Surgery Post-Mortem

[beep]...
"Wait, is that a...?"
[beep]...

"We've got a pulse!"

"I thought we lost it in surgery!"

"We did, but it's back. Let's make the most of it!"

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I'm not dead! And neither is my blog, though neither of us made it through that surgery clerkship unscathed. For the first time in nearly three years, I will not be logging something I learned for each day of medical school. Between the night shifts, the already miserable day shifts, and studying for the shelf-exam, I just couldn't spare the time or, more importantly, the energy to write my blog on top of it. So I will give you my parting thoughts on surgery and then start clean with the pulmonology elective I started on Monday.

I loathed my surgery rotation, but I did not loath surgery itself. It's very satisfying to be able to definitively do something for a patient other than think, tweak, and wait - as is the norm in most of medicine. Your appendix hurts? Cut it out. Your gallbladder is inflamed? Cut it out. Your stomach holds more food than you'd like? Cut part of it out. Your leg is trying to kill you? Cut it off. Yes, surgery creates scars but, in a way, those are marks of where we tried to help.

I also liked the tight-knit team atmosphere. In order for a surgery to happen efficiently you need the collaboration of the surgeons, med student*, anesthesiologist, scrub tech, and circulating nurse - plus the countless other people who are tangentially involved, like the pre-op nurse, PACU nurse, whoever the people are that clean the stretchers, the laboratory for rapidly interpreting intraoperative specimens, and others. When everyone is working together like a well oiled machine (preferably to the groovy tunes of the Beatles (it happened once!)), it makes me proud to be an (optional) member of the team.

*You don't actually need a med student unless there is some part of the body that needs retracting that there isn't already a good retracting device for (e.g. the liver can typically be retracted by a adjustable metal arm attached to the bed) or if you're lazy and want someone to help** the resident suture at the end.

**Note: this may not actually speed things up.

But even at the hospital I rotated at, noted by past students for being pretty mellow compared to other hospitals, the professional environment was often toxic. Attendings belittled the senior resident who belittled the residents and interns who belittled us. Everyone is overworked and sleep deprived, but to show either is to show weakness.

This field is also the only one I've experienced all year where a resident or attending asks what you want to do for a living and is annoyed when it's not their field. Tell a psychiatrist that you don't want to do psychiatry and they respond, "Ah well, few do! But let's see if we can give you the basic knowledge that will help you in whatever field you do choose." Surgeons tended to want us to learn what they had to learn: names and techniques only very tangentially applicable to anyone shunning the surgical specialties.

My least favorite part of the rotation was that I was so miserable that I was at times a grumpy asshole to the few residents who actually were nice me and to my classmates who were just as tired as I was. They say you get used to the schedule and pace of surgery, but honestly I worry about the version of me that would come out the other side.