On the pull of the OR (or consideration of a life in surgery)

The Surgery rotation has been treating me well. For my inpatient immersion, I’m assigned to Surgical Oncology, so lots of tumor resections, addressing complications of tumors, or prophylactically removing tissue in case of cancer. The residents are busy and as considerate as they can be. I try to stay out of their way and not make myself their problem. The attendings are busy as well and do not play unnecessary games.

I have some early mornings but no real complaints, especially since I usually get out in the early afternoon. I’ve seen some interesting procedures, but now that I’m settling into the OR, I find the excitement and anxiety fading and some level of belonging in their place.

Last week, a peer told me that she bet if anything would pull me away from Psychiatry, it would be Surgery. I see that. I feel it. To put it quickly, if I were a younger man then I think I would’ve gone into surgery.

I will be 30 as I finish medical school and enter intern year. A surgical residency is at least five years with another few years for additional fellowship training. Contrast this with a psych residency of four years and done. Especially considering that mileage that I would accumulate throughout those surgical years versus psych. Or the different mileage.

I like the OR. I like the opportunity for clear and direct communication. I like how a procedure in a small surgical field can reduce the world into a small 2″ x 2″ block and everything else fades from view. I like how the OR rewards awareness and consideration for the future.

I also see how much room there is for growth in OR culture. I won’t pretend to understand the stressors and trauma that one experiences while completing a surgical residency and living as an attending. That said, I see the small snaps of patience leading to a reprimand of a scrub nurse in training. I see the rigid hierarchy that allows a demanding and overbearing attending to belittle the skills of a clearly competent chief resident. I see personal style confused for excellence, and if the procedure is not completed to that personal style then it is a lack of skill, not a difference in approach with similar outcomes.

My peer mentioned that while the OR might pull me into surgery, the OR might not be ready for Eugene. Patient safety defines many of the behaviors that I described above, but what true considerations are there for surgeon wellness? I see the surgical residents and see few that look vigorous and healthy. I see the attendings and admire their skill, but also note their stooped posture.

For the OR, any comfort beyond music is seen as weakness. And of course, the attending picks the music. Anti-fatigue mats for tired feet are available, but lay unused. Step stools for short surgeons are acceptable, but utilizing one to step a leg in the Captain Morgan pose and relieve the lower back would be considered heresy. Ergonomic is a four-letter word in the OR.

At the start of third year and clinical clerkships, I asked myself if I would recognize the Eugene at the end of medical school. Would I recognize the Eugene that finishes a surgical intern year and residency? I doubt it.

I think life in surgery would be neat. Neat would not get me through those long sleepless nights in the trauma bay and will not sustain me through the beratings and emotional lows.

Perhaps in a different life.

Perhaps in an earlier life.

For now, I’m glad that I have the opportunity to taste this road-not-taken.

Long Form Sundays

On Death Podcast

7 thoughts on “On the pull of the OR (or consideration of a life in surgery)

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