Chapter 4: General Surgery

Chapter 4: General Surgery

September 23: Monday

5:15 am: Due to unfortunate scheduling, Casey is the senior resident on my team this week. Whoops.

6:20 am: Casey just pawned me off on the vascular surgery team instead of the general surgery team. Am I supposed to be insulted? Maybe he knows something I don’t about the general surgeons.

6:20 pm: Waiting for Magnus to drive me home from The Private Hospital. This is the first time I have sat down since I got here nearly 13 hours ago. I was in the OR all day long. Being way busier with longer hours here, I'm glad Magnus is at this site too.

The attending vascular surgeon named Dr. Vascular performed the first case, an aorto-bifemoral bypass. He made sure I could see the operating field and would point out various anatomical landmarks, though he didn't seem particularly interested as to whether or not I was present. Towards the end of the case he casually asked if I could tie knots, to which I replied, “Yes”. Dr. Vascular’s face betrayed a fleeting skepticism but he responded with the challenge of, "Ok good, come here and tie this knot." I tie some knots. He nods approvingly and then offers the suture and needle driver as a follow up test. I take the tools without hesitation and begin suturing. As I continued to close and adjust my handiwork at his suggestions, some of his comments were, "Good technique", "Excellent", "You seem to really be enjoying this, aren't you?" This culminated in the coup de gras statement, "Ok, you should be a surgeon." Followed immediately by, "what are you doing right now? You should come into my next case..."

Vascular surgery is so cool! All those tiny little vessels, coursing through the body under high pressure! Maybe I’ll be a vascular surgeon.

September 24: Tuesday

7:35 am: This rotation is so different than my previous ones. Barely any notes or direct patient care (at least while the patient is awake) for me to do. I'm just expected to be in the operating room all day. I arrive, preround, round, then off to the OR.

Casey warned me about Dr. Gump. She is a chief surgery resident, which is a senior resident in their last year of training. Her reputation of having poor technical skills, medical knowledge, and leadership ability are apparently well known amongst the surgery folk. I'll just try and stay on her good side and learn what I can from her.

7:45 am: There are only small scrubs (men's small, mind you) that are comically big on me. The residents and nurses were, rightfully so, laughing at me tripping over my pants.  Sigh.

8:01 am: I didn't notice yesterday but the views from some of the patient's room looking over my little city are really beautiful. 

11:45 pm: Well that was terrifying. I was just pimped nonstop for hours by a surgery attending. “PIMP” stands for “put in my place”; it is a technique used throughout medical training whereby it is established that the superior has more knowledge and expertise than anyone below them on the totem pole of medical training. As far as totem poles go, third years are at the very bottom. First and second year students aren’t even on the pole since they’re locked away studying. Pimping stems from the Socratic method of questioning a student with the goal of leading them towards a correct answer. If the teacher poses questions in a logical and progressive manner then the student should ideally be able to work through the problem and come to a conclusion on their own, even if they did not initially think they knew the answer. The College of Medicine endorses the use of the Socratic method. Pimping differs from the Socratic Method in that the goal of pimping is to point out that the student does not know as much as anyone senior to them. A student is asked questions repeatedly until they answer one incorrectly, at which point the teacher (be it a resident, or attending, or even a fourth year medical student if they’re being a total dick) can point out how little they know, deride them for not studying enough, or otherwise embarrass them. Ultimately, the student is reminded of their lowly stature on the totem pole and berated for their lack of medical knowledge. So yes, today I was pimped for HOURS.

5:05 pm: On the flip side, I was well prepped for Tuesday lectures and got props from the über impressive Dr. Mastermind for knowing my shit. Can’t please ‘em all.

7:10 pm: Nighttime rounds. Two patients already stated to me variations of: "this all happened so quick, I was sick and then I was in surgery- what happened to me?"  Patients arrive in pain, scared and overwhelmed, then whisked off to surgery, and wake up in hospital sedated and confused. I spent a lot of time provided basic education and support tonight.

9:01 pm: This is my first night on call... And it's with Casey. Now, I could have requested to do this differently but my goal is that I can help him (finally!) move out tomorrow. When I originally requested my schedule it looked as if I would be at The General Hospital while Casey was at The Private Hospital, then we would switch locations. I didn't realize there would be a week overlap where he would be my senior here at The Private Hospital. Since it's only for the first week he won't have any influence on my grade, for better or worse, anyway. He's an excellent teacher and we're completely professional at work so I don't mind working with him.

12:45 am (now September 25th): Saw some consults, wrote notes, and helped out with various patient care tasks. Time for a couple of hours of sleep.

4:02 am: I'm not saying I want to be in the hospital as a patient, but some of the patients look so cozy in their beds…

6:30 am: I miss talking to patients. Like today, there was a patient on rounds who was missing most of one of his fingers. It was well healed and completely unrelated to his current admission but I was curious and wanted to talk to him. There have been other patients that seem interesting that I have wanted to chat with but no, surgery is all business and prizes efficiency. Patients are parts that need to be repaired, replaced, or removed- not individuals.

After much thought and after helping out with some pretty cool operations, I realized that I don't want to be a surgeon. I miss spending time chatting with my patients. Just like internal medicine was not for me. There is a saying in medicine that when you find the right specialty you "have found your people." I love the efficiency, the pace, and the procedures, but surgeons are not my people. I will keep looking for my people.

6:55 am: Is it time for me to leave yet?

7:30 am: 26 hours since arrival and almost no sleep... Time to go home!

8:20 am: Rocking out to Party Rock on the way home was ideal. Goodnight my friends.

September 27: Wednesday

3:25 pm: Woke up from my post call nap. Studying and cleaning the apartment are on the agenda for today, then another date with Dr. Spengler tonight. Starting to meet and date new people while Casey is still living in my apartment has been an interesting navigational challenge. Because did he move out when he was supposed to?  No, of course not. It’s a strange stand off. It’s really hard to move on when you’re spending the day working with your ex and then sharing a bed with him at night. Why is this the slowest breakup ever?

September 26: Thursday

4:40 am: Even at 4:40 am the elevators are slow as shit here. My second date with Dr. Spengler was very disappointing. We chatted, laughed, enjoyed good food, then decided to check out a nearby wine bar because we were having such a fun time. But then disaster struck. In the midst of the conversation he casually mentioned doing something fun on my birthday- which is in January- and I began to get antsy and flustered. Like, semi-panic attack. Well, actually, full on panic attack. I don’t want a boyfriend- I just want to start dating again. Clearly I’m not ready to reenter the relationship scene. This whole dating thing was a terrible idea. He’s having a fun night but I’m still processing the fact that the guy with whom I’m having dinner with is not Casey. My date was followed by me coming home to Casey having not yet moved out. The annoying and frustrating aspect of the evening is that the date went really well. By the time the date ended all I wanted was to be hiding in my apartment. Sorry Spengler, I just can’t right now.

5:24 am: I will never again take sleep for granted. 

10:39 am: I scrubbed in with Dr. Mastermind this AM. He is wonderful- he teaches throughout the whole case, points out anatomy and yet still works very efficiently. At the end of the case he stepped out and left the Gump and I to close. While holding the laparoscopy camera she was repeatedly leaning her hefty body on my arm, causing my arm to move, and she would then remind me sternly not to move the camera unless she said so. Uh, I'm trying but I can't hold up your ginormous amount of body weight! It's as if she has no proprioception. Her general tone is condescending. In a patronizing voice she'll bark stuff like, "Good job holding that retractor, don't let go now." As much as I would like some coffee, I'm not about to let go and go grab a latte, but thanks for the advice. Her tone of voice is grating to my psyche.

10:24 am: The residents seem so unhappy and stressed here all the time. Perhaps because the two chiefs rotating here right now are idiots. Maybe it’s just surgery residents in general. Dr. Gump is my chief and Magnus is with Dr. Arse. Dr. Arse is notorious for screaming at and humiliating medical students. Some of the junior surgery residents confided in us that the more condescending, short tempered, and berating a chief is, the greater the likelihood that they are overcompensating for being poor surgeons both in terms of knowledge and technical skill. The junior residents then added that Dr. Gump and Dr. Arse are prime examples of this type of behavior. Magnus and I exchanged looks of dismay- we’ve got several more weeks with these chiefs.

1:20 pm: Dr. Vascular is bringing me back to his OR this afternoon! No offense to general surgery but vascular surgery is so freaking cool. Besides, Gump has yet to teach me anything, or really to speak to me at all. I am certainly not her primary concern, nor should I be, but all the other residents manage to make teaching points, ask me questions, or at least engage me in some sort of medically relevant conversation.

One of the nurses noticed I was freezing in the OR and brought me a scrub coat to wear. Both here and back at The General Hospital almost all of the nurses I've seen and worked with have been enormously helpful to me. When starting a rotation at a new hospital it is very disorientating and as med students we just don’t know anything about anything so their guidance is so appreciated. Thank you nurses for being kind and helping to the med students!

8 pm: At 5 pm I was about to walk out the door... then the team got a consult. Instead of being given to the student on call, Gump gave it to me. Nearly three hours later I am finally heading home. If I were Gump, I would give 5 pm consults to the student on call because they have to be there anyway and send the other students home. My feet are throbbing with every step I take as I walk out. I'm really enjoying a lot of aspects of surgery but the hours are so physically painful and, from my lowly med student perspective, Gump seems to be managing the team very poorly.

September 27: Friday

I got nothing.

September 28: Saturday

Sitting outside, enjoying the cloudless sky and fresh fall air at the coffee shop next to my apartment. I didn't have time to write on Friday because I scrubbed into two big cases that spanned 15 hours. Not only did I not have time to write, I didn't even see the sun yesterday. Being in darkness both going to and leaving the hospital is depressing. In my grand total of 20 free minutes I ate lunch while getting feedback from a resident, did paperwork, went to the bathroom- then straight back to the OR. But here was my day:

Case 1: femoral popliteal bypass surgery with Dr. Vascular

Love love love. Vascular cases with Dr. Vascular are awesome. I'm not saying that holding retractors isn't important, but it's way cooler to also be allowed to bovie, place clamps, remove body parts, and tight knots. For this case, we removed the saphenous (leg) vein and cleaned it so it could be used to make a new connection between the femoral artery and then popliteal artery. By making a new connection we restore blood flow to the leg. A good blood supply is crucial and means a happy healthy leg. Little to no blood supply means a painful dead leg and amputation. I know it's technically not general surgery so I’m not even supposed to be in his cases but he's so awesome.

In this patient, her (or his?) native artery was damaged by atherosclerosis resulting in compromised blood flow to her leg. I say 'her' with a question mark because I was fairly certain the patient was female but really, not 100%. As much as I'm enjoying vascular surgery, I'm not getting enough face time with my patients. Pretty much the only thing I know definitively about my patients is whether they've recently been on anticoagulants or if they have heart disease. 

One of the many critical points in the operation is during the anastomosis between the femoral artery and saphenous vein because the saphenous vein will act as the new artery and must be connected perfectly. I watched intently as the senior resident began connecting the two vessels. Dr. Vascular, watching me gawk at the senior resident, offers "Silvia, would you like a put a couple stitches in?" A stunned and excited "yes!" escapes my mouth. The scrub nurse hands me the micro tools so I can get a feel for them and practice a bit. I then stepped in where the senior resident had been working a moment earlier. With all my concentration and steady hands I begin stitching the vessels together. In one smooth movement, a small bite through the femoral artery and saphenous vein brings the vessels together. I did three stitches, and if asked I don't think I'd be able to pick my favorite one.

After the anastomosis is completed it is, of course, very thoroughly tested to make sure there are no leaks. During testing, Dr. Vascular and the senior resident add additional stitches until there is a watertight (well, blood tight) seal. As soon as the clamps are removed two little squirts of blood pop up like miniature red water fountains, identifying where the anastomosis needs reinforcement. Once the holes are patched Dr. Vascular informs me that my area held strong, and both leaks were on the opposite side of where I worked. Success! It may sounds silly but I don't care, I beamed with pride at my three little throws.

While chitchatting with Dr. Vascular at the end of the case my favorite comment from him was, "I don't want to ruin your life, but you really should consider vascular surgery." Oh Dr. Vascular, if ever I were to be a surgeon, I would totally follow your footsteps!

At the end of the case I closed almost the entire calf incision by myself. Before I threw a single stitch though, he put me on a surgical stool and had me perfectly set up with proper body position, view, and lighting. I started on the deep layer first, and then moved to the skin, which was friable from both age and poor blood flow. I worked slowly and methodically to bring the edges of her paper thin dermis together smoothly. After completion and inspection, the resident told me it was the best closure he has ever seen by a third year medical student. I might have had a visible skip in my step when leaving the OR.

Twenty minutes for lunch and feedback then back to the OR for case two.

Case 2: sigmoid colon resection with Dr. Gump. 

My arms are aching from silently holding the laparoscopic camera the entire case. I was a still and silent part of the scenery for nearly five hours. They could have just put the camera on a pole. My real job during the case involved ignoring Gump when she teased me about wearing make up to work and about my glasses. Yes- I am 29 years old and another adult just made fun of me about my glasses.

At the end of the case Gump asked me to close the laparotomy incisions. These require only one simple stitch at the skin. The bed was at my waist so I couldn't see well. I started to lean down and she demanded, "no, stand up, back straight now". Ok... But I can't see. I put the stitch in but it doesn't close well so I cut it out. She explains to me in detail how to suture the skin and then tells me to try again. I still can't see so I do another poor stitch that needs to be cut out. At this point, I thought of three logical things that could happen: 1) we could raise the bed, 2) I could sit down (just as Dr. Vascular had me sitting in the morning case) or 3) I could bend down a bit. The fourth option, which was the one Gump went with, was to have me try again. Gump could ask me to put in a hundred stitches but if I can't see then none of them are going to go in right. I throw a third stitch that does not close the skin well. Gump sighs, cuts it out, leans over (!), then puts the stitch in herself. She then goes on to explain to me the importance of suturing and goes on and on about how I really need to work on my technical skill. “Fuck you Gump!” I screamed with rage (though only in my head). I was seething with frustration, my skin was crawling, but I just smiled and subserviently replied, "yes, ok" and focused on all my earlier accomplishments with Dr. Vascular. I am getting physically angry again as I sit here at the cafe just thinking about how frustrated I was getting yesterday. I can't talk about this anymore. 

September 29: Sunday

5:45 am: I've been here since 5 am and haven't seen a resident yet... I'm kind of dreading today. Turns out one of the surgery residents saw photos of Casey and I on Facebook and proceeded to tell all the other residents and the Chiefs at The Private Hospital that we dated. As gossip in and of itself I don't care, but Dr. Arse is the chief on call today and I don’t want him to have any reason to start shit with me.

My fem-pop patient is doing well. I’m keeping an extra close eye on her.

I'm listening in on a conversation between Dr. Arse and an attending surgeon dubbed Dr. Angry Little Hobbit (a name surreptitiously given to her by the junior surgery residents). I’m a little nauseous hearing them speak. In over three months of rotations, this is the first time I have heard physicians speak rudely about patients. I don't want to write what they are saying because they're being so horrifically offensive. The overwhelming majority of surgeons that my friends and I have met are much kinder than we had anticipated. The old school mentality of work work work and torture your underlings is fading. Looking at Dr. Arse and the Angry Little Hobbit, they seem like misfit holdovers in this setting.

9:00 am-ish: Every time I look out the window I long to be outside. Not sure why I am so antsy today, usually I am pretty content to be at the hospital. On rounds, Casey and I noticed that Gump would not talk to either of us. Gump even made a point to greet the medical student standing next to me, "Good morning med student J, how are you today?" Casey and I stayed at the back of team during rounds and laughed about it because we dislike Gump so much anyway. But I have a new nagging concern - the chiefs are in charge of grading the med students. Gump will determine my grade. I’m so screwed.

10:13 am: It took nearly a week of searching but I finally found a stash of extra small scrubs- which are still too big but at least it's not as ridiculous looking now.

2: 20 pm: While in the OR I was offered a stool to stand on so that I could see the field more easily. Everyone started laughing when I replied that I was already standing on one.

5:15 pm: I survived rounds, laid low, and am now chilling with the junior resident on call and listening to Hendrix. So far, so good. Still feeling antsy though. On Magnus’s way out for the evening we traded horror stories of working with our respective chiefs. As bad as Gump is, the Arse is apparently living up to his reputation and provided an endless barrage of screaming, belittling remarks, and condescending statements at Magnus.

5:55 pm: It's too quiet here. It’s busy, but all the surgeries are scheduled. The atmosphere is lacking the chaos that I enjoyed at The General Hospital.

8:15 pm: It's always mildly concerning before taking down a wound dressing- you never know what you're going to discover underneath. Imagine watching a scary movie. With each layer of dressings removed the suspenseful music playing in the background creeps louder. Bloody and sticky gauze piles up on the bed and the patient begins to shift uncomfortably as you get closer to their surgical wound. You're possibly about to see something nasty but you have no idea what exactly is coming around the corner! A suspenseful pause in the orchestra just before removing the innermost layer of dressing that directly covers the wound... then, the music booms and reaches a fever pitch as the oozing surprise underneath is revealed! Full exposure! Shield your eyes! Blood, pus, ulcers, raw skin, bone, muscle, a smelly hot mess!!! Umm... Not really. Usually it's a 'clean, dry and intact wound' (written c/d/i in the charts) held together by some combination of stitches and staples. So much for the build up.

10:15 pm: I was told to unpack a patient's wound so the team could inspect it and put fresh packing in. "Packing" is basically putting strips of sterile gauze inside a wound so that the wound closes slowly over time from the inside out. If you close the wound too soon you could trap bacteria inside which may lead to an abscess. I removed the outer dressing of tape holding down an 8'x8' sheet of soft dry dressing and found a 2'x4' oval shaped wound just inferior to the patient's left rib cage. The outermost layer of packing was visible and the wound did not appear particularly deep or angry looking. I pulled at the end of the strip of gauze and hand over hand started to unpack the wound. And I kept pulling. I felt like a clown pulling an endless string of scarves of out a mysterious abyss. It kept going and going and the pile of gauze on the bed was getting larger and larger!  Fascinating! Where will it end? I had to focus on keeping a pleasant neutral face so that patient would not get concerned. Foot after foot of bloody, purulent gauze kept coming out. Occasionally I'd come across a knot where two strips of packing had been tied together. Hand over hand, on and on it went. Twenty-four feet of packing later I finally reached the other end. Twenty-four!

The surgeons inspected the wound and my next job as the lowly medical student was to repack the chasm. In order to properly pack the wound I needed to place fresh gauze inside, starting from the deepest crevices. To reach the furthest depths, I ended up having my fist and a third of my forearm inside the patient. 

I immediately went and ate my dinner afterwards. I think I have reached full desensitization.

September 30: Monday

10:00 am: I got a solid night of sleep and woke up feeling great, which was quickly overshadowed by Casey telling me that Gump and the Arse took it upon themselves to inform Casey's Program Director and my Clerkship Director that we used to date. Not sure what the goal was in doing that. Getting us in trouble? Gump and The Arse are ridiculous.

2:00 pm: Of course once the med school found out about my involvement with a senior resident they had to follow up. An email popped up in my inbox from my clerkship director asking me to come to her office immediately. Great. Well, off to her office…

October 1: Tuesday

"You had it right, but the you backtracked because I tricked you. I made you question yourself," Dr. Mastermind laughed lightly while addressing a stumbling medical student attempting to answer a question. His goal is to get us to stick to our guns and be confident when we answer questions- even if we may be wrong. There’s a saying about surgeons, “Often wrong, never in doubt.” A corollary quip about pathologist exists as well that posits, “Often right, never matters.”

Back home. Zooey has been a fabulously cheery addition to my apartment and the few hours I’ve been away from work have been great. We spent most of this evening talking about New Orleans and cooking dinner together.

October 2: Wednesday

7:05 am: My patient, Lady CRC, exudes an aura of calm, peace and hope. I scrubbed into her sigmoid colectomy yesterday to address her colorectal cancer and have been following her since. Unfortunately due to time constraints typical of being on surgery, I can't spend nearly as much time with her as I would like. I want to hang out in her room and discuss her life and adventures and learn her story. Not today.

3:15 pm: I'm hiding and eating lunch. Well, hiding makes it sound bad.... Rather, I'm sitting in a place that is not readily visible while I eat my lunch. And by not readily visible, I mean that I am sitting on the roof of the hospital. Whatever. It's not like I can't be reached between my cell phone and my pager.

I used to think it was pretty rude when Casey would put his feet up on chairs when out in public. A moment ago, right as I sat down to quickly eat my lunch and type out a few words I put my feet up on the bench next to me and audibly sighed because it felt so good to my body. No more judging the surgery residents that immediately put their feet up upon sitting down.

A classmate of mine is finally getting to see her fiancé tonight. He has spent the last seven months deployed to Afghanistan. She is not allowed to leave the hospital early to be with him.

October 3: Thursday

Being the proactive medical student that I am, the surgery teams walks into a patient’s room during rounds and I immediately start to take down a dressing so the team can assess the stump of a recent amputation. Having now seen one recent amputation I was not especially concerned about what I would see under the many layers of gauze and ace wraps. However, seconds after pulling back the first layers of gauze the patient began moaning in pain and I had a bad feeling about what I was about to see. Blood and fluid had soaked through many of the deeper layers of gauze, making the dressing sticky and difficult to unwrap. Pulling at the adherent layers caused my patients to cry out even louder, begging for me to stop and let him take a few breaths before continuing. I worked as gently as I could, getting increasingly concerned and curious about what on earth was going on under there as the smell worsened. Suddenly, the remaining clump of soaked, sticky gauze fell to the bed, and I was left staring at the cut off end of this man’s tibia and fibula, macerated and infected muscle, and a bit of loose skin that was encircling everything. It looked like a cartoon ham that had been left to rot.

I collected the pile of used dressings from his bed and tried to look nonplussed as I turned to throw them away. At that moment one of the residents realized that another vascular surgery patient needed to be seen ASAP. I was feeling a mixture of gross fascination and disappointment yet sweet relief when the resident chose me to go off and see the vascular patient. Quickly, I turned and left the man and his stump behind to be redressed by the resident and another student. I guess I'm not fully desensitized yet?

The week is almost done!

Man do surgeons love to gossip. And as a med student, we are generally ignored to the point where residents do not think we are even still in the room. I’m randomly eavesdropping on the multiple conversations around me. The attendings are talking about residents and nurses. The residents and nurses are talking about the chiefs. They’re griping about how horrible Gump is, how inefficient she is, and how she is a terrible chief. Amen to that.

Oh I’m now listening to the scrub nurses talk about Dr. Angry Little Hobbit. OMG. The nurses have a technique they use in the OR to try and protect the residents from her! Apparently they repeatedly ask her questions and distract her in order to keep her attention pulled away from screaming at the residents. Wow. I had no idea the extent of the selflessness of the nurses here.

9:00 am: An attending was lightly pimping me today about my weakness: liver anatomy.  As I was hemming and hawing about the name of a particular ligament a nearby resident leaned in behind the attending and mouthed the answer to me. It was very sweet of him, unfortunately, he was wearing a surgical mask so did little to help me out.

5:15 pm: I was very excited to get off work today at 4:45 pm instead of the usual seven or eight pm. Then I realized I still worked a 12 hour day.

While watching Glee I started laughing at some funny nonsense scene. Zooey ran out of her room with a look of shock and amusement on her face and exclaimed, "It's nice to hear you laughing!" I didn’t realize how rarely I must seem outwardly happy between working all the time and the breakup. I’m not unhappy, I’ve just been feeling a little numb to the world.

October 4: Friday

11:20 am: Six cases back-to-back! Even got to first assist for two of the cases. Usually the correct type and size of gloves are only ready and waiting for the resident and attending surgeon. I felt very special today when upon entering the OR my gloves and gown were ready and waiting for me.

3:32 pm: Sitting and waiting for my next case while hanging out with Magnus. While chilling in the surgeon's lounge we began discussing his name for this book. For reasons still unknown to me, his knee jerk response was to enthusiastically exclaim, "Magnus!" I offered other less absurd options but none of them were as random and made him as happy. So, inexplicably, my closest friend was christened Magnus for the pages of this book.

4:44 pm: An hour later, I'm still waiting for my next case. Fortunately, Magnus is on call tonight and offered to cover the case I'm waiting for so that I could go home. I may be imagining this but I think Magnus was hitting on me today. Whatever. Home I go for margaritas and tacos with Zooey!

October 5: Saturday

My first full weekend off in a month! Very exciting. Today, in theory, is the day that Casey moves out the remaining 1% of his stuff. Golf clubs, a painting I made for him, his medical school diploma, and the remainder of his kitchenware. I bet 50-50 odds he actually shows up today to complete the transition of out of MY apartment. 

11:15 am: Thank you surgery rotation for teaching me about efficiency. Instead of studying at home while holed up in my bedroom, I planted myself at a nearby Starbucks. I chose this particular locale because it is a veritable meat market of young professionals forced to spend their weekends prepping for an array of qualifying exams, comps, and board exams. Efficiency = picking up men while studying.

October 6: Sunday

Casey finally moved the last of his possessions out of my apartment. We looked at photos, went through old vacation scrapbooks, and talked (and other stuff) and still couldn't figure out what exactly what about our relationship wasn't right for him. But if it isn't right then there is nothing that can be done. Moments after his car pulled away I was on the phone bawling to my mom. I wish she was closer so I could get a hug from her. I just put out word to my friends that I could use a little love and support right now. Zooey gave me a great hug that also helped.

Momma says to keep looking forward and not back. She’s happy he is gone. And big picture, so am I.

"Confidence, passion and emotion." Words to live by. Ok so that may have just been said by Drew Bree's in the pregame huddle before my Saints took the field against the Bears but I think it can be applicable to life outside of football. Magnus and I spent the rest of evening rooting against each other as he’s from Chicago and I’m a Tulane graduate.

October 7: Monday

5:02 am: On call again.

It is freezing in the ORs at The Private Hospital. I have taken to wearing a full outfit, usually consisting of leggings and tee shirts, every day under my scrubs. Even with a full outfit under my scrubs I was still shivering today.

You know it's gonna be a bloody surgery when (after you've already scrubbed in and can't alter your attire) you notice that the residents and nurses are all wearing full face shields. My little oval shaped nerdy glasses will provide minimal coverage against massive splatter. Uh oh. I’m still oddly psyched about scrubbing into my first limb amputation.

I’m mildly jealous that nurses get to take breaks during surgeries. Surgeons, residents,  and med students do not.

12:23 am: The call room for the students and residents are on the tenth floor of The Private Hospital. Only one of the fifteen elevator banks here goes up to tenth floor. I'm so tired and bleary eyed that took me three tries to find the right bank of elevators.

4:31 am: My alarm is blaring. Where am I? Oh right. At work. I slept at work.

9:20 am: People do all sorts of ridiculous things to avoid going to the doctor. When can I go home? I really want to go to sleep.

11:14 am: I picked up my thoracic surgery evaluation. It was far better than any internal medicine evaluation. I had near perfect marks coupled with an excellent assessment. The closing comment from Dr. Thorax summarized, "I would love for her to consider a career in surgery." :)

1:15 pm: Tuesday lectures. I'm sitting in class (even though I'm post call and should be sleeping) and am getting the feeling that I need a hug. Sleep deprivation is not good for my mental well being.

2:30 pm: The lecture I'm in right now is dragging on painfully. Thing is, it's not her- it's us. She is engaging and going at a good pace but when she asks questions there is just crickets. I don't know if it's burnout from constant fatigue, the mental and physical exhaustion, or just not caring, but seriously, she must feel like she's pulling teeth with us. I am certainly not helping the situation as I sit here in my own head, typing about my own life.

2:43 pm: There have been studies showing that when people spend too much together they tend to find each other more attractive. Is that some sort of cabin fever? I wonder if any of my classmates are hot. I’ve never really looked at any of them that way. Would I hook up with any of them? There are a slew of good looking guys but mostly they’re young, and things could be super messy. Either way, more fun to think about than focusing on the surgery lecture.

5:05 pm: Finally home!! I’m too tired to do the math but I think I was at the hospital for 36 straight hours…

October 9: Wednesday

5:42 am: Ungrateful patient. Ugh. Sorry that my post-op check is disturbing your slumber. He’s laying in bed whining, "You guys aren't doing anything. If this is what surgery is always like, I am never getting another one." BTW, the team saved his life last night. And we're monitoring him constantly in case he crashes and dies... 

3:20 pm: Excellent feedback from Dr. Mastermind.

Working with Gump is pure torture ever since finding out that Casey and I dated. Her tone of voice is constantly condescending. She never addresses me by my name and keeps me out of the loop on any updates about our patients. On the other team, the Arse is routinely screaming at Magnus. He told me that he has a baseline level of anxiety and fear when at work. Earlier this morning I heard the arse yell out, "Magnus, if you ever fucking present a patient like that again I will fucking kill you." Yep. Death threats at work. You know. The usual. At least Gump doesn't yell me. I think I prefer being ignored. On the bright side, as Gump has taken no interest in me I have little bit of freedom to chose which cases I attend each day. Obviously I try to work with Dr. Mastermind and Dr. Vascular as much as possible.

8:40 pm: Carrying my iPad and journaling throughout the day has been very therapeutic. I can rant and rave on paper so it doesn't inadvertently get turned on my patients, friends, family, classmates, or any other innocent bystander. I wonder how on earth my classmates are dealing.

October 10: Thursday

1:30: Last call day! At 7:28 am this morning after rounds I had to make a tough call between taking two minutes to go pee before a long case versus taking two minutes to buy and scarf down a muffin- and no, I could not possibly do both. I opted to go with peeing. I went into all-morning case running on no food, no water, and no coffee. I could feel the ache in my head about halfway through they case and it kept building and building.

To beat down the worsening headache and stave off a migraine I just downed a cup of coffee, a bottle of water, a sandwich, and a handful of ibuprofen. A guy tried hitting on me while I was at the cafeteria desperately seeking antidotes to my headache. Flattering? Yes. Good timing? No! I hope I didn't come across as rude. This is not the healthiest of specialties. I am chronically sleep deprived and suffer from an aching back and feet. To avoid having to pee during long cases I fluid restrict myself all day, resulting in a baseline dehydration.

6:14 pm: Dr. Mastermind pimped me for nearly three straight hours during a colectomy this afternoon; all in the presence of the Gump. I was well prepared for the case and I missed almost no questions. The nurses were even joking that he could ask me any random fact and I'd come up with the right answer. There is no paralyzing fear when working with him. When I am intimidated by the attending or resident I tend to freeze up. He is brilliant and brings out the best in the people with whom he works. I was on a roll. At one point he starts asking me about tumor markers for different cancers around the body. I respond correctly to random questions about CA-19-9, CEA, alpha feto protein and on and on. He then goes way off course and asks me to name the bacteria responsible for causing the plague. I look up at him from behind my mask and protective eyewear and responded, "Yersinia." Even Gump had to be impressed. I have no idea from where that little bit of information popped into my head. I love working with Dr. Mastermind as much as I hate working with grumpy frumpy Gump.

When it was time to close Dr. Mastermind positioned me to help Gump. Gump was taken aback by my newfound surgical skill and stated that I clearly had been practicing at home quite a bit. I really hadn't practiced a single stitch at home. Nearly 100% of my free time has been spent studying surgical texts to improve my knowledge so that I can rock cases like the one we just finished with Dr. Mastermind. As miserable as I am working with Gump, she is still my chief and is responsible for grading me. I've gone with the tactic of killing with kindness. I still mostly get ignored but I figured it was the safest route and gave me the best chance of getting a decent review. I wish Dr. Mastermind could grade me. It's becoming clear though that my issues with Gump are not entirely mine; apparently it has been noticed that she favors the male students and residents.

Unlike medicine I've done everything I could possibly do to make the most of this rotation. I arrived to the hospital by 4:30 am every day to preround on my patients, prepped for every case, studied every night, and in general worked my ass off every single day. I’m trying not to get too down and frustrated that I probably won't get recognition for all the work I put in because my grade is at the mercy of the Gump. It also hasn’t escaped my noticed that working and studying nonstop every day is a great way to stay distracted from my home life.

5:48 pm: I got a sketchy text from my mom, "so are you on call...?"  This cannot be good.  After many texts back and forth she finally admitted that my dad is going to the emergency department with weird chest pain.

8:19 pm: After a negative EKG and serial labs being normal, my dad is determined to be ok. It seems most likely that he has costochondritis (sore chest muscles) from being out of shape and lifting his chubby grandsons, rather than a heart attack.

12:01 am: The view of downtown from the roof of The Private Hospital is stunning. I love the efficiency and pace of surgery. I suspect I will miss that on my next couple of rotations.

8:00 am: I got into bed as the church bells across the street started ringing in eight o'clock. Last surgery call is over! Goodnight.

October 11: Friday

Remember K Canoe from the cabrewing trip? With the blue eyes? I randomly texted him a couple of days ago, "hi, sorry I went MIA, I've been of surgery the past 2 months and practically living at the hospital. I'm around now if you're still interested in chatting." I heard back six hours later. We started texting back and forth and now we've got a date planned. Should be fun. Hopefully better than my last few dates that were all so awkward/bad I don’t even think I mentioned them. I have a feeling he’s not a relationship type of guy, which is pretty much what I want right now…

Other than Saturday night most of the next six days will be consumed with studying for my surgery shelf exam. Three hours after the test ends I'm hopping a plane to NY for my cousin's wedding.

October 12: Saturday

Study study study.

Date tonight with K Canoe.

October 13: Sunday

My date last night was great though ended kind of blah. I have a sneaking suspicion that he is relationship seeker just like the others.

I am so close to being done with surgery I can taste it. I'll finally be done with Gump and no more hearing the Arse ream Magnus all day. No more painful exhaustion, aching feet, throbbing back, shooting neck pains, being pimped all day, listening to shallow gossip, 30 hour call shifts, being surrounded by Casey's friends- no more. So close!

Have I mentioned yet how much I love my new roommate, Zooey? Even with working all the time we're still becoming good friends.

October 14: Monday

9:15 am: The rooftops at The Private Hospital are so peaceful. With the fall weather approaching it's crisp and cool outside (and also deserted). I’m only going to one case today so I'm able to sneak in a real breakfast and collect my scattered thoughts.

10:15 pm: I'm so excited to finish surgery tomorrow that I can't sleep. Which is bad, because I still have to be up at four am. I don't have any patients to say goodbye to because I didn’t have the time to connect with any of them, and I don't foresee a tearful farewell when parting with Gump. Basically I'm going to make it through rounds then escape The Private Hospital as soon as humanly possible. 

October 15: Tuesday

4:01 am: My last day waking up at 4 am! Wahoo!

9:07 am: I bailed as soon as rounds were over and my notes were finished. I had to refrain myself from running through the lobby and out the door. The moment I walked through the door to my apartment I threw off my scrubs and it felt like ripping off a layer of unhappiness.

So content right now. Studying while relaxed and cozy at my favorite Midwest bagel shop, savoring lox and cream cheese on a toasty warm everything bagel and a pumpkin coffee before heading off to Tuesday lectures. Even while rapidly approaching a notoriously challenging surgery exam I feel my body relaxing.

1:05 pm: At Tuesday lectures, sitting next to Magnus as usual. We're so happy surgery is over.  

Jade, an incredibly sweet and fun fellow third year, came up to me during our lectures and asked me to share the following story: Jade's lifelong best friend is getting married on a Friday night during our upcoming family medicine rotation. On that rotation we have lectures all day on Fridays instead of Tuesdays. Jade requested to be excused early from Friday lectures and offered to make up the coursework. The family medicine clerkship director replied, "Why did you decide to go to medical school if you just want to be in weddings?" Jade repeated the quote several times to make sure I had it written down correctly. She looked shell shocked while she was talking to me, about to either cry or laugh at the absurdity of the response the clerkship director had given her.

I was stunned that the knee jerk response by the department was to question her dedication to the medical profession. We give everything to be here. After all we’ve been through. How are we supposed to be caring and empathic towards our patients when we’re not allowed to be that way in our own lives? Talk about a recipe for bitterness. Funerals are considered valid excuses for missing work but I believe weddings should be too. Living people matter in this world; it’s too late for the dead ones.

2:35 pm: A student tried answering a question but did not use the proper medical terminology so the surgeon condescendingly sneered, "You need to answer my questions using grown-up doctor words." Oh fuck off. It’s taking all my energy and concentration not to roll my eyes. Two more hours then no more surgeons in my life for a long while.

11:36 pm: The best thing about getting into bed tonight was changing my alarm from four am to half past seven. Even after two straight months of waking up at four am I never became a morning person. And every painful morning I would swear that I was going to go to bed early but I never did. I should probably go to bed soon but I'm lost in my thoughts at the moment.

October 16: Wednesday

9:23 am: Spending an uneventful day at the med school studying with Magnus for the surgery exam. We vented about our respective chiefs for a bit then got to work.

Um, I was emailed a request to talk to my surgery clerkship director... I’ll be back…

30 minutes later….

During the impromptu meeting with the clerkship director I was directly asked if Gump primarily worked with the male students. I didn’t verbalize anything but cautiously nodded my head, ‘yes’.  She cocked her head and replied, "Ok, that's what I thought." I'm not sure of the details but I was then informed that Gump will NOT doing my surgery evaluation! How did this happen?!? Even better, my review is now going to be left in the capable hands of Dr. Mastermind and one of the other senior residents. I feel a weight has been lifted!

I thanked her and exuberantly went on my way. If I do well enough on the exam I'll be eligible for high pass or honors, which provides renewed motivation to study.

October 17: Thursday

7:30 am: Dreams of Casey all night. They were different scenes but revolved around seeing Casey either with another woman, or alone and him refusing to talk to me or even look at me. The scenes played over and over, once at a beach, once at his apartment, once at a restaurant, over and over again. I no longer existed to him. I woke up dejected, lonely, and sad. Sometimes I wonder why my brain likes to torture me.

There are many things about the rotation that I value and that I will miss. On the contrary, there were many aspects of the rotation that I can't wait to leave behind. I really enjoy the pace and efficiency of surgeons. I did not enjoy that I didn't get enough face time with my patients. During the last couple of days I had no patients to say goodbye to. In terms of independence, from now on I will try to figure out two or three solutions to a problem before asking for help. And I have a new understanding of and appreciation for being efficient. As one resident confided, “they don’t pay us more to work harder.” And in terms of being paid, considering how many hours surgery residents work, they make less than minimum wage if you do the math.

October 18: Friday

Oh sweet relief. Sitting at the airport, back at the same little wine shop, sipping on the wine bar's current flight of white wines. I feel the tension melting away. The exam was rough, don't get me wrong, but it's over. I hope I did well enough to get honors but there is nothing I can do about it now. It’s done. Over.

As I sit here sipping on my wine

Something interrupted me mid sentence while writing the above sentence and for the life of me I can't remember what on earth I was going to share. I think I'm a little brain fried from surgery.

Time to board the plane for NY. Time to see my family.

End of Chapter 4

My medical memoir, Love, Sanity, or Medical School, will be available soon on Amazon and other eBook platforms!