Chapter 5: General Surgery

Love, Sanity, or Medical School

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Chapter 5: General Surgery

September 23: Monday

5:15 am: Due to unfortunate scheduling, Casey is the senior resident on my team this week. Whoops. When I originally requested my schedule, it looked as if I would be at The General Hospital while Casey rotated 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.

6:20 am: Casey just pawned me off on the vascular surgery team instead of keeping me on the general surgery team. Am I supposed to be insulted? Maybe he knows something I don’t about the general surgeons. As I understand it, general surgeons mainly do surgeries on organs within the abdomen such as the gallbladder, the appendix, and the colon.

6:20 pm: Waiting for Magnus to drive me home from The Private Hospital. This is my first time sitting in nearly 13 hours. Spent the entire day in the OR. Being way busier with longer hours here, I’m glad Magnus is at this site too or else I don’t think I would see any of my friends this month.

The attending vascular surgeon Dr. Vascular performed the first case, a complicated and intricate procedure called an aortobifemoral 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. “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 included, “Good technique,” “Excellent,” and “You seem to really be enjoying this, aren’t you?” This culminated in the 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 for me to do (at least while the patient is awake). I’m expected to be in the operating room all day long. I pre-round from 5 am to 6 am, round with the team from 6 am to 7 am, then I’m in the OR from 7 am until about 6 pm, which is when the night team arrives.

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

7:45 am: There are only size small scrubs available here (men’s small, mind you), and they are comically big on my petite five-foot-two-inch frame. 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 overlooking my little city from some of the patients’ rooms are really beautiful.

11:45 pm: Well that was simultaneously terrifying and exhausting: three straight hours of hardcore pimping by a militant surgery attending. Time to run back to The General Hospital for afternoon lectures.

5:05 pm: The über-impressive Dr. Mastermind gave me props today for being well prepped for his lectures and knowing my shit. Time to run back to The Private Hospital for my overnight call.

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

9:01 pm: This is my first night on call… and it’s with Casey. Now, I could have scheduled this differently, but my goal is that I can help him (finally!) GTFO of my apartment tomorrow.

12:45 am (now September 25): 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 them look so cozy in their beds.

6:30 am: I miss talking to patients. Like today, I saw a patient on rounds that happened to be missing most of the fingers on one of his hands. His hand is completely unrelated to his current admission, but out of curiosity I wanted to hear his story. There have been other patients with whom I’ve wanted to chat, 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 scrubbing into some pretty cool operations, I realized that I don’t want to be a surgeon. I miss spending time chatting with my patients. Surgery is not for me. Just like internal medicine is 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: Twenty-six hours since arrival and almost no sleep. Time to go home!

8:20 am: Rocking out to LMFAO’s “Party Rock Anthem” kept me wide-awake on my drive home. Goodnight my friends.

September 25: Wednesday

3:25 pm: Woke up from my post-call nap. Studying and cleaning my 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. Him continuing to live here feels like a strange sort of standoff. As if he’s waiting for me to cave and ask him to take me back. Well, it’s not going to happen. Though admittedly, it is 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 ended terribly. We chatted, laughed, enjoyed a delicious meal, and 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 flowing 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. Spengler is out having a fun night but I’m still processing the fact that the guy with whom I’m having dinner is not Casey. I came home from my date to find that Casey still has not yet moved out. The annoying and frustrating aspect of the evening is that the date went really well. By the time we finished our glasses of wine, all I wanted was to be hiding in my apartment. Sorry Spengler, I can’t right now.

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

10:39 am: I scrubbed in with Dr. Mastermind and chief resident Gump this morning. Dr. Mastermind is wonderful; he teaches throughout the whole case, pointing out anatomy and other interesting findings, yet still works efficiently. As the lowly med student, my job today alternated between holding the laparoscopic camera and the retractors. The laparoscopic camera is a small, flexible camera used to see inside the body during surgeries. Retractors hold tissue and body parts back so that the surgeons have a better view of what they’re operating on. While holding the camera, Gump repeatedly leaned her hefty body against my arm, causing my arm to move. She would then sternly remind me not to move the camera unless she instructed me to do so. Uh, I’m trying but I can’t hold up your ginormous body weight! It’s as if she has no proprioception. Her general tone is condescending. In a patronizing voice she’d 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 acid tone of voice is grating my psyche.

10:24 am: The residents seem unhappy and stressed all the time. Perhaps because the two chiefs rotating here right now are idiots. Maybe surgery residents in general are just miserable. Dr. Gump is my chief and Magnus is stuck 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 so-called 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 me shivering 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 worked with have been enormously helpful to me. Starting a rotation at a new hospital is extremely disorientating and as med studs, we really don’t know anything so their guidance is so appreciated. Thank you nurses for being kind to us!

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 now 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 student 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 physically painful and, from my lowly med student perspective, Gump seems to be managing the team astonishingly poorly.

September 27: Friday

No energy left for typing. Must sleep now.

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 long cases that spanned a total of 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 went straight back to the OR. But here was my day:

Case 1: femoral popliteal (“fem-pop” in surgeon-shorthand) 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 make the initial incisions, open the body, place clamps, remove diseased tissue, and do all the stuff that residents get to. 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 and popliteal arteries. By making a new connection, we can restore blood flow (and oxygen flow) to an oxygen-starved 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’m not even supposed to be in his cases because it’s not general surgery, but he’s so awesome.

In this patient, her (or his?) native artery became damaged by years of high blood pressure and high cholesterol, resulting in compromised blood flow to her leg. I say ‘her’ with a question mark because I was fairly certain of the patient’s gender, 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 blood thinners or if they have heart disease.

One of the many critical points in the operation is creating the anastomosis, i.e.: suturing together the femoral artery and harvested saphenous vein. The two ends must be connected perfectly in order to successfully transform the vein into a makeshift artery. I watched intently as a senior resident began connecting the two vessels. Dr. Vascular, watching me gawk at the senior resident, offers “Silvia, would you like to put a couple stitches in?” A stunned and excited “yes” escapes my mouth. The scrub nurse handed me the micro tools so I could 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 both 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, 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 (literally, 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 sound silly but I don’t care, I beamed with pride at my three little throws.

While chatting 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 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 steadily holding the laparoscopic camera the entire case. I stood as still, silent scenery for nearly five hours. They might as well have just put the camera on a pole. My real job during the case involved ignoring Gump as she teased me about wearing makeup to work and about my purple frames. Yes, I am 29 years old and another adult made fun of me about my glasses.

At the end of the case, Gump asked me to close the laparotomy incisions. These are tiny and 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. “No, stand up, back straight now,” she barked.

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 (similar to how 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, involved me trying again.

Gump could ask me to put in a hundred stitches, but if I can’t see the surgical field, 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 (!), and then puts the stitch in herself. She then goes on to explain to me in excruciating detail about the importance of suturing and on and on about how I really need to work on my technical skill. “Fuck you, Gump!” I screamed (in my head). Frustration seethed through me and my skin crawled at the sound of her voice, but I merely smiled subserviently and focused on all my earlier accomplishments with Dr. Vascular. My heart is starting to race and I am getting twitchy as I sit here thinking about 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 junior surgery residents saw photos of Casey and me on Facebook and decided 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 “Chief” Arse is 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 – work, work, work and torture your underlings – is fading. Looking at The Arse and Dr. Angry Little Hobbit, they seem like misfit holdovers in this setting.

The other residents laugh at them and brush it off by saying, “Oh, they’re always like that, we don’t take it personally.” I don’t get that type of behavior. I wonder if they knew I was writing about them if they would still speak so... what’s the word... so freely? 

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, loudly stating, “Good morning med student Jade, how are you today?” Casey and I stayed at the back of the 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. They’re still too big for me, but at least I’m not as ridiculous looking now.

2: 20 pm: A nurse kindly offered me a stool to stand on while in the OR so that I could see the operating 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 appears to be living up to his reputation, too. He has been word-vomiting an endless barrage of belittling remarks and screaming condescending statements at Magnus.

5:55 pm: It’s too quiet here. It’s busy, and there is a ton of work to do, but all of the surgeries are scheduled, predictable. The atmosphere is lacking the chaos that I enjoyed at The General Hospital.

8:15 pm: It’s always mildly concerning 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 going to find something gruesome, but you can never predict the extent of the visual assault your eyes are in for. 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 buildup.

10:15 pm: Casey ordered me to unpack a patient’s wound so the team could inspect it and put fresh packing in. Packing involves putting strips of sterile gauze inside a wound so that the wound closes slowly over time from the inside out. If you close a wound too soon you can trap bacteria inside which may lead to an infection, or abscess. Unpacking is the corollary process of removing packing that has been previously placed. I removed the soft and dry outer dressings to find an unremarkable oval shaped wound below the patient’s left rib cage.

A tail 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, starting to unpack the wound. As I kept pulling, I felt like a clown tugging an endless string of scarves out of a mysterious abyss. It kept going and going and the pile of gauze on the bed grew larger and larger. Fascinating. Where will it end? I had to focus on keeping a pleasant neutral face so that the 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 involved repacking 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 boss and my surgery rotation supervisor that we used to date. WTF. Not sure what their goal was in doing that. Getting us in trouble? Gump and The Arse are ridiculous. Either way, the residents all rotate tomorrow and Casey will be heading back to The General Hospital. Unfortunately, the chiefs do not switch so Magnus and I still have nearly three more Gump-and-Arse-filled weeks.

2:00 pm: Of course, once my med school discovered that I was ‘involved’ with a senior resident they had to follow up. An email popped up from my supervisor asking me to come to her office immediately. I had to assure her multiple times that our relationship both started and ended before my surgery rotation and that I had no qualms about seeing him at work. I left out the part that we’re still living together and occasionally having sex. Whatever.

October 1: Tuesday

2:49 pm: “You had it right, but then you backtracked because I tricked you. I made you question yourself,” Dr. Mastermind laughed 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.

8:32 pm: 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 the evening talking about New Orleans and cooking dinner together.

October 2: Wednesday

7:05 am: My newest patient, Lady CRC, exudes an aura of calm, peace, and hope. She has colorectal cancer. Yesterday, I scrubbed into her OR case and we removed the diseased part of her colon. 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 eating lunch in a place that is not readily visible. By not readily visible, I mean the hospital’s roof. It’s not like I can’t be reached between my cell phone and my pager.

I used to think it 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 contentedly sighed because of the blissful relief. No more judging surgery residents who immediately put their feet up while 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 there to greet him when he arrives.

October 3: Thursday

The surgery team walks into a patient’s room during rounds and I immediately start to take down the patient’s dressing so the team can assess the stump of his recent amputation. Having seen one recent amputation, I was not especially concerned about what I would find under the many layers of gauze and Ace Wraps. However, seconds after I pulled back the first layers of gauze the patient began moaning in pain. An uneasy feeling about what would be found beneath the dressings quickly took hold.

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 patient to cry out, 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 sort of mangled mess existed under there. The smell worsened as I worked. Suddenly, the remaining clump of soaked, sticky gauze fell to the bed, and I stood staring at the cut-off end of the man’s tibia and fibula, macerated and infected muscle, and a bit of loose, ragged skin attempting to contain everything. It looked like a piece of meat 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, the senior resident received a call that one of the vascular surgery patients needed to be seen ASAP. I felt a mixture of gross fascination and disappointment yet sweet relief when the resident chose me to go off and see the vascular patient. I turned and quickly left the man and his stump behind to be re-wrapped 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! The med studs are generally ignored to the point where residents do not think we are even still in the room. I’m randomly eavesdropping on 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.

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. They repeatedly question her, distracting her 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 hemmed and hawed about the name of a particular ligament, a nearby resident leaned in behind the attending and mouthed the answer to me. It was a sweet gesture. Unfortunately, he was wearing a surgical mask so mouthing the answer did little to help me out.

5:15 pm: My initial excitement about leaving work at 4:45 pm instead of the usual seven or eight pm was hampered by the realization that I still worked a 12-hour day.

While watching Glee I started laughing at some funny nonsense scene. Zooey ran out of her bedroom 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 recently. A little affective anesthesia.

October 4: Friday

11:20 am: Six cases back-to-back-to-back-to… You get it. I even first-assisted in two cases. Usually the correct type and size of surgical gloves are only ready and waiting for the resident and attending surgeon. Today, I was thrilled to discover that my gloves and gown were laid out in the OR, ready and waiting for me!

3:32 pm: Sitting and waiting for my next case, hanging out with Magnus. While chilling in the surgeon’s lounge we began discussing his name in this book. For reasons still unknown to me, his knee-jerk response when asked what he wanted his name to be was to enthusiastically exclaim, “Magnus!” I offered many other less absurd options, but none of them was as random, or 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 so, I’m going 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. I plan to sleep for most of it. Today, in theory, is the day that Casey finally moves the remaining 1% of his stuff out! 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 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, had breakup sex (again), talked for a long time, and still couldn’t figure out exactly what about our relationship wasn’t right for him. But if it isn’t right, then there is nothing to be done. Moments after his car pulled away, I dialed my mom and bawled to her over the phone. I wish she lived closer so I could get a hug. Momma encourages me to keep looking forward, not back. She’s happy he is gone. And way deep down, so am I.

I 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.

“Confidence, passion, and emotion.” Words to live by. Ok so that phrase may have just been uttered by Drew Brees 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 the 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 now wear a full base layer, usually consisting of leggings and heavy shirt, every day under my scrubs. Still shivering today, even wearing multiple layers.

I’m oddly psyched about scrubbing into my first limb amputation. 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 surgeons and nurses are all wearing large face shields. My nerdy little oval glasses will provide minimal coverage against massive splatter. Oops.

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

12:23 am: The call rooms for the students and residents are on the tenth floor of The Private Hospital. Only one of the 15 elevator banks goes up to the tenth floor. I’m so tired and bleary eyed that it took me three tries to find the right bank of elevators.

4:30 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.

9:23 am: When can I go home? I really want 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 clinical grades 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), 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 nothing but crickets. I don’t know if it’s burnout from constant fatigue, the mental and physical exhaustion, or purely 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 life.

2:43 pm: There are studies showing that when people spend too much time 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 is a slew of good-looking guys but mostly they’re young, and things could be super messy if I dabbled in my class. 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 stayed 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 lying in bed whining and bitching. “You guys aren’t doing anything. If this is what surgery is always like, I am never getting another one.” 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 she found out that Casey and I dated. She 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. Magnus told me that he has a baseline level of anxiety and fear when at work. Earlier this morning I heard The Arse shriek, “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 at me. I think I prefer being ignored. On the bright side, as Gump now actively ignores me, I have a little bit of freedom to choose 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 extremely therapeutic. I can rant and rave on paper (well, not real paper – digital paper), so it doesn’t inadvertently get turned on my patients, friends, family, classmates, or any other innocent bystander. I wonder how my classmates are dealing with the stress.

October 10: Thursday

1:30 pm: Last call day. At 7:28 am I had to make a tough call, 2 minutes to go pee before a long OR case vs. 2 minutes to buy and inhale a muffin. No, I couldn’t do both. I opted for peeing. I went into the all-morning case running on empty – no food, no water, and no coffee. I could feel the ache in my head about halfway through the case and it kept building.

To beat down the worsening headache and stave off a migraine I downed a cup of coffee, a bottle of water, a sandwich, and a handful of ibuprofen a minute ago. 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 often fluid restrict myself all day, resulting in a constant state of dehydration.

6:14 pm: Dr. Mastermind cheerfully pimped me for nearly three straight hours during a colorectal case this afternoon, all in Gump’s presence. Being well prepared for the case, I missed almost no questions. When I am intimidated by an attending or resident, I tend to freeze up. But there is no paralyzing fear when working with him. He is brilliant and brings out the best in the people with whom he works. The nurses even joked that he could ask me any random fact and I’d come up with the right answer.

I was on a roll. At one point, he asked me about tumor markers for different cancers around the body. I responded correctly to questions about CA-19-9, CEA, Alpha-fetoprotein, and on and on. He then went way off course and randomly asked me to name the bacteria responsible for causing the plague. I look up at him from behind my mask and protective eyewear and without hesitation 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 dumpy Gump.

When it was time to close, Dr. Mastermind positioned me to help Gump, who appeared taken aback by my newfound surgical skill. She stated that I had clearly been practicing at home, a lot. In reality, I 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 tasked with grading me. I’ve gone with the tactic of killing with kindness. I still mostly get ignored but I figured it is the safest route and gives me the best chance of getting a decent evaluation. I wish Dr. Mastermind could grade me. It’s becoming clear that my issues with Gump are not entirely mine; apparently it has been noticed that she favors male students and residents.

Unlike internal medicine, I’ve done everything I could possibly do to make the most of this rotation. I arrived at the hospital by 4:30 am every day to pre-round 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 about the fact that I probably won’t get recognition for all the work I put in because my grade is at Gump’s mercy. It also hasn’t escaped my notice that working and studying nonstop every day is a great way to stay distracted from my personal life.

5:48 pm: I received 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 several rounds of normal labs, it is determined that my dad is ok. It seems most likely that he has costochondritis (sore chest muscles) from being out of shape and repeatedly 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 fell into my own cozy 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 two month ago? The one with the blue eyes? I texted him.

“Hi, sorry I went MIA, I’ve been on 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 planned a date. Should be fun. Hopefully better than my last few dates that were all so awkward/bad that 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… no relationships. Just fun.

Other than Saturday night, most of the next six days will be consumed with studying for my surgery final 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 started off great though ended kind of blah as we each went home to our own separate beds. I have a sneaking suspicion that he is a relationship seeker 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? Even with working all the time we’re still becoming good friends.

Tonight will be a Mexican fiesta at my apartment with Piper, Maggie, and Sophia. Beer and guacamole all around.

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 awake at 4 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 from running across the lobby and out the door. The moment I passed back through the door to my apartment I threw off my scrubs. It felt like ripping off a layer of unhappiness.

10:25 am: 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.

My sweet, hardworking classmate Jade approached 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 supervisor 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 talked to me, about to either cry or laugh at the absurdity of the response she received.

I’m 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.

On another note, I’m touched that she thought of my writing as a venue for her to get her story out into the world.

2:35 pm: A student tried answering a question but did not use the proper medical terminology so the surgeon snarkily remarked, “You need to answer my questions using grown-up doctor words.” Oh fuck off. Two more hours and then no more surgeons in my life for a long while.

11:36 pm: The best thing about getting into bed tonight involved 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. Every painful morning I would swear that I’d start going to bed early, but I never did. Speaking of going to bed, I should probably try to sleep, but I’m lost in my thoughts at the moment.

October 16: Wednesday

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 an urgent request to go talk to my surgery supervisor. I’ll be back.

30 minutes later.

During the surprise meeting with the supervisor, I was pointedly asked if Gump worked primarily with the male students. I didn’t verbalize anything but cautiously nodded my head. She cocked her head to the side and replied, “Ok, that’s what I thought.” I’m not sure of the details, but I was then informed that Gump will NOT be completing 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 merrily 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. There were different scenes but all revolved around seeing Casey either with another woman or him alone, 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, incessantly. I no longer existed to him. I woke up dejected, lonely, and defeated. I wonder why my brain likes to torture me.

There are many things about the rotation that I valued and that I will miss. I really enjoyed the pace, expertise, and technical skill of the surgeons. I have a new appreciation for efficiency. In terms of independence, from now on I will try to figure out two or three solutions to a problem before asking for help. On the contrary, there were many aspects of the rotation that I can’t wait to leave behind. The main issue though is I didn’t get enough face time with my patients. I barely knew who any of them were.

Final bout of studying.

October 18: Friday

Oh, sweet relief. Back at the airport, sitting at the 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.

As I sit here sipping on my wine

Something interrupted me while writing the sentence above. I have zero recollection of what I was about to type. Surgery has clearly fried my brain.

Time to board for NY. Time to see my family. Farewell surgery, farewell Casey, farewell shitty little Midwest City. I’m on my way to New York for the wedding of my cousin Violet and her fiancé David.

Love, Sanity, or Medical School: A Memoir, will be available soon on Amazon and other eBook platforms!