Highs and Lows of Surgery: Juice Boxes on my Surgery Rotation

31 Jan 2021

By Hannah Case

The first two years of medical school, I found myself fighting with an inexorable desire to be in the operating room. Surgery seemed alluring; addictive almost, yet I fought its appeal. I began convincing myself that what I surely desired was to go into pediatric hospital medicine. It wasn’t the hours, the sore feet, the years of training, the personalities, nor the competitive nature of the field that led me to adamantly deny my love for surgery: it was a subconscious fear that I could not survive the long hours of operating.  After all, what is a surgeon to do if their blood sugar plummets, their continuous glucose monitor (CGM)  alarms, and their hands begin to tremble as they’re delicately suturing?


Surgery was my first clerkship of third year. I recall the week leading up to my first day, during which I met with my endocrinologist and we discussed how to best manage my glucose while in the OR.  I could adjust my bolus delivery, which may spike my sugars, but I always found functioning high to be more forgiving than functioning low. I spoke with upper-classmen who were also diabetic, seeking their advice. Not one would explicitly tell me not to go into surgery because I was diabetic, though the hesitancy surrounding that decision seemed unanimous. So, on my first day of clerkship, I made a choice.


I informed my clerkship director and every surgeon, resident, or fellow that I had the honor of working with that I was diabetic. I taught each team’s circulating nurse how to operate my insulin pump and CGM for me, on the rare occasion it alarmed while I was scrubbed in. I meticulously scrutinized my glucose prior to scrubbing each case, adjusted my basal as needed, and consumed more protein bars (provided by my incredibly supportive clerkship director) than I thought humanly possible. For 8 weeks, I was more regimented in my diabetes care than I had been for the past 14 years of my life. I was so consumed with concern for the “what if’s” that I nearly let it dictate my future career.


Most medical students abhor being wrong. We strive for perfection; studying incessantly in order to elude any possible mistake. Yet there I was, scrubbed into a 10-hour-long heart transplant at 1AM, realizing that I had been wrong. Turning my back on surgery simply because I was afraid of managing my diabetes in addition to my OR responsibilities would have been a huge mistake and I am beyond grateful to those who aided me in that discovery.


No one bat an eye when I shared my diagnosis. I was able to first assist on colectomies, perform debridements, participate in Whipple procedures, see a transplanted heart-beat for the first time, close laparoscopic ports, help reconstruct a mandible, and substantially more. The craziest part: I only had to scrub out of one case because of my diabetes. In that instance, the circulating nurse notified me that my system was alarming because I was low. I calmly had the scrub tech replace my hand that was retracting and I scrubbed out. I drank juice, waited 15 minutes, scrubbed back into the case, and proceeded doing what I love. 

Hannah Case grew up in Orlando, FL.  She attended Tulane University to complete a B.S. in Biological Chemistry and a minor in psychology.  She fell in love with surgery while at Tulane as she helped volunteer as a circulator and found herself staring over the operating curtains in awe. She is receiving her MD degree from the Mayo Clinic Alix School of Medicine, Jacksonville, and is currently in her third year. She hopes to match into Otolaryngology (ENT) – a field she found her passion for early on in her surgical clerkship when scrubbing in on a glossectomy with mandibulotomy and flap reconstruction. She has been able to establish an AWS Chapter at Mayo Clinic Jacksonville and looks forward to inspiring and empowering women to pursue their passions. You can find her on Instagram @hannah_case_13.

Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.

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