On summer nights (or Surgery: a post-mortem)

Short week of nights. Monday, Tuesday, Wednesday. Shelf on Friday. Birthday weekend for my partner.

Monday, the night started quietly. Followed the intern around as he answered pages and checked on patients. While ignored by the surgical night team, I reviewed flashcards and answered practice questions for the upcoming shelf exam.

Tuesday and Wednesday went much the same. Lots of studying. Saw a laparoscopic appendectomy and a thromboembolectomy. Neat stuff.

I had been emotionally prepared to see someone die during a trauma alert. When on nights, my partner spent hours suturing an obese woman that had been stabbed dozens of times. Other students saw gunshot wounds to the head, or entrails flowing out onto the floor.

I had a glorified study hall.

That’s been the mood of my whole surgical clerkship.

My outpatient weeks have been filled with benign neglect. Days of following surgeons around the office as they rush from patient to patient, or some days in the outpatient OR observing relatively minor procedures. The residents are busy and they ignore me, for the most part. My main goal is to not get yelled at by the scrub nurses for doing something stupid. I’ve definitely gotten better at this as the clerkship wore on.

My inpatient weeks have been filled with benign neglect. Early morning rounds with the residents at 530a. Usually just a quick five minute encounter before they are onto the next one. I joke that I have forgotten how to talk to patients while on the surgical care clerkship. I’m not that far off.

After rounds, then I have an hour or two to burn before the procedures start around 730a. Watch a couple laparotomies, hold traction, and get asked a few questions. Go home, eat, sleep, and repeat.

Perhaps timing has a large role to play. The final clerkship means that the academic year is wrapping up and the new wave of interns approaches. The chief surgical residents are getting ready to either start a fellowship or set out on their own as an attending. The interns are wrapping up their initiation year and preparing for their second year in the Surgical ICU. They are all too busy to think about me.

My aim of Psychiatry also plays a part. When the resident or attending asks me what I want to do, I answer Psychiatry, and the conversation usually stops there. Sometimes they will tell me a story about psych or how we need psychiatrists. But inevitably, they quiet down and just get to work. If Surgery and the OR sits on one side of the healthcare spectrum, then Psychiatry sits on the other side.

Could I have leaned into the educational experience of surgery? Yes.

Did I? No.

I participated as much as necessary to keep my head down. I knew that surgery would be, at its core, neat. I also knew that I would not enter a surgery residency, so I just wanted to glide through the clerkship. I could’ve seen more procedures. I could’ve spent more time in the OR. But when I was in the OR, I was usually engaged. I always helped out the OR staff with moving the patients to the transport bed. I helped clean up.

At the end of the day, that’s about the best you can ask from me. Especially at this stage, when the medical make-believe of third year comes to a close. I’ve already begun to develop the tools necessary for my own residency, for my own psychiatry practice. Now I can see how things are going to get real, real fast.

I could’ve skipped this final week of nights. I could’ve had a normal sleep schedule going into the final exam, with free mornings and free evenings. It would’ve been so easy, the residents never really know who is supposed to be where. If you don’t show up the first day, they assume no students this week. If you play the game, you can fall through the cracks.

But, I made the conscious decision to attend. The final week of the clerkship, the final week of third year, I’m paying a boatload of tuition: I could show up and be present. Very likely the last time I would step in the OR, until myself or a loved one needs an operation.

Instead of blood and guts, I got the reminder that we get the cases that come to us. Sometimes a dozen emergency appendectomies come through the door and sometimes a gang of teenagers decides to stab each other at two in the morning. The hospital is a weird place filled with untold stories.

If you aren’t in the room, you never really know what happened. At least I was ready to be in the room.

Long Form Sundays

On Death Podcast

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