Culture of Medicine and Surgery (1)
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 consent and booked him to the operating room. Additionally, I had done several of these particular operations in the past. I knew the steps but did not want to push any boundaries with an attending surgeon I had just met. But I offered no excuses and accepted my punishment.
In the operating room, we stood by the patient and watched him breathe in and out, in and out, like a whispering seashore at dusk. The attending gathered his voice and bellowed: "Well, what the hell are you waiting for? Are you doing this or not?" I began the procedure, and he looked on, waiting to pounce on any slight misstep or hesitation. For the rest of the 1-hour case, I worked in orderly silence while he barked forth his general (life) dissatisfaction. I had not planned to serve as a doctor to two patients, one on the operating table, the other... Nor was it ever my intention to explore the innermost motivations and psyches of fellow residents and attendings, but it appears this is what I've gotten myself into for the year (more on that later).
On a sidenote: In upper endoscopy - the use of a thin-tubed camera to evaluate the upper gastrointestinal tract (esophagus, stomach, small intestines) - there is a characteristic appearance to the normal stomach, wherein you can see the propagation of contractile (called peristaltic) waves of smooth muscle starting near the camera tip and sliding towards the small intestine. It is a peaceful sight in an otherwise murky field of frothy mucus, scattered blood, and whatever underlying pathology that necessitated the endoscopic procedure to begin with.
The operation required the use of upper endoscopy. "Don't you know how to do this? Do you want me to operate for you, or what?" I said nothing and continued my portion of the procedure. On the screen, gentle peristaltic waves unfurled over the span of expansive stomach, vanishing at the pylorus and starting again for another of seemingly infinite cycles. How many more such cycles will my own stomach have? I had never thought of the stomach as zenlike - it has a thick, rugged wall that spills acid at most of its guests. And yet, I stood entranced by its rhythmic rolling while the attending yammered away with displeasure.
I found out later in the day that the attending surgeon had been igniting multiple tiffs with some of the other residents - although, curiously, never attendings - in petty, extravagant displays of power. During rounds, we listened as he proclaimed his grandiose opinions on a broad of topics, ranging from conspiracy theories to the inferiority of certain subspecialties. He remarked at the Junior residents that we could not possibly understand his 'high-level' thinking. A third-party looking on might interpret such behavior as insecurity. I wouldn't dare say that. I'm just a junior resident - lazy, incompetent, and stupid.
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 consent and booked him to the operating room. Additionally, I had done several of these particular operations in the past. I knew the steps but did not want to push any boundaries with an attending surgeon I had just met. But I offered no excuses and accepted my punishment.
In the operating room, we stood by the patient and watched him breathe in and out, in and out, like a whispering seashore at dusk. The attending gathered his voice and bellowed: "Well, what the hell are you waiting for? Are you doing this or not?" I began the procedure, and he looked on, waiting to pounce on any slight misstep or hesitation. For the rest of the 1-hour case, I worked in orderly silence while he barked forth his general (life) dissatisfaction. I had not planned to serve as a doctor to two patients, one on the operating table, the other... Nor was it ever my intention to explore the innermost motivations and psyches of fellow residents and attendings, but it appears this is what I've gotten myself into for the year (more on that later).
On a sidenote: In upper endoscopy - the use of a thin-tubed camera to evaluate the upper gastrointestinal tract (esophagus, stomach, small intestines) - there is a characteristic appearance to the normal stomach, wherein you can see the propagation of contractile (called peristaltic) waves of smooth muscle starting near the camera tip and sliding towards the small intestine. It is a peaceful sight in an otherwise murky field of frothy mucus, scattered blood, and whatever underlying pathology that necessitated the endoscopic procedure to begin with.
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| Stomach Peristalsis, Science Photo Library |
The operation required the use of upper endoscopy. "Don't you know how to do this? Do you want me to operate for you, or what?" I said nothing and continued my portion of the procedure. On the screen, gentle peristaltic waves unfurled over the span of expansive stomach, vanishing at the pylorus and starting again for another of seemingly infinite cycles. How many more such cycles will my own stomach have? I had never thought of the stomach as zenlike - it has a thick, rugged wall that spills acid at most of its guests. And yet, I stood entranced by its rhythmic rolling while the attending yammered away with displeasure.
I found out later in the day that the attending surgeon had been igniting multiple tiffs with some of the other residents - although, curiously, never attendings - in petty, extravagant displays of power. During rounds, we listened as he proclaimed his grandiose opinions on a broad of topics, ranging from conspiracy theories to the inferiority of certain subspecialties. He remarked at the Junior residents that we could not possibly understand his 'high-level' thinking. A third-party looking on might interpret such behavior as insecurity. I wouldn't dare say that. I'm just a junior resident - lazy, incompetent, and stupid.
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