sure to pack that wound all the way in to the base." "One centimeter suture bites when you're closing the abdominal fascia." I haven't always been a great teacher or patient example, but I try. Everyone remembers their surgery chief.

If a chief surgical resident says "I need an operating room NOW", the OR staff knows: 1. This is serious, 2. Someone will probably die if we don't hurry, and 3. The chief will know what to do when they're in there.

Even the surgical attendings will defer to their chief resident in consultation, scheduling, and patient care. If a chief renders an opinion, you can bet it'll be the last word. And so, after 1,017 (at last count) surgical cases, I'll soon be moving to the next level of duty, as a surgical attending. I'll again be shepherding young residents through difficult surgical cases and difficult patients. But it won't be with the badge of pride I wear on my (stained and torn) white coat:

J----- B. A----, MD
General Surgery
Chief Resident