A great day in surgery

My last day on the trauma service has turned out to be what you could say is one of the best days any physician could ask for. It started with patient C (a kickboxer who got rhabdomyolysis – where his muscles broke down and put him into multiple organ failure including a failing heart) whose tests showed he was finally stabilizing after almost a week of acute resuscitative efforts, he’s a long way from “stable” but doing a lot better than when he came in.
Then the shocking highlight of my day when a woman came in literally having had her hair caught in a mail sorting machine and being scalped and me and my resident spent a good 20 mins washing clots from under a loose hanging scalp and wrapping up her head while she was fully conscious talking to us.
There was the 2AM trauma case of a guy whose tractor flipped over onto his leg followed by the highlight, a 16yo who killed a horse by ramming into it with his ATV with a intracranial bleed who we took into the OR and evacuated. I ACTUALLY GOT TO CLIP OFF PIECES OF HIS SKULL with a bone cutter. I think we saved his life, he went from appearing to be dead on a ventilator to breathing on his own after the surgery. I hope he does well.

Finally eating breakfast with my residents who all complimented me on the good job I did. Definitely a sense of satisfaction and even a little pride. In particular Josh, my chief resident and someone I really look up to as a physician told me “you are one of the best medical students I have worked with”. All in all, a great learning experience

On a brighter note . . .

I think if surgery/critical care were a lifestyle specialty where I could be in California and travel to Asia occasionally, I’d TOTALLY do it. Its exciting, challenging, multifaceted and you really do get to say to yourself at the end of the day that you saved lives (Not true in most specialties).

My fallback plans are Anesthesia (where I would definitely get to do critical care but its also a specialty that appreciates and values good lifestyle), Urology, where everyone seems happy and the surgeries are cool. Medicine is looking more and more miserable and kinda painfully esoteric compared to the practicalities of surgery.

Liking surgery . . . or do i?

Last day (and night) on trauma surgery. My highlight today was talking to my patient Mr. T and his wife B, he was in a motorcycle crash that very nearly killed him and he was basically comatose last week, this week he is really recovering except for some minimal depression from being in the hospital. I gave him a pep talk, they talked about how nice it was to have me and complimented me, it felt very good to have played the role of the good doctor with the excellent bed side manner.

But that’s just it, in the end I think I’m a relativist. Its not that I have a “passion” for medicine. Its more that I feel very comfortable playing the role of the caring doctor. Do I really care about the patients? I dunno. I check up on them a lot, I hope they get better. But I am also really really glad to be outside the hospital and I groan at the thought of sacrificing the hours of my youth away at the hospital as a “resident”. Nonetheless, I think I empathize with patients, and to some extent that must mean taht somewhere deep down, I really do know a little what its like to be alone in a strange place. But on the other hand, I really do enjoy the compliments I get from patients, the compliments I get from my residents or attendings (my teachers). Those things also make me feel smart and with it. The added benefit of surgery too is that its almost exclusively an old boys club where you get to feel like one of the guys. That too is a role that I like to play.

So the real question that I have been asking myself for the last 3 years is, do I like playing the role of the compassionate physician at the beside who sacrifices his time and energy for the good of his patients or would I rather play the role of the coldhearted business person who doesn’t really help people but has time and money to spend on the material things in life?

Either way, I think shakespeare was right, life really is just a stage.

Notes on surgery

The last three weeks have been like a roller coaster, downhill at a 100mph one minute, then crawling up to the top for another drop. In Trauma surgery, its an amazing thing to be able to say that I helped save someone’s life. But the sacrifice to one’s own life is equally profound. In the last three weeks, I’ve spent less time outside the hospital than inside, slept an average of 5 hrs a night for 14 days straight without a break and have felt at times completely exhausted, mentally and physically. I don’t think I’ve used my cell phone at all except to call my girlfriend to get dinner after leaving the hospital. I’ve even questioned at several instances whether or not I even want to do my intern year at all.

The bright spots are the days when I can really talk to families of my patients in the ICU, watch the kidney of a 22yo suicide victim being fused with the arteries of a 38yo diabetic recipient or the day that one of my patients who fell off a bike and had emergent surgery to repair a bleed into her neck finally left the hospital.

Sleeping for 15 hours after being up for 35. Man, I can believe I’m paying tuition for this!