Flashback to around 13 weeks ago. A bunch of students in brand new white coats walked into a hospital as future students of the hospital – something they’d been looking forward to for many years. They could be forgiven for their excited faces & looks of amazement – they’d worked 2 hard years in Grenada to get to this point and were finally done with the classroom-all-day approach (and that impossibly hard “Step” exam that had absorbed their lives for the past few months). This was the point everyone looked forward to – starting rotations in an actual hospital. Actual patients, as opposed to “textbook examples” that rarely ever hold true in the real-world setting. They sat down for orientation and, after a few brief introductions, handed their schedules for the next year.
A couple of students, yours truly included, quickly had their amazement turn to sheer horror as thoughts of “oh shit!” crossed their minds – their first rotation was going to be surgery. … We’d all heard the rumors about how surgery was supposed to be the hardest out of all the rotations. You never really know whether you want to do it first or last until your schedule tells you you’re doing it first – at that point, you’re certain having it at any point later in the year would definitely be better. But it’s pointless to think that – the schedule is set in stone, so to speak. It’s not about surgery itself, or the hospital, or the staff you’ll be working with – it’s just the immediate reaction due to stories that have been heard and the realization that you’re going to be starting the hardest rotation of all with pretty much no experience in the hospital at all. Obviously everyone starts off that way in some rotation and maybe everyone felt that way about their rotation – but I know I definitely felt it after seeing “surgery” listed as my first rotation. After the week of orientation, including a talk or three by the head of surgery that had me even more scared (safe to say, I’m easily intimidated), the actual rotations began.
I started off in burn ICU. As the lone burn clinic in the state, there were a lot of cases with massive burns that we saw. That said, it was nothing like I expected surgery rotation to be – even for a “sub-specialty,” which is supposed to be “easier” (or at least more relaxed). It was … well, not really anywhere as close to as bad as I thought it’d be. I got into the OR and got to scrub into cases. I got to do basic things like stapling & gluing, and more hands-on things like helping lay the skin graft on the burn site (I know, nothing impressive, but still better than just standing there). I went to clinic and got to see many different cases of burns – and how the doctors interacted with the patients. After 2 weeks there, I went on to orthopedics, and then general surgery for six weeks (4 with GI, 2 with bariatric & vascular), and then cardiothoracic surgery (1 week) and then anesthesiology (2 days). And just like that, 12 weeks were over. Of course, it wasn’t that simple/easy. Anything but, in fact. It was hard. Stressful. Just ask my friends who had to put up with me over that time.
General surgery especially was very painful/stressful. The hours were the longest, the things to do were the most (on the plus side, you were always busy so you never really realized you were tired until you sat down). Rounding with the attendings, spending days with the PA on the floor, seeing many things in the OR (and the cardiac cath lab), going with residents to the ER consults – there were many opportunities to see things and to learn. And on top of that, the many amazing lectures (even the ones that went for 3 hours) throughout the whole 12 week process. I feel like I learned A LOT! (though it might not show in the test results…). But now that it’s all over, I find myself looking back. Wondering.
The 12 weeks – they were definitely an experience. One I’ll remember for a long time. The good and the bad. The things I got to do in the OR. The time I accidentally scratched an itch while scrubbed in (it had been like 6 hours – I practically forgot I was still scrubbed in because we were sitting & waiting). Getting grilled during lecture, and responding miserably (and getting worse with each question). The random words of encouragement (& thanks) from attendings and residents and patients. But while I didn’t exactly learn the technicalities behind any huge procedure or anything (that was not the point, I don’t think – no one is going to expect a 3rd year student to do a Whipple’s procedure or anything), I learned a lot about myself (and about surgery/medicine of course).
I think it’s at least partially due to the awe of being in such a setting (the OR is, despite what it may seem like, a pretty majestic place in it’s own way) and my approach to things being more like a visitor than a student- I was more interested in taking in the experience and seeing whatever I could than in anything else – but I feel (in retrospect) like maybe I didn’t make the most of the 12 weeks I had. I mean, I was there and present, but looking back, I wonder if it would have been possible for me to do more, experience more, learn more. I’m not very assertive in any regard really, and that probably held me back at times. I didn’t go out of my way to ask if I could make the first incision, or if I could suture, or even if I could do simpler things outside of the OR like pulling out a foley or whatnot. I had no problem sitting back and watching things happen as they unfolded, in hopes of just seeing everything possible. Don’t get me wrong – when they asked me to do something, I did. It’s just if they asked someone else, say the 4th year student on the team or the resident or the PA or the PA student, I didn’t really try to get in and be like “can I do this?”. I just stood to the side and let it happen as it did. At the time, the student in me didn’t mind at all because I just wanted to see how things happened – how other people approached such an opportunity. While I feel like I learned a lot, they always say you learn more by doing something than just seeing it (okay, I probably destroyed what they actually say, but you get the point) – and I guess maybe I wasn’t the best at that. So I probably didn’t learn as much as I could have. That comes with being more of a follower than a leader, I guess.
I started learning during the first 2 years of medical school that I do not do well with stress. At all. And in these 12 weeks, it became very clear that I still had not really learned to cope with stress. My diet (if you want to call it that) goes to hell (hello, easy to prepare junk food & soda), my body goes to hell (hello, stress ulcers), my sleep cycle gets destroyed (sleep from 10 PM to 3 AM because why not?), goodbye interests (movies, music, sports – who cares?), and on and on. I just deal miserably with it. Maybe it’s because, until 2 years ago, I’d never really experienced much stress (I’d just run from any such situation if it arose and got annoying – but even that rarely happened), but I’m really not good at dealing with it. Got to work on that somehow. The diet went from “eating relatively healthy” to “eating whatever” to “not eating at times.” The lack of sleep became a huge problem – especially when you threw in 24-hour on calls on the weekend that cut weekends in half and on-calls every 6 days. The daily schedule became “get up at 4, go to hospital, come back from hospital at 6, quick dinner, pass out.” There was very little time for much else (especially anything I might have enjoyed, like movies) – and any time something like that happened, I’d suffer for the rest of the week because I didn’t get enough sleep. At times, I’d be so tired that I wouldn’t even eat because warming up “1 minute pasta” took too much effort and I was simply too tired. Headaches, which had plagued me throughout undergrad before disappearing for a while, returned in a firestorm. I got super sick for the 2nd time in 2 years – this after not really getting sick at all for years. But honestly – when I don’t have the energy to even watch a movie, something is wrong (and only 75% of the blame can go on the fact that all the movies coming out these days SUCK!). … I would like to apologize to the people I bothered during the 12 weeks in this state of … I don’t even know. I was the “difficult patient” version of a medical student/friend.
I am very easily intimidated and run over. Like, “stupid easy.” I knew I was like this coming in – I just didn’t realize how much it would shape the experience I had. It made much of the experience a lot more torturous than it should have been. From rounds to lectures to trips to the OR to oral exams, I was pretty much a disaster at the worst possible times – in front of the attendings & senior residents. My mind would just shut down and leave just me as a living cadaver, making it even easier to carve into me – and we’re in a setting where if you set yourself up like that, others will take advantage. I’d like to think I got a little bit better by the end, but honestly, I’m not so sure.
I met a lot of new friends – residents who are going into surgery (or not going into surgery), other medical students, physician assistant students. I met some awesome doctors who are really, really good at teaching (and being doctors, of course). I became friends with people I’d seen the last 2 years but never really spoken to. And I got to see awesome things (and participate in awesome things).
Amongst the coolest things I did: taking out the appendix (sure the attending and the resident did mostly everything, but I got to cut it out); draining fluid from the knee; “running for blood” in 2 different cases (running is a slight misnomer, as you just walk really fast to the blood bank and wait for them to check and double-check everything before walking back to the OR at an equally fast pace); “pushing drugs” into the IV; holding the heart in place in the body to allow for a clear view during a bypass; helping a patient walk after a surgery and seeing how happy they were. (Nothing really mind-blowing, but at the time it was like “oh man I get to do something!”)
Things I saw: split-thickness skin graft (taken from the thigh and placed wherever need be); a hip replacement; a knee replacement; a low anterior resection; a hemicolectomy; an ileostomy formation; a mastectomy & tissue expander insertion (the longest case I was in – it went for 7 hours); a sleeve gastrectomy; a pericardial window; a carotid endarterectomy; a CABG; an aortic root repair – amongst other things.
Things I wish I had been able to see (just because they seem like awesome procedures to see at least once): kidney transplant – donor or recipient (I actually went to 2 nephrectomies while rotating in anesthesia, but both times missed the actual removal of the kidney from the incision site due to various circumstances so I still never really got to see it), AKA or BKA, pancreas transplant (apparently they only do that with the kidney transplant as well and I don’t even know if they did that in my 12 weeks, but I was never on that team so I never had a shot to see that), reversal of a Hartmann’s procedure.
Probably the weirdest moment of the 12 weeks had nothing to even do with the OR, or surgery really. Or even the hospital. … One of our on call days (a 24-hour call over the weekend) saw us paged (we were paged!) to the surgical library (where all the students/residents sit). We were told to go to the parking lot (of which there are many), and after all the confusion was sorted out, we found ourselves driving to Tree Top Adventures. When there, we were told why we had been called there – to participate in the ropes course. So we did – I did the whole thing too, even given my immense fear of heights. Us, the residents that had shown up and the chief of surgery – we spent 2+ hours on the ropes course and then ziplining. While on call. Quite simply, I learned that some fears are greater than other fears. And I conquered my fear of heights! … For the time being at least (I still refuse to climb up a ladder, or whatever).
Yeah. In terms of what I got to see in the OR as compared to what procedures did take place, I feel like I got to see a lot of what I’d have liked to see if I was an “innocent bystander” who had been granted access to the OR. Not everything, obviously/unfortunately, but close. Not that close means anything – this is a learning opportunity, and everything you didn’t see (for whatever reason) is one less thing you’ll know about when it comes up. (Though, if you base it on the shelf exam, I guess none of that really shows up.)
The “oh shit” feeling that crossed the mind when the schedule first came out – I can’t tell if it was justified or not. I mean, yes, this was a really hard first rotation and super stressful – and we saw people in other rotations who seemed to have much less stress – but on the other hand, it was probably a good one to start with. At least for me. It constantly kicked me in the ass – something I probably needed more than I will ever truly realize. Apparently the rest of the rotations will be “easier,” though we’ll see about that. Even now, I don’t know which is better to start with – the hardest rotation or something easier – because it’s all medicine. You have to do it at some point. And by starting with surgery, we’ve already seen so many different things (cases, presentations, approaches). That definitely cannot be a bad thing.
As for the future – who knows about the distant future. If I learned anything about me & surgery, it’s that it probably isn’t very likely. I just don’t seem to be molded in the same way as the surgeons/surgery residents I interacted with. (I know, some of this might just be mindplay, but whatever.) But then, I haven’t seen any of the other rotations yet, so it’s hard to really compare anything. And I guess I still need to develop (a lot) as a person, so who knows what I’ll feel like after that. The much closer future (like, you know, tomorrow) – I start pediatrics. A complete turn from surgery, it would appear, but I guess we’ll find out for sure once it gets going. I don’t know about the assertive and pushover, but I definitely need to work on the stress management thing.
The experience was exactly what I made out of it (just like they say it’ll be); the knowledge I gained, though, was much greater than I ever imagined it could be.
Ending on a different note – there were some pretty impressive things/moments in the OR that would’ve been awesome to capture on camera.