The Delinquent Hatter
Ok, I'll admit it. I've been rather tardy with regards to posting here the last few weeks. The month of June and the beginning of July were insanely busy. My time outside of the hospital during this interval has mostly consisted of sleep. I did get a lot of stuff done though, so it certainly wasn't time wasted.
Perhaps the most exciting event of the past few weeks was transitioning to being a fourth year resident at the beginning of the month. Responsibilities in our residency program are divided between junior residents (PGY 1-3), senior residents (PGY4-5), and chief residents (PGY-6). Being a junior resident means that all the mundane tasks involved in running a surgical service are yours to perform. The senior residents job involves supervising the junior residents, communicating important information to the chief residents and the attending surgeons, making decisions about who needs to go to the OR, and vastly increased responsibilities in the OR.
I love being a surgery resident, and the increased responsibility I've been given this year only heightens my enjoyment of what I do. I was on call in the hospital 4 out of the last 8 nights. On only one of those nights did I get any sleep. However, I had the opportunity to do some amazing cases and see some fascinating things in the emergency room. As always, the trauma cases are the ones that most intrigue me.
Trauma is different from everything else we do as surgeons. The rest of our patients are referred to us by other doctors who may or may not be idiots. Unfortunately, doctors that are idiots are much more likely to consult other doctors because they don't feel comfortable making diagnoses and treating the diagnosed disease process. They therefore harass other physicians with meaningless consults. However, if you run a normal surgical practice, you dictate a rather patronizing note to the referring physician saying how delighted you are to have been referred this very pleasant, intriguing patient when in reality you're not thinking any of those things but just need to say them to try to maintain business from that referring physician. That doesn't sit well with me. Then if the patient needs surgery, an extensive amount of energy is put into figuring out whether they're suitable candidates for the proposed procedure. Hours are spent discussing with the patient and family members whether or not it should be done.
Trauma is different. More often than not, if you operate on a trauma patient, very little time passes between meeting the patient and opening them up in the operating room. There are no fake sounding letters sent to referring physicians. Discussions with family usually occur after the surgery, not before.
Working up a new trauma is a very dynamic process. They arrive in your ER only with a tragic story of some misadventure. There is no neat list of medical studies saying that Miss Jones has a biopsy-proven cancer of "x-type" and is at "y-% risk of perioperative heart attack." It is just you and the patient who may or may not be actively attempting to die on you. The diagnostic process of working up and treating an unstable trauma patient is very stimulating and is a test unlike most others of your surgical skills.
I've been following the events in Israel and Lebanon with a combination of interest and horror. War is so incredibly barbaric and is evidence unlike any other of the falleness of humanity. I remember how traumatic it was to be in New York City on September 11, 2001. That was just one attack on one day in the city I lived in. People in a war zone like that in Lebanon and Israel live in it day in and day out. I don't know how you ever cope with anything like that.
Isn't a situation where the extremes of the fallenness of human nature are being demonstrated an example to demonstrate the other extreme of humanness -- that of being created in the very image of God with the associated ability to show love and compassion? For myself, I increasingly feel drawn to work with an organization like Medecins Sans Frontieres. Time alone will tell where the Lord wants me. In any case, as the Psalmist said, pray for the peace of Jerusalem.
Perhaps the most exciting event of the past few weeks was transitioning to being a fourth year resident at the beginning of the month. Responsibilities in our residency program are divided between junior residents (PGY 1-3), senior residents (PGY4-5), and chief residents (PGY-6). Being a junior resident means that all the mundane tasks involved in running a surgical service are yours to perform. The senior residents job involves supervising the junior residents, communicating important information to the chief residents and the attending surgeons, making decisions about who needs to go to the OR, and vastly increased responsibilities in the OR.
I love being a surgery resident, and the increased responsibility I've been given this year only heightens my enjoyment of what I do. I was on call in the hospital 4 out of the last 8 nights. On only one of those nights did I get any sleep. However, I had the opportunity to do some amazing cases and see some fascinating things in the emergency room. As always, the trauma cases are the ones that most intrigue me.
Trauma is different from everything else we do as surgeons. The rest of our patients are referred to us by other doctors who may or may not be idiots. Unfortunately, doctors that are idiots are much more likely to consult other doctors because they don't feel comfortable making diagnoses and treating the diagnosed disease process. They therefore harass other physicians with meaningless consults. However, if you run a normal surgical practice, you dictate a rather patronizing note to the referring physician saying how delighted you are to have been referred this very pleasant, intriguing patient when in reality you're not thinking any of those things but just need to say them to try to maintain business from that referring physician. That doesn't sit well with me. Then if the patient needs surgery, an extensive amount of energy is put into figuring out whether they're suitable candidates for the proposed procedure. Hours are spent discussing with the patient and family members whether or not it should be done.
Trauma is different. More often than not, if you operate on a trauma patient, very little time passes between meeting the patient and opening them up in the operating room. There are no fake sounding letters sent to referring physicians. Discussions with family usually occur after the surgery, not before.
Working up a new trauma is a very dynamic process. They arrive in your ER only with a tragic story of some misadventure. There is no neat list of medical studies saying that Miss Jones has a biopsy-proven cancer of "x-type" and is at "y-% risk of perioperative heart attack." It is just you and the patient who may or may not be actively attempting to die on you. The diagnostic process of working up and treating an unstable trauma patient is very stimulating and is a test unlike most others of your surgical skills.
I've been following the events in Israel and Lebanon with a combination of interest and horror. War is so incredibly barbaric and is evidence unlike any other of the falleness of humanity. I remember how traumatic it was to be in New York City on September 11, 2001. That was just one attack on one day in the city I lived in. People in a war zone like that in Lebanon and Israel live in it day in and day out. I don't know how you ever cope with anything like that.
Isn't a situation where the extremes of the fallenness of human nature are being demonstrated an example to demonstrate the other extreme of humanness -- that of being created in the very image of God with the associated ability to show love and compassion? For myself, I increasingly feel drawn to work with an organization like Medecins Sans Frontieres. Time alone will tell where the Lord wants me. In any case, as the Psalmist said, pray for the peace of Jerusalem.
posted by The Mad Hatter at 4:36 PM
5 Comments:
I don't know if I'll have time to read your previous postings. This one was so interesting, tho'.
I listen to the news and can only cry out, "Oh, God!!" There are 'poeple' over there, suffering incredible trauma on both sides of the conflict.
Maybe some day you'll do surgery on a boa constrictor and remove an electric blanket with all the fixins'. I heard that on the news this evening, too.
We enjoy reading your posts. Very interesting. I especially liked the one about finding a solution to your laundry issues!! I'm sure Les would be the same way if he was single.
My sister, the queen of Mennonite blog hopping, alerted me to your blog. I was quite amazed to find there is another Mennonite in Chattanooga. Of course, I'm just brimming with curiosity. At least now I don't have to feel quite so isolated. :)
I'll be at Erlanger for some of my clinical rotations this fall though it probably won't cross into your realm. I did my surgical rotation at Memorial Northpark and Memorial Downtown last semester. I think I'll be back in surgical next spring semester but I don't know which hospital since we haven't repeated a hospital yet.
I love reading your medical stories. Hope things continue to go well for you. And who knows, I may see you at Erlanger one of these days.
Hmmm...While I like your compassion for those in war zones, I think you could share some of it for "idiot doctors" too. Don't I sound like a mother? Mom
Mom,
Perhaps that was strong language to use. However, there are doctors in every field, surgery included, whom I strongly believe should not be practicing medicine. The medical community is not good at all at appropriately discipling incompetence. There is a slow move towards doing so, but it is happening at a snails pace.
Hans
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