MS4, Woot!

14 08 2012

Oh, hey there!

It’s been like 6 weeks since my last update, the first four of which were spent on the trauma service and studying like a crazy person for the surgery shelf.  For the past 2 weeks, I’ve been on vacation—and it was very, very sweet.  During that time, I’ve been able to really gather my thoughts and have come up with quite a few post topics for future entries.  Right now, though, it will just be a basic reflection on my time in surgery overall.

Surgery is historically one of the most stereotyped specialties of medicine.  Surgeons earn every single one of those stereotypes and generally do very little to undo them.  There is a very macho attitude that goes with surgery.  Not laid-back, Jersey Shore macho, but more like the super-strict, military special ops guys macho.  They never slept, never ate, never had to use the restroom, never got tired, never got sick, yada yada yada.

There were really no good days for me during my trauma month.  It seemed that there were only mediocre days, worse days, and terrible-horrible-no-good-very-bad days.

During one of my worse days, I ran into a pastor in one of the empty trauma bays while I was grabbing a lead apron (these are worn by everyone in the trauma bay because x-rays are taken at the bedside while everyone keeps working on the patient).  He asked me why I was in the darkened room  rather than the one that was clearly lit and ready to receive the incoming trauma, and I replied that the students were told to take lead aprons from the unused room in order to ensure that the other room didn’t run out and therefore leave the “important people” naked.

The pastor chuckled good-naturedly, and replied, “Well, I think you are important, and you are definitely important to God.”  I thought about that for a second.  As a student, I am not important; sure, I cut clothing off of the trauma patients, help roll them onto their sides so the doc can do a rectal, help lift the transfer board so the radiology techs can get their x-rays, but nothing I do is anything special that can’t be done by the next person.   So I said, “Yes, but I am not important to the trauma surgeons.” This is indisputable.

The pastor just smiled.  “You know the difference between God and surgeons?” he asked me.  I shook my head, choosing to allow the pastor to get his punch line in.  “God never calls himself a surgeon.”

I couldn’t help but laugh.

I did have some good attendings during trauma.  One in particular was very good about teaching, and he knew his literature cold—well, he knew the literature that supported his chosen style of practice.  But still, at least he was evidence-based, which is more than I can say about quite a few of the docs I’ve worked with throughout the course of this year.  Most of the surgeons I worked with were old-school, stuck in the rut of “because we’ve always done it that way,” and almost all of them were irritated with my inquiries into why things were done certain ways.  Some of the residents were beginning to adopt this mentality as well, which was annoying because they had been “practicing” for maybe 2 or 3 years.

One of the most appalling things to me was how the patients were treated, not just face-to-face, but how they were spoken about behind their backs.  Turns out there are a lot of very disrespectful ways to describe patients during rounds, and I will go into more detail about this in a later post.  It’s not like I’ve never heard residents refer to patients in less-than-flattering ways; this has been very common in all of my rotations—except pediatrics—this year.  It wasn’t surprising or shocking to hear a 500-lb patient referred to as a “chunky monkey.”  Hearing a patient presented at rounds as a “F**king piece of sh*t,” however, was appalling.

Constant immersion in that environment, from the people to the lack of empathy to the constant stress, lack of consistent meals, and sleep deprivation led to some changes in myself that I didn’t like at all.  Regardless of how hard I tried, cynicism crept on in.  My temper was shorter, I had a harder time seeing the bright side, and I began to care more about getting out of the hospital at the end of the day than how my patients were doing.  It was miserable.

The environment of surgery coupled with generally being burned out from 3rd year also had an adverse effect on the filter between my brain and my mouth.  That is to say, it disintegrated.  I also stopped caring about the “playing the game” part of passing my rotations, and I stopped caring quite so much what my residents thought of me.  That said, I am not expecting stellar evaluations from this one.  Possibly not among my best choices, but as I don’t actually want to be a surgeon, I haven’t lost any sleep over it.  And at least my integrity is intact.

At any rate, surgery is over.  Unfortunately, so is my vacation.  Now it’s back to the normal grind studying for Step 2 and preparing for my year of master’s classes, which means that it’s also back to using this blog to procrastinate!  Hoooooray!

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2 responses

15 08 2012
S.A.B.

Very interesting post; its weird to see how viewpoints on surgery are always polarized, people either love it or hate it.

Also, you’re going to doing a masters next? I didn’t quite, follow that part.

17 08 2012
S.A.B.

Also, what are your thoughts on this article/post in NY Times, “The Bullying Culture of Medical School”

http://well.blogs.nytimes.com/2012/08/09/the-bullying-culture-of-medical-school/

So, what do you think?

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