M & M (not the candy)

Surgery residency programs across the country have a weekly Morbidity and Mortality (M & M) conference at which any deaths or complications are discussed. It is basically a discussion of what happened and whether or not the complication could have been prevented. Presenting a case as an intern is a daunting task, as the faculty may ask any question they want. It tends to be the conference at which the well-prepared residents shine, and the poorly prepared ones crash and burn. It is my favorite weekly educational conference unless I am the one presenting a case gone wrong.

I always get nervous prior to any presentation there just because you cannot always predict which way a discussion will go, and therefore what questions you will be asked. Any medication used or not used, any procedure done or that could have been done, and diagnosis and its differential are relevant topics for discussion.

Today I presented a case. It involved a topic that we don't deal with much in modern day surgery since the advent of H-2 blockers and proton pump inhibitors, but which the older surgeons who practiced prior to the advent of those medications dealt with very commonly. It is therefore a diagnosis that people in my generation are not as well-versed in and therefore not as comfortable discussing.

I therefore spent the entire evening yesterday frantically reading every text book and operative atlas I own that had any discussion of ulcer surgery. I discovered various new operative techniques I hadn't even known existed. Every text supported our management as appropriate despite the complication, and that was reassurring. The conference went well and I survived unscathed. No unexpected topics were raised by anyone. The conference did fulfill its purpose though, as I definitely learned more about gastric surgery through the process of reading for it.

This month I will be on research after spending a busy month last month basically operating non-stop. With two papers due to two journals in the first half of December, I will be busy. However they both will be published, and one will be presented by me at a major conference in February. It is nice to see some of the work from previous research months finally paying off although I am getting more and more nervous about presenting in February. I will be presenting a paper on breast cancer treatment. We have very solid data, but it is intimidating to know that surgeons who have been in practice for decades, some of whom have specialized in breast cancer surgery, will be listening and then will be free to ask any questions they want to. In the next two months, you can guess what I'll be studying. A favorite quote of my med school friend, Tejas, is "the dictionary is the only place where 'success' comes before 'work'."