Chapter 1: Intersession I

Chapter 1: Intersession I

Chapter 1: Intersession 1

June 24: Monday

8:24 am: “Welcome to third year!” a smiling Dean of Something Educational boomed across the medical school’s packed auditorium. I didn’t hear many remarks past those beginning words of the requisite welcome speech because I became distracted in catching up with my friends. I’d recently returned from vacation with my longtime boyfriend, R. Casey Jones, and had not yet seen anyone. Aside from all my friends looking expectantly at me to share news that I do not have to share, while not so subtly glancing at my left ring finger, it is wonderful to see everyone.

9:17 am: All medical students are warned that the third year of medical school is the most stressful, exhausting, and confusing year in the whole process of becoming a doctor. I first learned this a few months ago when reading a 2009 study published in Academic Medicine entitled “The devil is in the third year: a longitudinal study of erosion of empathy in medical school.” Some disturbing phenomenon happens during this year where medical students morph from cheerful, motivated, optimistic future doctors into bitter, cynical individuals. Since reading that article, I’ve come across multiple other studies and reports highlighting the horror that is the third year of medical school. Even just last week I came across an article in Slate magazine ominously titled “The Darkest Year of Medical School,” which discusses how third-year medical students experience a dangerous rise in depression, suicide, and substance abuse.[ii]

I’m curious about how this happens and to what extent it will happen to my classmates and me. I intend to record this entire year on my iPad mini, which happens to fit comfortably in the pocket of my short white doctor’s coat. My goal is to subtly jot down notes throughout the day using the app “Notability.” I’ll be recording events not only as they unfold in real time, but also capturing how I interpret these events and how I react to them. Medical student secretly turned gonzo journalist!

At most schools, mine included, medical students spend the first two years hunkered down in hiding, memorizing textbooks. We learn basics such as chemistry, immunology, pathology, physiology, anatomy, etc. In stark contrast, years three and four of medical school are spent rotating through the different medical specialties, letting us try out each one for a month or two. Every medical student in the country completes the same core rotations: surgery, internal medicine, family medicine, neurology, psychiatry, pediatrics, and obstetrics and gynecology. The goal is to expose us to each of the major specialties, helping us determine which medical field we will enter.

10:30 am: Oh, I should probably listen now, the speaker is explaining how third year will work for us. There are three blocks of rotations this year; each block is 16 weeks long. At my school, the students are split into three large groups, and each group rotates through each of the blocks. Kicking off each block is an intersession week, where I am right now, designed to prep the students for their upcoming rotations. As my first block consists of internal medicine and surgery, my lectures this intersession will review common medical conditions (heart disease, diabetes, etc.), basic surgery skills (such as suturing and tying knots), and anatomy. There will be two other intersession weeks this year. Intersession two will precede my block of family medicine, neurology, and psychiatry. The third intersession week will be before my final block of pediatrics, and obstetrics and gynecology.

11:45 am: Immediately following the welcome lecture, we were treated to a talk about not letting residents and attending physicians physically, emotionally, mentally, and/or sexually torture you. Apparently, many med schools have poor track records when it comes to abuse of third year med students. At least my school is aware of this issue and is preparing us for potential exploitations? The speaker also casually mentioned that we’re not supposed to work more than 80 hours in a week or more than 28 continuous hours.

June 25: Tuesday

12:35 pm: In general, doctors all wear white coats. However, there is a well-established hierarchy in medicine and not all white coats are the same. Atop the totem pole is the attending physician. The attending has completed their entire medical training and is in charge. Next down are the fellows. Fellows have finished residency and are completing optional specialized training (one to three years) before becoming an attending. Fellowship is not required, and most residents go straight into being an attending.

The residents are next down on the ladder; residents are licensed physicians. The first year of residency is called intern year. Interns and residents see and examine patients, write orders for lab tests and prescriptions, and make decisions regarding patient care. The resident has more power than the intern, though the attending has the final say on all matters. Interns are more heavily supervised than other residents and tend to do the most scut work. Throughout residency (which is three to seven years, depending on the specialty), a newbie intern develops into a senior resident. Supervision gradually becomes less and less, with the senior residents having the most freedom.

Medical students are doctors-in-training. We have not yet graduated medical school, and we do not yet have our medical licenses. We can see patients and perform procedures under the supervision or direction of an intern, resident, fellow, or attending. First and second year medical students aren’t even on the totem pole since they’re locked away studying.

Visually, the totem pole looks like this:

Attending physician

Fellow

Senior resident

Junior resident

Intern

Fourth year medical student

Third year medical student (my current location)

Teams are led by a single attending, but may include any combination of residents and students. Hospitals with residents and medical students are referred to as teaching hospitals.

2:15 pm: FYI, all medical students and residents move up the medical totem pole by one rung on July 1. Always. If you’re a patient, you may want to avoid teaching hospitals in July. We’re all new to our respective roles.

3:23 pm: Learning how to gown and glove for surgery is surprisingly more complicated than it appears.

7:22 pm: Ouch. Rough afternoon. I spent the afternoon hours in anatomy lab being pimped by surgery residents and attending surgeons. “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. 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. So yes, today I was pimped during anatomy lab.

June 26: Wednesday

11:15 am: Cancer, obesity, and genetics. A thoroughly depressing day of lectures. 

2:10 pm: During lunch I received my schedule for the next eight weeks. I start with four weeks of inpatient internal medicine, followed by four weeks of outpatient medicine. Inpatient means the patient is admitted to the hospital and stays there overnight. Within the hospital, the sickest patients go to the Intensive Care Unit (ICU). Slightly less sick patients are in the Step-down unit; which is one tier less intense than ICU-level care. The most stable inpatients are on the floor, and are called floor patients. On the other hand, outpatient typically means a clinic, where a patient goes for doctors’ appointments or checkups. This may seem obvious to some people, but my mother, who has no medical background, has informed me that I need to explain these distinctions.

5:25 pm: Afternoon lectures on wound care provided us with some nasty images of pus-ridden infections and made me excited for my surgery rotation. I’ve never fainted at the sight of blood and guts, but we were just warned that third years happen to faint with alarming regularity. The professor informed us that it usually happens on days when we’re feeling really sleep deprived and haven’t eaten, drank, or sat down all day. Which apparently are most days of third year.

June 27: Thursday

11:53 am: Morning lectures were chock full of review about viruses, bacteria, and other infectious diseases.

5:43 pm: I decided to go to medical school at age 24. After studying art history and studio art in undergrad, I earned a master’s degree in counseling psychology and art therapy. I then worked at a top-notch hospital in Chicago. My mornings were spent on the inpatient psychiatry ward and in the afternoons I did bedside counseling and art therapy with children and young adults. Most of my patients on the various medicine wards were severely ill, often staying in the hospital for weeks at a time. I developed wonderful relationships with my patients and would inevitably bond with them. I mourned them when they died, attended their memorials, and cried with their family members; it felt as if my friends were routinely dying. I hated my job but loved being at the hospital, so, the abridged story is that I decided to go to medical school.

I left my job and forged ahead into the world of medicine, completing my pre-medical school requirements at Northwestern University. Casey matched to a teaching hospital called The General Hospital for his surgery residency. We packed up our lives in Chicago and relocated to this random Midwest City. I applied to medical school and was accepted to The College of Medicine, which is the medical school affiliated with The General Hospital. So now here I am. I’m a 29-year-old artist-former-counselor-turned-medical student from Long Island, NY, living in a random little Midwest City, about to start my third year of medical school.

June 28: Friday

7:30 am: I’ve kept journals since I was five years old. I have over 20 journals lined up on my bookcase, all penned in my terrible handwriting. I’ve never shared them with anyone. The idea of writing for a potential audience to read is terrifying.

However, writing a book has also been a lifelong dream of mine. Capturing the events of third year by journaling electronically seemed like the perfect set-up. To provide some distance, I’ve decided to refer to myself by a pseudonym, almost as if I am recording someone else’s story and not my own. After spending much of the week deliberating, I chose the name Silvia for myself in homage to my favorite song by the band Miike Snow.

12:15 pm: An all-morning review of the pharmacology of immunology is precisely as boring as it sounds. But no matter how boring, I have to know this stuff. At each rotation’s end is a multi-hour, nationwide, standardized flogging, politely known as a final exam. Our grades are used to compare us not only to each other, but also to all the other third-year medical students across the nation.

We also get graded on our clinical skills. This includes how well we interact with our patients, our competency doing procedures, and if we go above and beyond the requirements of the rotation. Our overall grade combines our exam score and our clinical grade for a final mark of fail, pass, high pass, or honors. Our grades influence our class rank, and where we will be able to match for residency. In order to get a residency spot, or ‘to match’ into a specialty, one must be a competitive candidate. As there are now more medical students graduating each year than there are residency positions, medical students tend to get über-competitive when it comes to grades and class rank.

2:15 pm: We’re back in the auditorium, sitting through a ceremony officially welcoming all the third-year students to our clinical years. Everyone looks prim, proper, and eager in freshly laundered white coats. We’re reciting the oath we took at our induction into the field of medicine at the start of medical school. Instead of reciting the Hippocratic Oath, a few students wrote an oath to represent our class and what entering medicine means to us at this time and place in our lives. The Dean of Something Important is back at the podium, spewing more warnings about third year. Right now she is reminding us to rely on each other and help each other through the year. She is telling us to reach out if we are drowning and need help. “Suicide is not the answer,” she informs us. I look at my closest friends, Piper, Sophia, Jane, and Maggie, and get the feeling I have no idea what I’m in for but I’m glad these women are sitting on either side of me. The Dean of Whatever concludes her speech with, “Congratulations on making it to third year. Thank you for listening, and good luck.”

Ipad in hand, down I go into the rabbit hole of third year.



Chapter 5: General Surgery

Love, Sanity, or Medical School

Available here on Amazon!

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!


Chapter 4: Thoracic Surgery


Love, Sanity, or Medical School

Available here on Amazon!

Chapter 4: Thoracic Surgery

August 26: Monday

5:45 am: No other cars were on the road as I drove in. I meet my team at 6 am. It’s weird being at the hospital before Starbucks opens. I’m nervous.

It’s so disorienting to start on a new rotation.

Four weeks of thoracic surgery here at The General Hospital. Thoracic surgery involves operations on the lungs and esophagus, typically to remove all or part of those organs due to the presence of cancer.

7:30 am: We had a two-minute orientation informing us that we’re not supposed to work more than 28 hours in a row or more than 80 hours in a week. We were told to never make evening plans, because we may end up working late and then we’ll be pissed. Plan on working until nine o’clock every night and that way if we get off at six o’clock, we’ll be happy. Ok…

7:39 pm: I survived my first day, a solid 12 hours. Quite the change from outpatient medicine. As the medical student, my role is pretty straightforward. I’m to read ahead about the surgeries I will be attending, and know the relevant anatomy, reasons for the procedure, complications, and related whatnot. While in the OR, I watch the operation, and if it’s appropriate, I close part or all of the incision or do other small tasks, while the attending supervises and points out anatomy or diseased tissue. The attending is in charge and the resident is “first assist,” aka the main helper. I would love to first assist because just watching an operation gets a little boring, but, unfortunately for me, the surgery residents always get priority.

Today I learned the elaborate ritual of cleansing one’s body and soul in preparation for performing an operation. Surgeons work within a sterile field in the OR. The field includes the patient, and anyone or anything that may come into contact with the patient. In order to be allowed within the bubble of the sterile field, one must go through a series of sequential steps. The procedure, nearly religious in its solemnity and precision, starts with putting on a surgical cap, facemask, and eye shield. This is followed by washing your hands and nails thoroughly for three minutes, drying your hands with a sterile towel (starting at the fingertips and working towards the elbows), then donning an OR gown and two layers of sterile gloves, all without touching anything in the surrounding area. Once sterile, you cannot touch ANYTHING that is not sterile, or you will break the field and piss everyone off. Your hands have to remain between your shoulders and your waist; you literally can’t put them down at your sides. Once sterile, you may approach the ceremonial operating room table.

The first case I scrubbed into involved repairing part of someone’s esophagus (the tube running from the mouth to the stomach). Almost immediately after scrubbing in and stepping up to the table, I developed an itch on my nose. Trapped in my sterile attire, I spent nearly two hours next to the OR table trying to rub the tip of my nose against my surgical mask in order to relieve the annoying sensation. No luck.

Another case involved placing a trach, or breathing tube, into someone’s neck. I learned that bleeding tissue is not always bad, because at least that means there is good blood flow to the area. Unlike zombie movies, dead tissue cannot come back to life. Simple. Logical. I like this surgery thing.

The nurses are really helpful here. In addition to being kind, they thoughtfully taught me about the magic of swabbing a bit of peppermint oil on your surgical mask before beginning a smelly surgery. Oh, and I like when they play music in the OR.

9:15 pm: I’m in bed. My alarm is set for 4:45 am. I’m forcing myself to stop writing and go to sleep early.

August 27: Tuesday

7: 25 am: It’s remarkable how differently the surgery team wants their patients presented during morning rounds. The entire presentation takes about one minute and notes are written ASAP. We see every single patient from 6-7 am, have a quick breakfast if there is time, and then we’re off to OR at 7:30 am.

My surgery team is as small as my medicine team but we have just as many patients. We round so much faster than when I was on medicine, yet the same amount of work gets accomplished. Everything seems so much more efficient. Maybe I should be a surgeon.

A patient in the surgical ICU keeps yelling, “Ice cream! Ice cream! Ice cream!” Well sir, I would like some ice cream too, but you don’t hear me making a fuss.

10:35 am: Every physician has one body part that they can’t stand. I have yet to meet a doc without an aversion to at least one type of injury or illness. Popular dreaded subjects include eyeballs, feet, poor dentition, and hand injuries. Mine is mucus, or in laymen terms: boogers. I gag and nearly vomit whenever I see snot. I already knew this but I did not know the extent of my disgust. Today, I learned that my new least favorite thing to do in the entire world is remove nasogastric (NG) tubes. NG tubes run through a patient’s nostril to their belly, and can be used for either feeding or for suctioning stomach contents. I will not go into detail about removing them because I will get nauseated again.

11:15 am: The surgery intern hates eyeballs.

2:05 pm: Today is our first day of surgery lectures. One of the surgeons, Dr. Mastermind, someone we have never met before, immediately starts posing questions after we sit down. He then looks at us, and starts calling on us by name to answer! Apparently, he memorized all of our names and faces from the medical school directory so that he could look us in the eye and call on us the first day. Oh my.

A student is fumbling to answer one of Dr. Mastermind’s questions. After a moment Dr. Mastermind deadpans, “It’s ok to make up answers, just say them with confidence.”

Dr. Mastermind is teaching us surgery secrets. He just quipped, “When in doubt, take it out.” I’m already a big fan of this surgeon. Turns out he works at The Private Hospital, where I’ll be rotating next for general surgery.

5:45 pm: I’ve been awake 13 hours already and my day is nowhere close to being done.

The walls of the operating rooms are tiled a light blue, with the carefully arranged surgical equipment lying on sterile blue towels. The surgical lights reflecting off of the tiles and the array of metal tools gives the room a blue tint. I feel as if I’m underwater when in the OR. Swimming or drowning though? All the surgeons and nurses are gowned and gloved so that only their eyes are visible, making them appear to be in SCUBA gear.

The speed and efficiency of surgeons is daunting and impressive. The threat, no, not threat… the… the concern of seeing Casey throughout the day is annoying though. I feel like I’m on his turf.

9:23 pm and off to bed. Alarm set for 4:15 am.

August 28: Wednesday

4:55 am: The only awake people at the hospital are the overnight teams and third year medical students.

In just over two days I have already done more than I did all month on internal medicine. I’ve scrubbed into several surgeries, made calls, returned pages, given orders, removed chest tubes, done procedures, written progress notes, and completed other random tasks. My intern walks me through procedures or tells me what he wants done and then trusts that I will do it. I am actually being helpful to him and to the team (I think). Very refreshing.

6:03 am: A pale, frail, older female patient is wandering the halls of her floor. Her ethereal, floor-length white dress with flowing sleeves makes her look like a ghost. I wonder if anyone else can see her.

8:56 am: Post rounding. I’m at the thoracic surgery clinic today with the impressive Dr. Thorax. Most of the patients are here because they have new or suspected cancers. The physicians who are able to work in oncology amaze me.

10:58 am: One of my patients is a not-old-enough guy who has two separate cancers. Neither is curable without major surgery but to resect both would likely leave him without the ability to ever speak or eat again. His family asked Dr. Thorax what she would do if it were her. An interesting discussion ensued about the complexity of the operations, the likelihood of complications, and the chance that he would have an acceptable quality of life at the end of it all. He hasn’t made a final decision, but his initial thought was to take the pain medications we offered, not have either surgery, and live out the rest of his days enjoying time with his family. I think I’d do the same if it were me.

August 29: Thursday

4:55 am: It feels like I’ve been on this rotation for way more than three days because so much happens each 11- to 15-hour day.

I never noticed before, but the staff elevators announce each floor in English and Spanish. The patient elevators are only in English. Strange, no?

Today I learned that an entire bagel fits comfortably inside my white coat pocket. Score!

Yesterday evening marked Casey’s last night here before he leaves on vacation. By the time I return home tonight he will be gone and he won’t return until September 10. After his trip, it will finally be time for him to pack up and move out of my apartment. I’m gearing up for a rough couple of weeks. At least I’ll have my new roommate Zooey to distract me. She arrives on the 15th.

There is all of one patient in the clinic today. His lung collapsed a couple of days ago so he is here for a checkup. It’s not common for a lung to spontaneously collapse in a young person, but when it happens the patient is typically a really tall skinny male.

Twenty minutes later: Wow, he is a walking example of my textbook description of spontaneous pneumothorax (lung collapse) in young males. In addition to being tall and skinny, he came across as sweet and shy, too.

August 30: Friday

What a relief not to have to worry about seeing Casey throughout the day. All the surgery teams changed today. My new team consists of a senior resident, a surgery intern, and a surgery physician assistant (PA). The senior resident is a friend of Casey’s. He is tall, friendly, and donned in classic green surgical scrubs, so his name will be the Jolly Green Giant, or JGG. Everyone seems happy to teach and let me be involved. I already know JGG well because of Casey. I don’t know the intern yet, but he is rumored to be kind, smart, and helpful. On a similar note, I have heard that the surgery PAs are excellent. All in all, I seem to have lucked out with my team.

Allegedly there is a ‘mystery bug’ at a nearby hospital that has closed their operating rooms until next Wednesday. Creepy. Every single operation had to be rescheduled. I can’t imagine how bad of a bug it must be to cause the cancellation of five days’ worth of operations.

After finishing up at the surgery clinic this afternoon I got lost walking back to the main hospital. In the midst of my confusion I stumbled upon Dr. Neuro, sitting on a bench, eating a red Jolly Rancher. We chatted a bit, discussing my surgery rotation and surgeons in general. Casey was brought up, followed by how poorly I may have done on my internal medicine final exam because I was so scattered in the aftermath of our breakup.

This led to me almost breaking down crying on this random little bench somewhere on the hospital grounds. Our conversation basically turned into an impromptu therapy session. Dr. Neuro has such a calming presence. His polite but gently probing questions about my daily life caught me completely off guard. Out of necessity, I’ve been keeping fairly solid walls around me at work, but he drifted right through them. It’s slowly dawning on me that I’ve been so busy I haven’t really been processing all the change going on in my life. I’m really looking forward to having this weekend off to recoup.

I worked from about 5 am to 5 pm each day this week and totaled about 60 hours for my first week on surgery.

Wahoo! I just found out I don’t have to come in on Monday because it’s Labor Day and there are no surgeries scheduled. A three-day weekend!

August 31: Saturday

I think it is time to start changing out the photos in the apartment.

September 1: Sunday

11:05 am: Welcome to September.

I had a list of things to do yesterday. Clean my apartment, go food shopping, print out new photos, etc. Instead, I met up with my friend Callie at her apartment’s pool. We ran into a group of girls from our class and our quiet day catching up turned into an impromptu pool party.

The fun continued as we went bar hopping downtown. One of the many fun things about hanging out with Callie is that she knows everybody, and she is an excellent wingman. My evening ended with a handsome blond ortho resident getting my number and texting me goodnight. Woke up today in a super messy apartment with no food in the fridge but hungover, tanned, and happy.

4:59 pm: With newly printed photos of friends and family, I began the task of changing out all the happy photos of Casey and me. The first photo I took down had captured an adorable moment from when we saw Arcade Fire in Chicago a couple of years ago. The rush of tears came on so suddenly and forcefully that my hands were shaking and I nearly dropped the frame as I pulled the photo out. I pushed on. One at a time I removed all the photos from our travels throughout the world over the past six years and 11 months. Memories from dozens of cities and events spread over three continents were placed gently in a neat little pile. The oldest photo I came across was a strip of black-and-white photo booth pictures from when we first met in Chicago. In the sequence we’re smiling, then kissing, then looking at each other and laughing. We looked so happy. I was all of 22 and he was 25.

Next, down came the stuff on the fridge. It had been covered with save-the-date cards, wedding invites, and baby announcements from all of our friends that met, fell in love, got married, and started having babies. Because that is the normal way things happen. Most people don’t just date forever.

Lastly, I replaced a piece of artwork I had painted for him last Christmas called Fenomeno by Remedios Varo, with another of my own recently completed paintings. It’s a full-scale replica of Picasso’s Las Meninas that I fell in love with when I saw it in Barcelona. Now I’m done. I can’t handle anything else today.

Fenomeno Replica, Acrylic on Canvas

Las Meninas Replica, Acrylic on Canvas

8:37 pm: To cheer myself up I signed up for an online dating service. Why not? I don’t think I’m ready to start dating but it would be a nice ego boost to get some attention online.

September 2: Monday

Labor Day. Upon moving into the apartment three years ago Casey painted the master bedroom green. Twenty minutes ago, I finished repainting it a smoky blue.

September 3: Tuesday

5:15 am: Love wearing scrubs to work. Hate not seeing my friends because I work all the time. And today starts my first 24-hour call day.

5:30 am: Unfortunately, the new patient on the census is the young man from clinic last week. His lung collapsed again over the weekend, and this time the surgeons ended up resecting (removing) part of his lung. Now he’s got all sorts of intravenous lines and tubes in him, including a chest tube, which is preventing the remaining part of his lung from collapsing again.

7:30 am: Wow the music in the OR today is screaming heavy metal. Of all the possible tunes to be blasting out of the iPod of my super-efficient soft-spoken attending Dr. Thorax, heavy metal is definitely a surprise. In my humble third year medical student opinion, it’s waaaaaaaaay too early in the morning for all this yelling!

Normally, I would not be chilling in the OR typing away on my iPad but the current OR patient is undergoing a lung lavage. The patient has a lung disorder called Protein Alveolar Proteinosis, where their lungs essentially collect a lot of crap, making it difficult to breathe. For the procedure the docs repeatedly fill one of the lungs with water and then drain it, over and over again, to help clear out all the material that has accumulated. The process is then repeated on the other side. The result is an almost immediate relief of the majority of symptoms once the patient awakens. Fifty liters of fluid will be used today and the process takes about six hours. It’s pretty strange to think about the treatment objectively, though. The docs are essentially drowning the patient repeatedly. So here I am, sitting and studying (and occasionally typing) for a couple of hours. I wish I had a fleece, though; it’s freezing in the OR in just scrubs.

Several hours later: I’m an ice cube now.

Just passed Maverick in the hallway outside the surgery department and had a three second conversation. Awkward. Not him, me. He’s an emergency medicine resident, a stereotypical outdoorsy climbing type who always looks mildly mischievous underneath his curly brown hair. We met nearly two years ago while volunteering for a medical school event, and I always get stupidly flustered around him. Our conversation back then was nothing Earth shattering, but something about his personality appealed to me. I remember vividly thinking, “If I were single, I would totally go for this guy.” The thought immediately struck me as odd because I never had any interest in cheating on Casey. Maybe in the back of my mind I already knew that Casey and I were in a dead end relationship? I wonder if Maverick is single now? Maybe Callie will know as she always has the best resident gossip. The Boss would probably know too, but I bet she’d kill me if I dated one of her residents. There’s no point in finding out though, I’m not ready to date yet anyway.

Terrifying Tuesday lecture. The surgeon is telling us about a shooting trend that happened a couple of years ago. A guy would call 911 and report that a man had been shot. The thing is, no one had actually been shot yet. The caller would then wait, with a victim bound at his feet, until he heard the sirens of the approaching ambulance. Upon hearing the sirens, the caller would then shoot his victim in the back of their neck, thus severing their spinal cord, and then run. The purpose of waiting to shoot was so that the EMTs would arrive soon enough to save the victim’s life. Instead of dying, the victim would forever be paralyzed from the neck down. My stomach is churning.

10:50 pm: A senior surgery resident came over to me and reports, “There is a patient with burns covering over 90% of his body. He is getting his dressings changed at 11 o’clock. You should go and watch.”

11:45 pm: I don’t even know how to describe what I just saw. I had never seen a burn patient before. I walked into the uncomfortably warm room and surveyed the unconscious and heavily medicated patient as the nursing team organized the materials for his dressing change. His arms and legs were covered in white bandages, thoroughly soaked with blood and seepage. The toes on his left foot poked out of the bandage, unscathed and healthy pink. His right foot did not exist anymore, having been obliterated in the fire. A white sheet covered his belly, held taut and stapled directly to his abdomen. Layers of white gauze covered his face.

A severe burn causes the skin to contract, which constricts the blood vessels and compromises blood flow. Body parts die without blood. To ensure adequate blood flow it’s sometimes necessary to make incisions in the skin to relieve the pressure. Big, long strokes are needed wherever these contractures (skin contractions) take place. Escharotomy is the word. At this patient’s hips, shoulders, and peeking out from the bandages on his extremities, you can see where the surgeons have intentionally split his flesh. Along the escharotomy incisions, shiny yellow fat and blood vessels strained to escape the confines of his dead grey-brown skin. The sheet over his belly covered a bag containing his intestines, which spilled out after the escharotomy on his torso.

I put myself in a position where I could be called upon to help if the nursing team needed an extra hand with the dressings. As horrific as this appeared to me, I wanted to help. It was the least I could do. I looked behind me to locate the nearest chair in case I felt faint. As the final preparations with his new set of dressings were finished being laid out, I asked the simple question, “What happened?”

The nurses began unwrapping his many layers of gauze while sharing that he ran into a burning house to look for trapped occupants. Upon stepping into the house, a flashover engulfed him in flames. According to Wikipedia (my source for all things in med school), a flashover can reach over 930°F. His buddy was able to force the door open and pull him out mere seconds later. In those few moments, he sustained burns to essentially his entire body. And now here he lies in the burn unit. A moment after the story concluded, I was asked to help hold his leg while the nurses repositioned him onto his side. It felt heavy and warm in my hands. As I held up his leg, I couldn’t help but think that his body already resembled the skin of the cadavers we dissected in previous years in medical school.

I don’t have a lot of experience with nurses, but the care they took in changing his dressings amazed me. I don’t think I could ever do that on a daily basis. They are the kind of people I would want caring for my own family members.

When I asked about his prognosis, a nurse whispered to me that she hoped his family would choose to revoke life support.

12:16 am: So now here I am, in my bitty little call room that looks like an ancient college dormitory (or a prison cell, depending on the angle). My roommate for the evening, one of my classmates, got right into bed and seemed to fall asleep easily. Not me. I had to process what I just saw. My hope for the burn patient is that he is well sedated and feeling no pain and feels loved and is honored for having his last conscious moments on this earth spent trying to save the lives of others.

4:30 am: I hate my alarm clock. And waking up in a call room is weird.

5:38 am: I already pre-rounded on my patient so just rounds and then home hopefully by 8 am. I’m excited to go home and sleep in my own bed for a bit; away from the cancers, the traumas, and the burns at the hospital.

September 4: Wednesday

Slept in and then spent the rest of the day working on my apartment, purging the rooms of Casey’s presence. I didn’t move to a different apartment, but I want it to feel and look as if I did.

September 5: Thursday

How is it Thursday already? I’m so confused with these days. So much gets accomplished every day that it feels as if I’ve been on surgery for weeks already, not eight days.

The tall thin young man may be discharged today. Hopefully no more collapsed lungs for him.

September 6: Friday

5:02 am: Woke up in a weird mood; I think I dreamt about Casey last night. Happily, I will be in the OR all day. Like literally ALL day, as there are big surgeries today. Need to get my game face on and not look mopey!

4:18 pm: I scrubbed into an esophagectomy today on an older gentleman named Professor Z. Basically, the operation is exactly what it sounds like: they take out the esophagus and connect part of the pharynx directly to the stomach. It’s fascinating to watch surgeons open people up, rearrange their insides, then put the person back together.

4:45 pm: JGG is planning to go out of town tonight and is practically jumping out of his skin to leave. To his dismay, a patient unexpectedly developed a pneumothorax while at the same time a new ED consult arrived. Just as our clerkship director warned us; don’t make plans for 6 pm.

The surgery intern and I bonded today. He skipped lunch because he was too busy, so I shared the peanut butter crackers that are always stashed in one of my 50 white coat pockets. While munching away he confided in me that he doesn’t like the days when JGG is trying to run out the door, because he doesn’t feel confident enough yet to be left solo. I could see his frustration and underlying concern about being here alone if something bad happens to a patient. I wonder if seven years as a surgery resident will morph him from being a super nice guy into someone cynical and bitter. I hope not.

September 7: Saturday

I love sleeping in and waking up feeling refreshed. I’ve been getting emails from the online dating site and one caught my eye. A tall, fair, blue-eyed resident name Dr. Spengler struck up a conversation. Seems great on paper. I emailed him back.

September 8: Sunday

10:45 pm: First night in my new bed. When Casey moves out he’ll be taking our bed with him, so I had to order a new bed for the master bedroom. My room. I’m sitting with my iPad right now, but it’s not the same as writing on paper. I miss my journal. Writing with the knowledge that someone someday may read my words changes how I put them down. I am trying to be clearer and more deliberate with what I write as opposed to my usual stream of consciousness ramblings. Time for sleep.

11:15 pm: Sigh. I’m still struggling and having trouble sleeping. I can’t think about Casey yet because I still get angry, sad, and lonely, often all at the same time. Other than working, studying, and redoing the apartment, I am attempting to meet new people. There was the one from the canoe trip and the ortho resident, neither of which I followed up with even though both have been texting. Either could be a fun rebound but I don’t know. I’m not ready. I really have to go to sleep. My alarm is set for 4:30 am. Ugh.

September 9: Monday

7:12 am: Professor Z seems to be doing well post esophagectomy. His kind nature and good spirits are already well known and appreciated amongst the surgery team. Walking into his room today I was greeted by an array of stunning, brightly colored bouquets. One bouquet contained a variety of bright orange flowers (my favorite color), another featured red roses, and a trough-shaped vase near the window overflowed with blue and purple flowers accented by a couple of peacock feathers. Clearly, I’m not the only one who enjoys his company. He seems to have quite a few admirers.

3:10 pm: During a free moment, I slipped into a daydream about the random summer I worked at a beach in California. Memories of the warm weather, the sunshine, the sand between my toes, and the cold surf vividly filled my mind. My pager began wailing and jolted me from my reverie. I have to figure out how to obtain a wound vac. Wound vacs (short for vacuum) are suction devices that are placed over wounds and literally suck out fluids like blood and pus. Gross. One of my difficult patients developed a purulent, malodorous, nasty, boomerang-sized infection on her back and now needs a wound vac. Surgery is really good at ruining nice daydreams. Back to work.

I’m sitting awkwardly close to a fourth-year medical student who asked for feedback from a senior resident. The resident coldly replied, “You are very smart, you have a lot of book knowledge, but you need to work on your common sense. You need to learn to think and organize your brain before words come out of your mouth.” Oh wow. There was more to that conversation, but not much. Surgeons certainly don’t mince words.

September 10: Tuesday

4:49 am: Casey returns today. He will be back in my apartment by the time I get home from work.

I walked down the surgery hallway a minute or so after a gunshot wound victim was wheeled from the ED to the OR. The patient bled so profusely that the hallway the patient rolled through had a vibrant trail of blood traveling down it and a metallic smell clung in the air.

My internal medicine exam grade is in. I’m freaking out. We can ask for our grade through email but I’m going to go check in person because if I failed, I don’t want to start crying in the middle of the surgical ICU.

30 minutes later...

Ok so not only did I pass but I scored high enough to qualify for high pass or honors. The secretary at the internal medicine office, Ms. CV, must have sensed my relief and shock because she looked at me quizzically and then asked me if I was ok. My incredibly logical response to her query was to start crying. What is wrong with me? I swear I’m not a crier. She gave me a hug and we chatted while I calmed down. We sat for nearly 20 minutes and discussed life and love while I ate a pack of Smarties from the stash that is always at her desk.

Ms. CV told me about when she was young and naive and dating the wrong guy. She realized he was the wrong man for her, but carrying out the decision to leave him was a terrible experience. But, she added with a grin, she then met the right man. She and her husband are about to celebrate 34 years of happy matrimony. It’s remarkable how someone taking a couple of minutes out of their busy day to sit and chat with you can cheer you up.

1:43 pm: Tuesday lectures. A trauma surgeon is lecturing to us about firearm injuries. He added, “I don’t know how to take away weapons in our country, but I know how to help trauma victims.”

3:28 pm: My favorite quote so far today came from a pediatric surgeon who implored, “You should be passionately connected to the care of your patient.”

3:45 pm: Magnus must be bored because he keeps texting me random memes.

September 11: Wednesday

6:11 am: At what point does it transition from being called breakup sex to just having sex with someone you used to date?

8:20 am: I have a rare peaceful hour and a half before I have to be anywhere, so I’m relaxing on the front steps to the medical school, enjoying the sunshine. I immensely dislike being indoors in windowless underwater operating rooms all day. At least I get to do my surgery rotation in the fall. The winter students rotating will arrive before the sun is up and leave after it is down every single day. Can you imagine only seeing sunlight on weekends?

There are a lot of people hurting today and I feel their pain. Most of the day I will avoid watching television, because 9/11 coverage still makes my heart ache. I was 17 years old, sitting in third period math class when an announcement came over the loudspeaker that a plane had struck the World Trade Center. I had a moment of panic, knowing that my father worked mere steps from the Twin Towers. My teacher rambled on about numbers to a progressively uninterested room of students until the bell signaled the end of class.

My fourth period American History teacher brought my class to the library, where a steadily increasing number of students were convening to watch the coverage live. I sat in a daze on the open winding staircase between the first and second floors of the library, unsure what was going on. We silently watched the news unfold, with a collective gasp and cry when the first tower fell, sick with knowing that some of our family members were inside. I couldn’t reach my dad but was able to get in touch with my mom. She informed me that my dad was okay but then revealed how his phone had gone dead mid-sentence as the first tower collapsed, her overly calm and measured voice betraying an underlying strain and rising anxiety.

The school tried to corral all the students on school grounds but my friends and I snuck out a side door and drove home. I paced my bedroom, journaled, and called every family member I could think of to see if they had heard anything else from my dad. I felt rage for the first time that day, the event inciting anger and hatred towards those responsible. I also felt fear, but mostly I experienced an overriding sense of helplessness. I had no skills, no ability to help, and no power to do anything useful. After pacing tracks into my carpet for nearly eight hours, my father finally turned up safe and sound at our house on Long Island.

These days on 9/11 I cry not only out of sadness but also out of fear. My parents, my sister and her husband, and now my newborn baby nephews, all live blocks from each other in midtown Manhattan. The rest of my family, including all of my aunts, uncles, and cousins, live in Washington, D.C. and Boston.

Terrorist attacks and other catastrophes are out of my control, so I try not to dwell on them. I’m usually pretty good but sometimes it’s hard. I’ve had nightmares about being inside a collapsing building, seeing the walls shake and debris start falling. I wake up crying and won’t be able to shake the post-nightmare haze until I hear my momma’s voice. So yes, today will be spent avoiding television. I’ve been a bit fragile when it comes to triggering the waterworks these days and breaking down about 9/11 while I’m at work sounds awful and embarrassing. I will do a quiet, private reflection and remembrance when I get home later tonight.

8:45 am: The unmistakable sound of bagpipes playing Amazing Grace filled the air. Looking around, I spot a 9/11 memorial going on atop the building across the street. There are people lined up on the roof, removing their hats and placing their hands over their hearts. Just lost it. I’m outside the medical school building crying. So much for waiting until later for a private moment.

9:26 am: Back inside the College of Medicine I went to the bookstore to get a snack after washing my face in the bathroom. One of the internal medicine residents with whom I’d become friendly saw me and without a pause commented, “Hi, oh, you look tired.”

I simply replied, “Oh yes, I’m on surgery.”

No other explanation needed. In reply I got an encouraging, “Hang in there, it gets better!”

Yes, I am tired and my beautiful green eyes are not looking their best at this moment. My eyes have bags under them from staying up too late having sex with my ex-boyfriend, and that fine tint of red and swelling is due to sitting outside crying about 9/11 less than an hour ago. Little-white-lying that I looked tired just because I’m on surgery seemed easier and unquestionable.

It really has been a quiet morning, I’m not used to this on surgery. I’ve already written so much today and it’s only 9:48 am. For having not done much other than go on rounds and make phone calls, this day already feels too long.

In a surprising turn of events, there were more residents than patients at Dr. Thorax’s clinic. This means my only job is to take out about a billion staples from an esophagectomy patient, whom I had followed during my first week on surgery. It’s nice to chat with him and his wife and to see that he is doing so well after such an intense surgery.

September 12: Thursday

7:01 am: I enjoy starting off my days visiting… um…. I mean pre-rounding, with Professor Z. He is always in good spirits. Each day his voice gets stronger and he gets chattier.

After rounds each morning we visit pre-op patients who are scheduled to go to the OR that day. There is only one patient today. She is an elderly lady named Primadonna, who is having a suspicious-looking lung nodule removed. This may turn out to be cancer, unfortunately. Here she is, lying in her pre-op bed, gowned and ready to go for surgery, awaiting a possible diagnosis of lung cancer, and she is sitting and puffing away on an e-cigarette. Talk about addiction. I wanted to take a photo of this woman. She held onto that e-cigarette until the nurses started wheeling her out of the room to go to the OR, at which time she reluctantly handed it off to her daughter.

I told a resident how much I envied the surgeon’s efficiency. He replied, “They don’t pay us more to work harder.” In terms of being paid, considering how many hours surgery residents work, he told me that they make less than minimum wage if you do the math.

I’m about to leave Dr. Thorax’s clinic. There was another third-year medical student at clinic today too. I examined, presented, and wrote notes on six patients this morning. The other medical student saw one patient. One! What was he doing all morning?

Still been emailing back and forth with the online guy, Dr. Spengler. I think we may actually go out on a date soon.

September 13: Friday

While pre-rounding on Professor Z today, I learned that he has recently retired after being a professor for over 40 years. Now that he is retired, he has decided to focus on his writing. We talked about his former job, life in the hospital, and recovery after illness. He does not like being out of control of what is happening to him. Completely understandable. He is most looking forward to a shower and the Starbucks coffee that his friend is bringing him later this afternoon. He joked about his hair being messy from not showering but he supposes that this new look is apropos to his burgeoning career as a writer. I’m thrilled he is doing so well but will miss our morning chats when he leaves the hospital.

September 14: Saturday

Mental asystole.

September 15: Sunday

5:13 am: The hospital is creepily quiet at 5 am on Sunday mornings.

Zooey moved in yesterday, but I’m yet again on call so I won’t have a chance to help her get settled.

6:02 am: There is a pleasantly demented man in the surgical ICU that constantly calls for his nurse. I keep hearing, “Nurse! Nurse! Nurse!” Pause and repeat. He isn’t exactly yelling; his voice has an operatic quality and he bellows the words as if he’s performing an aria at the Metropolitan Opera House. He is closely tended to in the ICU and is not in any distress or pain, he just keeps singing whenever his nurse leaves the room. The overnight team informed us he was like that all last night too. In the most complementary and respectful way possible, I will call him Operaman.

I pre-rounded on e-cigarette-smoking Primadonna and let me tell you, she is the most miserable and nasty patient I have met so far this year. She let me know how bothersome it is to have nurses and physicians checking in on her. Lots of F bombs and degrading comments that always start with, “You people…” I’m pretty sure she believes we are trying to torture her. She is mad that she is coughing shit up, but after chain smoking for 45 years it’s really not that surprising, yet somehow it’s our fault. Her lack of insight and empathy is profoundly shocking.

12:00 pm: I’ve been here six and a half hours, and Operaman is still going at it.

2:45 pm: Still yelling. It’s been busy today but not too busy, and the ICU is calm at the moment. I’m gonna go chat with Operaman.

3:45 pm: What a pleasant man. First, I asked Operaman about his pain. He informed me that no, he wasn’t in any pain and that his nurse is wonderful. He told me about where he was from and what he did for a living. He smiled while telling me that he has a lot of children and has lost track of how many grandchildren and great grandchildren he’s got at this point. He kept looking at me and repeating, “Thank you for coming in, it gets awful lonesome in here.”

6:00 pm: Thirteen hours down, 13 hours to go...

7:50 pm: Operaman started up again so I sat with him for a bit and we discussed football and watched the Broncos-Giants game. I told him I needed to go study but I promised to come back and visit later. He promised not to yell in the interim. Five minutes later he started singing again. As part of his dementia I’m guessing he probably has a pretty poor concept of time.

9:20 pm: I sat with Operaman a bit longer. He wanted to hold my hand while we chatted and appeared sad that no family visited him today. He kindly asked me if I could stay and be his doctor.

September 16: Monday

Zzzz.

September 17: Tuesday

1:36 pm: Tuesday lectures. I spent four hours in the OR this morning. Surrounding the operating table – the intern, the senior resident, the attending, the scrub nurse, and a pulmonology fellow. That is a lot of people doing intricate work in a limited amount of space. Dr. Thorax was nice enough to let me scrub in, but I could not get anywhere near the OR table. I stood nowhere near the operating table for four hours. I basically stared at the back of JGG’s scrubs, trying to not break the sterile field. Of those four hours, I spent about two and a half of them thinking about what I will wear on my date with Spengler tomorrow night. It’s my first first date in forever. I’m guessing it’s like riding a bike. From an academic standpoint, I learned that I am capable of falling asleep standing up.

1:43 pm: Trauma lectures have the best images. Evidently not every student in the room is looking at the gory images from the PowerPoint because the surgeon is currently screaming at my classmates, “Make sure you look at that picture. Look! Look at it!” These surgeons are way too intense for me. Relax man. Take a deep breath.

2:15 pm: A calmer surgeon is now lecturing. He is stressing the importance of asking the right questions in order to reach a diagnosis. He claims that 80% of diagnoses can be made by history alone. Interesting.

3:01 pm: The third out of four lectures just started. I am so painfully tired today. I slept all day yesterday because I was post-call and then couldn’t sleep last night.

4:05 pm: My favorite surgeon, Dr. Mastermind, is lecturing again today and offering some gems of advice. “Whenever there are two ways to do things, that means neither one is perfect.” Plus, “Sometimes surgery doesn’t work out perfectly, but as long as you do the right thing, it’s ok.”

September 18: Wednesday

7:28 am: I can’t help but feel mildly insulted when the JGG is surprised that an exam finding I report to him is actually present. Today he remarked, “Oh look, there really is a small air leak with cough on Ms. Primadonna’s chest tube.” I swear I don’t make things up. I really do arrive at five in the fucking morning every single day to pre-round on my patients.

Hand hygiene is super important. Number one in terms of preventing the spread of disease. That being said, it is excruciatingly painful to use alcohol-based hand sanitizer upon entering and leaving every single patient room on rounds when you have a paper cut. Ouch.

The highlight of rounding today involved being pimped and randomly knowing about Takotsubo cardiomyopathy (aka Broken Heart Syndrome), which led to Dr. Thorax announcing that I am “one of the smart ones.” I didn’t reveal that I learned about it from watching Scrubs.

My new roommate Zooey texted me, “I haven’t seen you in a couple of days, everything ok?” I responded, “Yep, just been practically living at the hospital.” Zooey seems so sweet; I wish I had time to get to know her better.

On the flip side, I can’t believe Casey hasn’t moved out yet. Ostensibly, there are some delays in finishing the new apartment into which he is moving. I still like having him around, so I haven’t really been forcing him out the door either. I know I can’t move on until he leaves though. What’s worse is now that Zooey moved in, Casey and I are both sleeping in the master bedroom. Great planning, right?

4:43 pm: I’m exhausted. Been falling asleep on rounds and in lectures all day. I’ll be rushing home soon to change for my date with Dr. Spengler. Fortunately, Casey is on call tonight, so I don’t have to awkwardly leave my own apartment wearing a skirt and heels on a Wednesday night.

11 pm: Great date, must sleep now.

September 19: Thursday

5:15 am: How is it already September 19? Last time I checked it was the end of August. I caved and went to work today for the first time ever with zero makeup on. I needed five extra minutes of sleep. I feel like a true third year now.

7:20 am: At some point I’ll write about my date last night with Dr. Spengler, but I have to focus on prepping my presentation on Barrett’s Esophagus that I am giving tomorrow night.

8:25 am: I’m back at Dr. Thorax’s clinic for the last time.

Today marks the first time I’ve cried with a patient. I requested to see this particular patient because I had worked with him in clinic two weeks earlier. On entering the room, I found an anxious looking patient with watery red eyes sitting on the exam table. I hesitantly ask if he is ok, (which by now you know is the easiest way to make someone cry), and the patient immediately bursts out sobbing.

I sat with the patient for a while and once he calmed enough to talk, he told me that his child died yesterday. The patient sobbed and cried out for his lost child. Stunned and shocked, I regretted that I had nothing to offer my patient, no words of solace or comfort. What could I possibly say to a parent who lost a child not a day earlier? I simply sat there, held his hand, and cried too. The patient was so distraught that he didn’t think to cancel or reschedule his appointment. After I informed Dr. Thorax of the situation, she too went and sat with him for a bit.

1:08 pm: As I packed up my bag and got ready to leave, Dr. Thorax thanked me for my help, told me I have solid surgery skills, offered that her door is always open, and suggested that I come speak with her before the end of the rotation. Success.

7:30 pm: Home from work, ate a quick dinner, and now it’s time to put together my presentation for tomorrow. My goal is to be done by midnight. That gives me four hours of sleep... again. Can people die from exhaustion?

September 20: Friday

5:30 am: Today should be my last day on surgery, but since I’m on call, technically my last day will be tomorrow. I can’t believe I’ve survived half of my surgery rotation already. I’m absolutely wiped.

I stayed up all night writing and editing my Barrett’s Esophagus presentation. I haven’t gotten much sleep any night this week. Once again, I’m too tired to put on makeup. I’m not talking about a lot here, a little under eye concealer, a swipe of Urban Decay Sin eye shadow primer potion, a thin line of bright eyeliner and some mascara, totaling about three minutes of my morning. It’s not much but I enjoy spending three out of the 1440 minutes in my day focusing on myself.

7:00 am: My presentation got pushed back because Dr. Thorax isn’t here today. I don’t mind, though I wish I had known last night because I’m going into a 28-hour call day running on fumes.

1:05 pm: I now have a random free hour (because I no longer have to practice my presentation), so I’m sitting with my pumpkin spice latte, catching up on emails and paperwork. An email arrived from Ms. CV, the secretary from internal medicine, letting me know that she was thinking about me and asking how I was doing. Another email featured a ton of adorable photos of my chubby baby nephews. This afternoon turned out so lovely! Too bad I can’t leave the hospital for at least another 17 hours.

A couple of minutes to talk about my date with Dr. Spengler. I experienced instant relief upon seeing him, as he actually resembled his photo. Overall, he is tall, cute, super sweet, nerdy, and quite chatty. Throughout the date, I sat there obsessively thinking, “Oh wow, I can’t believe I’m on a first date with someone” and wondering if people would look at us and think, “I bet they’re on a first date.” Weird, weird, weird to be on a first date! We totally hit it off and had a great time. He didn’t kiss me goodnight. Wuss.

I ran into another medical student and he immediately commented, “You look tired, you must be on surgery.” I give up. I will wake up three minutes earlier in the morning and resume wearing makeup. I made it a whole two days without makeup. As an aside, please don’t ever see someone and tell them they look tired. Seriously. Just stop.

4:00 pm: My day is getting better and better. Since the patients are all calm and stable I can take a nap. It is blissfully quiet and cool in the call room... Zzzz.

5:15 pm: Hands down the best nap I have EVER taken. I feel mildly human again.

I can’t believe this part of the rotation is almost over. Way more my speed than my internal medicine rotation. I did a ton of suturing and stapling, improved my surgical skills, and took the chance to get my hands dirty as much as possible. I love doing procedures, though I do miss having time to sit and chat with my patients. The surgeons were welcoming and encouraging, if not a little high-strung at times.

September 21: Saturday

4:10 pm: The rest of call wasn’t particularly busy or exciting. I scrubbed into an appendectomy and passed out in my call room bed by 1 am. Unfortunately, I awoke at 5 am to pre-round, and couldn’t leave until after rounds concluded, sometime around 9:30 am. So that made for a 31-hour shift, clocking in at a grand total of 96 hours this week. Wait, I thought I’m not allowed to work over 80 hours a week? Don’t worry, as long as my weekly totals average less than 80 hours then the occasional 96’er is kosher. Fucking loopholes.

Next up, off to The Private Hospital for general surgery. All I’ve heard about rotating there is that the hours are worse.