A Budding Emergencist
Friday, November 17, 2006
  Surgeons as superheroes?

As I drag myself through two general surgery months in my internship, bleeding and drained, I still can not fathom the motivation that enables doctors to endure this torture. Surgery has a quasi-religious, paramilitary feel to it. With apologies to Dr. Sid Schwartz, allow me to vent.

My chief resident has me parroting this refrain: "The chief resident is always right". Even when he's wrong, he's right. For example, on evening rounds, (I had literally just begun my call, and had been away for 18 hrs, a lifetime on a surgical floor) he mentioned that a particular, delicate, demanding patient was tolerating clears. I happened (being the intern, I am expected to have all information about the patient on hand) to have the orders list in front of me. There it was, the order HE wrote that very morning, for a clear liquid diet. This is unusual in that; 1) the chief resident rarely, if ever, writes orders himself; 2) that he would forget an order he wrote; 3) would fail to take advantage of an opportunity to pimp a hapless intern in the minutiae of patient management. I, keeping above drilled maxim in front of my thoughts, refrained from correcting him. Subsequently, he reported to the attending the same, which the attending plainly denied--it was right there in the orders--"DIET: CL LIQ". I received a verbal beating for failing to correct the senior resident, and was held responsible for his embarrassment in front of the attending. This kind of pathological evasion of responsibility is beaten into the training resident from the beginning, and represents to me part of the fundamental inhumanities of surgical training.

You know, I wouldn't mind the 15 hour days, the narcissistic, entitled patients, the petty vengeful nurses, if I had some support from above. If there's no team, the whole thing falls apart.

It reminds me of a conversation I had with an attending at a different hospital who wrote me a letter of recommendation. I asked him why surgeons have to start operating at 7 or 7:30, thus needing to round at 6 AM, thus making necessary prerounding at 4:30 or 5. He said it is because the surgeon is the ultimate doctor, responsible for every facet of knowledge of medicine as well as surgical mastery. In short, surgeons must be super-heroes. While the rest of us struggle to maintain our humanity in the face of death and awesome responsibility, surgeons reach towards some ultimate, the ideal, to be the ubermensch.

Boing boing's Cory Doctorow frequently refers to comic-book superheroes as "underwear perverts," and, given the surgeon's chosen attire, I'm not sure I disagree.

My point is that, perhaps in struggling towards omnipotence ("The only way to heal is with cold steel") and omniscience (c.f. my attending's explanation), some essentially human aspects are minimized and overlooked, like compassion, responsibility, and appreciation. It's enough to be human--sometimes trying to be more than human involves denying simple humanity.

One must be human.
Seriously, I understand what you're saying and I also have a great deal of respect for surgeons but they are not even close to being the masters of the universe that many people think them to be be.

Once you spend a little time with them and the luster will wear off quickly.

As for surgeons being the ulitmate doctor, well, maybe in academic medicine but most surgeons are perfectly content to have the hospitalist manage their patients pre- or post-operatively as they don't want to be bothered with medicine except as it relates directly to their procedure.

Like any other skill, if you don't use it you lose it. Medical knowledge is no different. If you never manage your patient's diabetes for example then you forget how, except for the ability to write for "sliding scale insulin" which is adequete but hardly optimal.

Would a woman go to a general surgeon with a complaint of unusually heavy vaginal bleeding? Would you take your kid to surgeon for an unsual rash? I'll give them credit for the surgical mastery part but for the rest of it they call for help like everybody else.
P.B.: Of course, this rant is limited primarily to academic medicine and really to surgical housestaff and residents. I've often wondered how the fire-breathing senior surgical residents I've been abused by transform into the reasonable surgeons that inspire me.

I think the answer lies in a criticism made by a veteran orderly to me about a new attending (actually an ER doc) who was needling me: "He tries to do too much with someone else's hands." In other words, a supervisor/leader must accept and adapt his criticism to the trainee's level of experience, NOT his own. I think a lot of my surgical seniors (including the one evaluating me) make this error--because they are good at something they judge it trivial and those who have difficulty with it lacking.

I'm not whining. I work my ass off (just finished a 29-hour call) and don't have a problem with it. However, when I'm judged according to a standard inappropriate to my experience (yeah I'm not as good as the other surgical interns--I'm not a!@#%@^@#$ surgical intern, asshole!!!), then we have a problem.
Man, I have always wanted to be a surgeon and for some reason what you just wrote makes me want it even more. I am not sure why but I would absolutely love that job.
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Emergency medicine, from the beginning of a new doctor's career.

Location: Big City, Metropolis, United States

Walk softly and carry a big vocabulary. Don't be inhuman. Find and greet God in every person you meet. The patient is the one with the disease. Do not get distracted. Charity begins at home. Do good and be happy. Don't just do something, stand still. Wear sunscreen. Don't get anyone pregnant, and don't go to jail, young man. Budget your luxuries first. You don't know what you don't know. People like learning, they just don't like being taught. When in doubt, go out. When life gives you lemons, make lemonade. Honey attracts more flies than vinegar.

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