Thinking ahead...

I'm at the point in my residency now where folks are starting to ask me what I plan to do when I'm done in another three years. Until this point, I've been going through the phase of ruling things out. I definitely don't want to do either plastic surgery or vascular surgery. It is unfortunate, as they make up to three times what other surgeons make. However, I don't want to deal with either patient population. Vascular patients are for the most part rotting away starting at the digits and moving proximally. They are very depressing people to take care of.

That leaves the other main surgical subspecialties such as oncology, colo-rectal, cardiothoracic, trauma, and pediatrics. Pediatric surgery is OK, but taking care of the syndromic children can be less than fulfilling and constitutes a large proportion of that population. Cardiothoracic surgeons can't find jobs right now due to the increasing proportion of cardiac patients being treated by cardiologists with cardiac stents. Harlan has told me that he'll never shake my hand again if I do colo-rectal surgery, so that's out. Plus, a small but significant proportion of that patient population has somehow made their rectum the focus of their significant psychiatric issues, and expect you to fix their rectal problems (which are more in their heads than not.) Oncology patients are usually sweet, however, I don't find palliative work rewarding. That leaves trauma.... and I love it.

It has really become a trauma/critical care/emergency surgery field. Basically you're a general surgeon with extra training in being a general surgeon. They are the surgeons other surgeons consult. Last week contained one of those moments that reinforced that direction.

I was called to evaluate a young man admitted by the medicine service. He was obviously very sick, and was going to die in the next 30 minutes unless we figured out what was going on. My best friend from within my residency year level had caught wind of the consult as well, and showed up. Together we figured things out, and decided that he had a surgical emergency. Though it was a diagnosis neither of us had seen before, we got him down to the operating room, found an attending surgeon to help us, and did the case. We were right and fixed the problem. Had we not of intervened, he would have died within the hour. There are few other fields in surgery that provide that kind of gratification. I was on cloud 9 for the next 2 days.

A number of people at the hospital have suggested that I consider doing surgical critical care/trauma. We'll see. I have yet to do my trauma chief rotation. That involves dealing with a lot of NOG's (Non-Operative Grief). Most NOG's are drunks that did something stupid, have a laceration or something and just need to sober up. They can be very frustrating patients to take care of. So maybe I'll change my mind after a couple of times being up all night with NOG's.

Southernisms

My first experience with Tennessee English that I can remember came when I was driving through the state about 10 years ago with my sisters. We had stopped at a Subway for lunch. What was normally a smooth process of saying whether or not you wanted black olives, lettuce, pickles, etc on your sub turned into a series of "What did you say"'s. It definitely wasn't English.

While I no longer find the Southern Appalachian dialect incomprehensible, it does still have its oddities that I fail to understand. One of them, until today, had been the name for a "pen." Instead of asking if you need a pen, Chattanoogans will ask you if you need an "ink pen." I've always had to fight the urge to respond, "No, I'd rather have a water pen," or something else along the same sarcastic line.

Saturday I was rounding on the ICU patient census with several other doctors, and one of the nurses asked Dr Jeff Horn if he needed an "ink pen." At the end of rounds, I asked Jeff if it had ever struck him as slightly redundant ... rather like asking for wet water or cold ice. It hadn't ever struck him as odd before, but he agreed that it was a linguistic oddity. He advised discussing the matter further with our local expert on Southernism's, Dr Bob Aderhold, a Georgia redneck otherwise known as the "puff ader." Monday morning, I ran into Ader in the SICU, and presented my troubling linguistic problem with the "ink pen" to him.

Without hesitating for even a second, he confided that he had also been troubled by the redundancy of the term. In fact, he had almost lost his faith in the efficiency of Southern English as a result of these thoughts. However, one day the necessity and importance of saying "ink pen" rather then just plain old "pen" dawned on him, leaving him with a lasting peace of mind. The simplicity and logic of the argument left me dumbfounded.

He explained, if you don't say "ink pen," how would your audience know that you don't mean a "straight pen, a bobby pen, hat pen, or even a dog pen or bull pen?" He has a very valid point.