no guts no glory, right?

well here i am, into my 5th month of surgical training. i don’t know what kind of perverse rationalization and/or profound self delusion got me into this mess, but here i am, knee and elbow deep in soap suds enemas and the glorious, if not malodorous world of general surgery internship.

somehow, when i was a kid, i never imagined that i would be waking people up at 5 in the morning, asking them if they farted, pooped, or peed. or that i would sometimes be digging my finger into a demented senior citizen’s bumhole in a sisyphean effort to scoop out loose excrement from a massively dilated rectum.

flick of the wrist

i have about 10 cases under my belt. picking out a lipoma is more fun than i thought. it’s like when you pick a good size booger. except when you pick a booger you don’t have to write a post op note, dictate an op note, write post op orders, or see your booger back in clinic in a week.

masochism

masochistic moral superiority

i think a lot of general surgery revolves around masochistic moral superiority, in various interpretations of the phrase.

i think we tend to look down on people who we perceive to be slackers. like anesthesiologists for example. nurses. radiologists. even surgical subspecialists.

why? masochistic moral superiority. it’s like some relic from medieval times when people punished themselves to stay morally pure. like when religious people do all sorts of shit to themselves for having the weakness of mind and spirit to actually enjoy life. as if self punishment is good. i don’t know why general surgeons like punishing themselves. but it’s undeniable that we do.

i guess it’s the hope that after all the training and the beat down, we can become the type of people we wish to be. supremely knowledgeable, able to handle any acute problems, being a badass that knows exactly what to do at all times… or is it “sometimes wrong, never in doubt”?

why do i want to become that person and at what cost? whatever happened to the common sense view that enjoying life is the best way to enjoy life? somehow along the way, i’ve been taught to think that delaying gratification was the best way to have a happy life. and now that it’s no longer about delaying gratification but not having any hope of it at all, i have to stop and wonder, what the hell? what is so devoid in my life that i need to become some sort of hero, taking on society’s bullshit burdens?

they say internship sucks and it gets better. i ask, why can’t it get like… a lot better? am i bold enough to ask whether it can actually be good, rather than just being “better than shitty”? i think some people go to work excited about their day and find fulfillment and possibly joy from their work. i really see no hope of that in medicine. i like operating and i think i have as much natural ability as anyone when it comes to manual dexterity. not that it matters. what matters now is being able to write fast because everything is done by paper and all i do is write bullshit orders, bullshit H&Ps, bullshit progress notes, and bullshit discharge summaries. i haven’t looked forward to a single day of my 10 weeks so far, and some days i go in with a sense of dread that accounts for not only the drudgery of the day ahead but also the entire year, entire residency… perhaps entire career. going to work at 5:30am everyday gets old and i don’t know that i will ever get used to it. and why should life be about getting used to pain? i am smart, accomplished, and i work hard. so why should i suffer?

oh well back to work to check pulses and spend 5 hrs writing notes that no one reads.

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.