month 3 update: it still sucks

pre-2003: what’s the worst thing about q2 call? you miss half the good cases
post-2003: what’s the worst thing about q7 days off? you miss 1/7th the discharge summaries and hospital-to-hospital transfers

internship is not very pleasant. everyone talks about the steep learning curve and how i’ll learn so much this year. and surgical training is supposed to be about decisiveness, being trained to handle anything. i still feel like every situation i’m in requires me to consult the second year resident or above. like i can’t make a single move without running it by someone else first. i sort of felt like residency would be different. i still feel like a medical student in a long coat. well i did have a lot of independence on trauma and it blew up in my face often. i don’t know what’s worse, being unable to make any decisions, or making too many. i wonder when my decisions will magically become better.

that being said, it’s a cool feeling once in a while, to be called to the OR to finish up a case or see something sweet. when i get those rare pages from the OR nurse summoning me, i feel like clark kent changing into superman as i change from my shirt and tie into scrubs.

the other day i saw an open repair of a thoracic aneurysm, where the aorta was exposed above the diaphragm, with the heart beating away in the corner of the exposed field. i still haven’t decided whether seeing something like this is worth it all; i’m not the sort to be amazed by much, or deeply passionate about any particular thing. so i’m skeptical.

anyway, by way of updates, it’s been about 9 weeks and i haven’t quit yet.

my life outside of the hospital and from work is virtually non-existent. i’m ok with that, more or less, so far.

boasting that my life sucks a little less than before

well i just did a week of my new rotation and i can’t really complain right now.

it’s quite a luxury to go to work knowing that i don’t hate every single one of my patients. a luxury i did not have on my last rotation. it is also quite a luxury to deal with people who have insurance, because that means i don’t have to spend hours out of every working day talking with the social workers and hoping for a miracle to get some place to accept an uninsured person with TPN, PICC, gigantic open wounds, aspiration precautions, and post traumatic stress disorder. yeah that was a fun.

i also very much enjoy the fact that we have 3 patients on my service, all of whom are in the SICU. this means that the ICU team manages my patients, and therefore, i never get paged about them. this makes my weekend call pretty awesome. on saturday i rounded on my patients for no more than 15 minutes, then promptly went to sleep. woke up, got lunch, and slept some more. then rounded on my patients one more time, then went home. on sunday, i rounded on my patients for maybe 10-12 minutes, had some breakfast, went to sleep again, then went home. and for all this hard work, i get the next two weekends completely off.

one thing i notice about working here is that everyone has piss poor hygeine. not surprisingly, a pretty good amount of our patients develop post operative infections, and many end up returning back to our services. i think the ID folks here need to get their crap together.

i also managed to log my first OR case this week. yes, that’s right. this badass surgeon just sutured some skin at the end of the case. if that doesn’t get the panties dropping i don’t know what will. 2 chest tubes and one skin closing in 5 weeks of surgery residency. a few years at this rate and i might do as many procedures as an m3 on psychiatry.

going from working my ass off and having a crapload of responsibility to hardly working and basically being a medical student is pretty sweet. i think i discovered like 9 months too late that i sort of enjoy not working very hard. i still hold onto some fantasy that all of this BS will pay off in some intangible but profound way maybe like 20 years from now, but intellectually i know this is completely delusional. and yet i persist. i think people just want to say that i keep at it because i know deep down that it’s worth it and what i really want to do, but i think the truth is a lot less profound. i think i’m just too scared to stop and admit that i don’t really care about meaning, about altruism, or intellectual development. i don’t think i want to admit that i just want to watch tv and eat potato chips on a sunday afternoon for the rest of my life. and admit that deep down, living a pointless and numb life is not the great tragedy that i wish it to be, because despite my feelings of moral and intellectual superiority, i’m actually ok with achieving nothing great, ok with not helping the needy, and basically ok with just being a regular schmoe doing his own meaningless thing that no one necessarily will remember when i’m dead. i guess when i say i wish i could be happy just like all the other thoughtless schmucks out there, i’m really saying that i wish i could admit that i am one of them, instead of pathologically deluding myself and taking some perverse gain in playing the role of a troubled and depressed intellectual and/or humanitarian.