Monday, April 11, 2011

Theoretically Speaking

It was finally warm today after several days of cold, raininess. It’s funny how much the ordinary seems so great after a few days of sub-par. My spirits immediately lifted as I walked out of the hospital (before six pm hallelujah) and it was warm and sunny out versus cold and dark, as it has been the past several months. Working so many hours just doesn’t seem as bad when you walk out of the hospital and it is still light out, even though it may still be the same time as usual on your watch.

I’m on thoracic surgery right now, basically surgery involving any structure in your chest (except for your heart). Let’s just say, theoretically speaking, there is one attending- the intern attending (IA). It is a right of passage to work with IA, all his cases get passed onto the intern. It’s the intern’s job to see his patients, round on his patients, and report back to IA about his patients. The upper level residents refuse to work with him. A benefit to this is that often as an intern, you get to help out with much more sophisticated cases than one normally would see. However, if you go into a 2-hour case starting at 3pm, you know you are not getting out of there before 10pm- just another rite of passage.

IA is very methodical- at the beginning of a case, the skin is sterilized with iodine. Normally, the nurse will do it- she uses a foam paintbrush to paint iodine onto the part of the body that is getting the operation. Not IA. IA must prep the body himself. He uses a specific number of strokes and watches the clock as he does so, brushing on the iodine for a specific number of seconds. After prepping the skin, the sterile drapes are put on the patient, covering everything except for the operation site. Normally, the resident will drape the patient so the patient is ready to go when the attending walks into the room, ready to start the procedure. This is appreciated, and expected. Not with IA. If he comes into the room and you have already draped his patient, he will rip them off and shove them in the trash, furious. IA drapes himself every time- with two cover sheets and four towels. Before the procedure, there is a checklist that is reviewed to make sure everything is appropriate- this is called the “time out”. Before every case, IA clears a stool, sets the checklist down, and goes through every check. If you try to put another sheet of paper down on the table that has the checklist, he will grab it, ball it up, and throw it on the floor. Only the checklist is allowed on the table during the time out. Every instrument is held a specific way, every stitch is sewn in a specific manner, every time. If you do anything the least bit off, you can see the anger rising, IA involuntarily furious his set plan has been slightly disturbed. Call it meticulous and methodical, call it obsessive compulsive. It’s not necessarily a bad thing, as long as you are willing to incorporate new and improved methods from time to time into your set ways. In fact, I wish I were more meticulous and methodical. Sometimes I feel like I am way too all over the place- using the wrong drape, forgetting to put on my eye wear, accidentally touching something non-sterile. These are all little details that eventually get rectified, and I know as I get more comfortable in the OR and with myself as a surgeon, all the little details will become routine to me. But, until then, I feel like a total moron at times. Someone at the hospital once asked me if brunette was my natural color. Very funny.

Sometimes, IA will leave in the middle of the case to go have a cigarette. You sit there scrubbed in (i.e. in all sterile gear so you really cannot move) with the scrub tech and anesthesiologist standing there, staring at you. And all you can do is stare back at them, make awkward conversation about the weather or last baseball game, and wonder if it’s possible for lightening to go through 5 floors into the OR, bypass all the metal in the room, and hit you directly so you can get the hell out of the case.

IA eventually comes back in, the tremor in his hand a little more steady. Everyone thinks IA’s hands shake because he needs a nicotine fix. That may be partially true, but I think IA has Parkinson’s. His methodical and meticulous habits are performed in halting, deliberate movements. When he tries to move a stool out of the way, he sets it down stiffly, in a cogwheel like fashion, indicative of the disease. It looks like he his slamming the stool down in anger, but I just think he cannot help it. I don’t think IA has much else going on in his life, surgery is it. And he has a disease that’s making him lose control of his body and of the only life he has ever known.

I think about IA and wonder about the people who think you need to give up everything to truly be a good surgeon (or a good anything for that matter). You have to focus all your time, all your energy into that one specialty in order to be the best you can be at it. To an extent that may be true. But is it really worth the sacrifice to be the best you can be? To spend a lifetime dedicated to a career that a disease or an accident can abolish in an instant? And in the end, who is going to be around? None of the patients that you saved or the clients you helped or the people you defended. In the end, it always comes down to your family and the people who truly love you. With that desire to succeed, if you run off your family or never make the time to love someone or have someone love you back, when you finally get to the top of that ladder, it's probably a pretty lonely place. It most likely takes a hell of a lot of multi-tasking and sleep deprivation to be a great professional, a great spouse, a great parent, a great sibling, a great friend, but I bet it's possible.

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