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Culture of Medicine and Surgery (2): Malignant Trauma

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Preface : I have written several views into my experience on Trauma and Acute Care Surgery, a rotation in which I spend the majority of my preliminary surgery year. The description that follows is the mildest of these. The underlying theme in all of the writings is that Trauma Surgery purposefully maintains a culture of malignancy, perhaps out of some warped fealty to a stern, militaristic tradition of the past century. This has been my experience while working in different hospitals and in talking with other Surgery/Surgery subspecialty residents. It is important to note that my description of trauma/acute care surgeons does not apply to all attending surgeons. At my institution, there are a few very intelligent, civil, and able trauma surgeons, but their general decency is often overshadowed by the bad actors, of whom there are not just a few. 09/15/2019 A few months ago, I made food deliveries for GrubHub. It was simple, honest work. A notification would pop up on my phone i
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Progress

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( Note : Specific details of individuals depicted below have been altered for full anonymity. See upcoming article about "Levels of Anonymity in Medicine.") Lately, it seems all I do is scuttle to and fro around the hospital: Emergency room, operating room, clinical wards, emergency room, and so on. A mental checklist reels and menaces in my head, always brimming and never complete. Then, as I scurry from Emergency to the OR, anxiously praying to do things well and on time, I glimpse outside through the vast hallway windows : Mountains stretch the horizon, leaning to kiss low-hanging clouds that blend with the sun into a golden vanilla foam. An elderly man sits by the piano next to an elevator, playing Segovia on his guitar for patients and visitors. A boy in a hospital gown walks by with his therapy dog German Shepherd. His mother beams proudly, smiling with cautious relief ("I'm so glad he is doing better now.") With the mountains, the music, and the bo
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Sunday Morning

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It's a lazy morning admixed with calm and dread. 9 AM. I try not to think of how many (few) hours remain in the day and the horror show of the week to come - more Trauma Surgery: Attending surgeons yelling at each other and residents, residents yelling at junior residents, and everybody constantly on edge. There is hierarchical abuse in this particular system. Don't get me wrong: I have appropriate respect for the orderly nature of hierarchies; it's the abuse and incessant displacement of blame I don't care for. Everybody is told to take responsibility, but nobody does. I could go on ruminating over the absurdly dysfunctional nature of Trauma Surgery, in a specialty that one would think requires a practiced coolheadedness, but then I would succumb to the same nerve-fraying, time-sinking vortex of worry as I and my co-residents experience when actually at work. In an unusual turn of events, I have had the bright fortune of having two consecutive weekends completely
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Walking throughout the Hospital

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Hospitals with residency programs tend to be large, and residents are usually instructed to park in the most far-flung, inconvenient lots, so I have been walking a lot lately; 15,000 steps per day, on average. I am still getting used to the layout of the place, so I'll often walk in one direction for a bit, only to realize that I'm going the wrong way. So I turn around, and my Garmin logs the extra steps. The pager, once just an inanimate object, without feelings, has become a serial harasser. I've daydreamed about filing a restraining order against it at the local court. Every time it shrieks, the strident sound tears at the middle of my chest - a deep, unquenchable affliction - and I recoil in trepidation at what the ensuing phone call might bring my way. More consults. I have yet to start the previous one. Busywork piles on. I become nauseous, beaten down, resigned to the heavy burden of constant rushing. When the day's work ends, there is no satisfying completi
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Culture of Medicine and Surgery (1)

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I got chewed out by the attending in a protracted, daylong affair. In one scene, the medical student stood silently with her head slightly bowed. She and I had built a sense of mutual respect and camaraderie. It was a veritable massacre, a public execution. The nursing staff stood at a distance, perhaps overhearing, as the guillotine slammed down again and again, just to be sure the job is completed. After our last operation, the attending turned to me in this public setting and said: "You know, you really have to be prepared for cases. If you're not prepared, attendings won't let you do much." And so on. The implication was clear: I am lazy, stupid, and incompetent. My belly was soft when it received the torturous blows. This was one of several recent attacks launched by this particular attending at several of the residents. I had, in fact, prepared for the surgery. I had been the one to see the patient on a consultation basis just the day before. I obtained consen
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Day 5: Changes

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When you enter a hospital as a resident for the first time, your world changes. You become a child again - the environment is new, and you must learn quickly just to survive. Orientation is over, and I am on my second clinical day. Incisions have been made and closed. Just a month ago, I delivered food. It seems like ages. Every place has its quirks and politics. I'm not much of a politician. My continued existence here is uncertain, as I am contracted for one year. It's a tryout. What happens after this year lays only slightly in my hands and is left mostly to the vagaries of fate. It is nice seeing fellow residents engaging in banter and enjoying their categorical positions, and I admit to being slightly envious that they have it all figured out. At the very least, they have job security. The flood of emotions from one day to the next is overwhelming. On my first clinical day, I felt like I was back at home where I belonged, assisting in operations and acting as a doct
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Day 1: Orientation

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Date: Early July, 2019 The sympathetic engine is churning at near-maximal revolutions [sympathetic nervous system: fight or flight response, fear]. At first, it was energizing. Now, I'm learning to ignore the steady trickle of catecholamines and glucocorticoids in my bloodstream. A constant nuisance of fire trucks and police sirens wails in my head. A new threshold has been set. Now we begin. Johns Hopkins Mediccine Residency has begun. Orientation is underway. It is a day that has been long in the making. Nobody could predict how I would end up here, least of all I. A promising, inquisitive, and immature medical student graduated several years ago and began a surgical residency. If not for delays, he would be finishing up and moving onto a fellowship now. Today, he is back at square one: hopeful, invigorated, anxious, and slightly confused. (Have you learned your lessons? If not, life will teach them despite all your cries to stop.) How should I begin? I began...r
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