I'm supposed to show up in my cute little white coat that's stuffed full of books, notes, and pocket tools at 0400. I'm supposed to report only to residents, because the attending is to be awed and feared. He/she is the omnipotent, omniscient, omnipresent being who strides onto the floor confidently, a few inches off the ground. Eye contact must not be made, and it is proper to cower just a little bit in his/her sight. If true fear is not inspired, a good grovel should be thrown in every few hours. If groveling is not ergonomic, you just have to hope they catch you in solemn prayer (praying to their divine-ness, of course). When the attending asks you to present a patient, beware! You will be interrupted quickly, and dismissed even quicker. Your saving grace will be the resident physicians, who are the buffer zone between you and the attending. They are supposed to be terse, possibly flustered, and always running out of time. You, the medical student, are an added chore. Go put a Foley in 17. What?? You really don't know how to put a Foley Catheter in? Get someone else to teach you. I'm busy. Follow resident physicians like lemmings, and, even though they aren't attendings just yet, cower if appropriate. These are the horror stories we students heard from the class above us. Fresh meat, we are.
I must say with a sigh of relief that this is not how OB-GYN really is in Asheville! But I'm not going to lie; of all the rotations this year, this is the only one that gives me a bit of the shakes thinking about it. It's uncharted territory (especially for the young, nulliparous male). Yeah, I'm sure the residents get a kick out of some of my patient care suggestions and butchering of common medical abbreviations (apparently "R+R" means "resection and reanastomosis," not "remove and repair" - but close!), but I'm always pleasantly corrected later. Thus, the next morning I won't act such a fool in front of the omnipotent one on rounds. The residents always have time for me; they teach and don't appear flustered (at least not that I can tell). My chief even helped me horde numerous packets of needless 2.0 Vicryl, so I could tie two-handed knots over and over and over again. I think I picked it up quickly afterwards, but in the OR I'm sure it was like watching a 15 year old behind the wheel for the first time... you grit your teeth, and want to rip the wheel out of their clumsy hands, but you know it's their first time.... they need the practice. After a couple days of trial and error, I can now challenge my Eagle Scout Pops to a "knot-off." And the attendings? I may still have a little bit of healthy fear, and perhaps they do walk a few sonometers off the ground, but there's less grovelling, cowering, and praying than I expected. They don't even blink an eye when I "remove and repair" someone's small bowel. Actually, they've been downright great. It was a great week one, and I'm shaking just a little bit less.
I was also shocked when I made it through 6 weeks of Surgery without doing any serious "retracting." You see that bad boy up in the top left? Now that's a retractor. Med students are bottom of the totem pole in the medical community, so if we get to scrub in, we're supposed to be pulling on these cumbersome tools to hold the patient's skin back. The residents and attendings do all the cool stuff obviously, but most of the cases on Trauma and General Surgery didn't require any heavy lifting. We've been replaced by this tool called the "Bookwalter," which hovers over the patient's belly and secures multiple retractors at the same time (sorry, I can't grow hands either). But finally in Gynecology-Oncology, I got to do my due duty! I got to grab my Deavers and Army-Navies and pull up 'n away. Sure I had retracted here and there in Gen Surg, but now I got a chance to hold back skin flaps for hours and hours at a time (or that's what I'll tell my kids). Don't worry, Robert's ready to retract! And I am. I like being helpful in the OR if I can, and if I play by the rules... do we remember our rules?
Rule #1 - Don't Get in the Way; Rule #2 - Don't Touch the Mayo; Rule #3 - Don't Get in the Way, and Don't Touch the Mayo!
We're there to learn, but I also think that the patient always comes first. Pestering the attending into a fit of rage is not going to make the surgery go smoothly. Queries at the proper times, and struggling to pull back Goelets to help him/her visualize is going to make the attending happy. And believe me, a happy surgeon is a good thing. So I try to find a good balance between learning and helping (so long as I don't touch the Mayo, of course). We had a wonderful case this week that tested the hours I'm putting in the gym. A few minutes into retracting above the liver my left arm starting shaking as I flexed backward. It was a monster piece of metal, and for the life of me I can never remember it's name. But I know what she looks like, and we will do battle again...
This is our only taste of "real" medical education in our third year, but I'm glad for it. This gives us a chance to better understand a few things: like how much we will know at different levels in our training, what the medical hierarchy is and how it works, and what our lives are going to be like as residents. We also get the opportunity to learn from physicians not far out from medical school; those who perhaps understand our inadequacies a bit better, having walked our shoes just a few years before. It is also an important reminder that the people make all the difference in a residency program. I can't stress this enough. If I'm going to be spending 80 hours a week with just a few colleagues, they better be pretty chill. Fortunately, Asheville attracts that kind of person, I think. We're lucky here.
Now, back to the OR to defeat my nemesis.
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