surgery: a summary

What did I love about surgery?

Cutting people open. Yeah, I definitely said that to freak you out. But, you know, if I'm super honest it's probably true in some weird way... and now I feel the need to say:

please-I'm-not-like-Dexter-I'm-really-a-normal-well-pretty-normal-person-who-just-thinks-surgery-is-cool-and-someone's-got-to-like-it-if-you-ever-need-surgery-right??? 

But really, whenever they let me do anything it is such a rush. There was this one attending on my last rotation that apparently has a reputation for not liking medical students very much. Let's call him Dr. Gruff. On my first day, he "pimped" me for about twenty minutes, quizzing me about anatomy and the treatment of ulcerative colitis and what I knew about the patient (which wasn't much because it was my first day and I didn't know what surgery I was going to until about 10 minutes before it happened). But apparently I did a good job, because the scrub nurse told me the next day that I actually answered his questions and sounded confident... which apparently not everyone does, I guess. I wouldn't have known I did well because basically the only sign was that Dr. Gruff stopped asking me questions. And sometimes this can be a sign that you're completely hopeless. Anyway, the point of this story is that this attending actually started to like me. Probably because we talked about playing Candy Crush one day when one of the nurses brought it up. :) (Thanks Mom for introducing me to that one...)

So anyway, the real point of the story is that one day I was in the pre-op area for one patient when this doctor taps me on the shoulder and asks me to help roll another patient back to the OR. I get there and help set the patient up, but I'm expecting the resident to show up at any time, and they always take precedence over us to scrub in on cases. Suddenly the attending is there scrubbing in and the resident is nowhere to be found so I think: well, I get to be first scrub! I grab gloves and scrub in on the pilonidal cyst excision.

It was so exciting. I got to make the incision and do a lot of bovie-ing (reference my initial post about surgery). Now let me explain a pilonidal cyst to you, so you can be shocked at my excitement: a pilodnidal cyst is a big mass that fat guys sometimes get right above their butt cracks. Yep. I got to help operate on someone's butt crack.

(I thought about putting a picture here - but then I googled it. For those of you brave enough to click on the link, it's actually a good representation. For those of you who are not brave, this is when you thank me.)

But then, but THEN, the most amazing thing happened. In the next surgery, we were almost done and getting ready to remove part of the bowel. There's a part where they clamp off the mesentery (the tissue layer with blood vessels that supply the bowel) and then tie it off. The fellow takes a tie, and Dr. Gruff says to me, "let Chelsea have a tie." It was THE MOST flattering thing that I'm pretty sure anyone said to me the whole rotation. I guess it's hard to explain, but that's the way surgeons think. The opportunity to DO something is the biggest reward someone could give you.

Anyway, that was a big tangent. And I hope if Dr. Gruff ever finds this he knows that the nickname is all in the name of fun and I really did enjoy working with him. Except for when he passed my level on Candy Crush.

What else do I like?

The pace. There's always something to do and you're always on your feet doing something. Maybe I won't like this when I'm 60 years old, but I really love it now.

Being able to concentrate on just one problem. This is an oversimplification, because surgeons do manage their patients and all their medical problems when they stay in the hospital after the surgery, but in reality surgeons get to focus on the problem they are trying to fix with surgery and leave most of the rest for the patient's primary care physician. I like this. I think this means I have more of a specialist mindset, but we shall see.

photo credit

Anatomy. It's just cool.

What don't I like?

The lifestyle. Aka the lack of lifestyle. I honestly didn't mind the hours as much as I was expecting to, but by the end of just eight weeks I felt pretty worn out. I didn't have time to do a ton of things outside of work, although I did continue going to my dance class and hanging out with friends and things. But the residents worked probably at least 2 hours longer than I did some days, plus all day on the weekends. It's just hard to imagine anything being worth working that many hours for 7ish years. And it's not like attending hours are that much better. I heard over and over, "only do surgery if it's the only thing you can love" (this was all from non-surgeons, though, so take that for what it's worth.

Sometimes, the people. I liked a lot of people I met, but I didn't meet very many people who I really, really admired. Who I just thought their personality was really similar to mine, or someone who I would aspire to be. I don't know if the mentality in surgery is changing, if it truly is becoming less hierarchical and paternal and God-complex-y, but I don't want to lose my compassion. I don't want to lose my desire to be a servant to others. I've been told don't fall into the trap of choosing a specialty based on a mentor you really admire, but I wonder if the converse is also true - maybe I shouldn't choose a specialty where I had trouble finding people who I greatly admired?

To end, an analogy:

Something I found really energizing about surgery was that it reminded me of dance. Surgery requires so much work and time and dedication that you have to be passionate about it. In surgery, you are expected to learn quickly and to take all corrections immediately and to remember them the next day (this, at least, was a philosophy I learned from my dance training that I applied to surgery and it served me well). Surgery is physical and requires muscle memory and a striving for perfection. It requires you to think on your feet. Even though you may be performing the exact same procedure, the patient's anatomy may be slightly different or you might accidentally nick a blood vessel and you have to adjust immediately. And there is definitely an art to surgery. I heard more than one surgeon say that you could have done the most beautiful surgery on the inside, but if the incision looks terrible the patient will think you are a bad surgeon. To be a great surgeon, you need to be a perfectionist who does amazing work in every single operation. It also helps when people like you. Malcolm Gladwell taught me that.

So this was quite a hodgepodge summary, and I refuse to jump to conclusions, but - surgery isn't crossed off the list quite yet. :)