You Gotta Get Out Of Those Rooms
The days went by quickly at the community hospital. After procedures we’d assisted on, we were expected to perform post op checks on patients. The notes I wrote were similar to the ones I wrote in the morning during my first three weeks: brief. And almost lies. Like the previous rotation I would write A+O x3 and NAD and NT, ND, (+) BS as if it were a stamp. I would go see the patient, talk to them, check if they had urinated, tolerated PO, and ambulated, and see if they had any other concerns. Most of the patients would complain of incisional pain. My abdominal exams were always benign. If someone had had a problem, I am not sure I would have been able to relay it, or really formulate an accurate differential diagnosis and help the team. I suppose our notes were based on a principle, though: if the patient had a problem with something, they would complain about it. After a number of iterations of this exercise, though, it became clear to me that we were writing the same notes over and over. Not understanding what was being written was another issue, I think, and it was a kind of bullshit that was never, ever addressed.
Once this became rote…I realized that this kind of behavior and obsession over “helping out” – that I had seen all year in all of my third year experiences – was completely useless and actually mildly detrimental to my clinical learning. Essentially, during my surgical rotation here I saw residents blatantly take advantage of hard-working medical students’ desire to please and impress them under the guise that this was part of the learning experience. They made us write silly notes in the morning to decrease their own workload, and created a system where they would give us crap if we didn’t work hard enough, thus creating an incentive to do more scut work. One thing that is always true of medical students is that they obsess about being helpful, not realizing that there is a reason why they are still students and not house officers. My classmates and I would obsess over the notes and writing them and getting them all done on rounds. But the truth was there wasn’t really much to learn from writing a note. It was quite useless, actually, because many of the notes basically stated “continue current management”, described nothing of major importance on physical examination, and changed in direction only when a new surgical issue appeared (e.g. new bowel obstruction post-op, wound infection, etc). The perpetual self-doubt in which every medical student lives, that perpetual feeling of inadequacy – propagated by the permanence and distinction of the “short white coat” that every medical student is forced to wear– was responsible for this madness to some extent, but the residents aided and abetted it. Unabashedly. And we obeyed. I remember getting reprimanded one morning by this weirdo cat-lady resident for having been assigned the task of covering one wing of the hospital and only writing one progress note. When I said, “I was in the room talking to the patients”, she replied with something I will never forget: “You gotta learn to get out of those rooms.”
It then occurred to me that the rap that surgeons get for their bedside manner exists for a reason. Surgeons might be more or less skilled at talking to patients and listening to them, but they don’t have time to make that a priority and don’t do it for that reason. That’s fine – for my purposes, their field of expertise is operating, not talking to patients. But why did this have to come at the expense of learning? I found that in surgery there were a lot of people that not only didn’t have the time to talk to patients, but also didn’t want to talk to them, or teach medical students. Or really be there at all. Patients seemed annoying to them. Actually, everything seemed annoying to them, and that approach to managing patients just didn’t make sense to me, besides the fact that it made it difficult to learn anything about surgery. For me, relating to patients and listening to them was the basis of how I built the relationship and implemented change. It was the way I did my job. Based on my experience with surgery, that aspect just wasn’t there. This was an example of someone treating their job as a physician as what it really is, at the bottom of it all: a job. After surgery, the notion of “being a doctor” no longer seemed to have the moral dimension that it once had when I idealized it before starting medical school. I realized this, but I also realized something more important. It was on this rotation that I began to see that I could never get along with these people.
The rest of the procedures were laparoscopic cholecystectomies and appendectomies. I saw my first acute abdomen with bona fide rebound tenderness in a 12 year old patient with a ruptured appendicitis. There were countless cholecystectomies – the hallmark procedure of general surgery—almost none of them open. I remember one where the surgeon extracted 8 large emerald-colored gallstones from a young woman’s excised gallbladder. The sides were smooth and regular, like gems, forming some insanely complicated polygon. Somehow, there in the operating room, holding the laparascope camera, I thought of Teenage Mutant Ninja Turtles.
I still liked the OR and its awesomeness, although the novelty of it was beginning to fade. I was tired. I stopped wearing my Crocs to the OR and resorted to my Asics, my baggy scrubs like rapper pants oddly matching with my sneakers. Sometimes I unmatched the TwillTouch and SoftWeave fabrics, with two different textures on my skin. I drove home in my scrubs, enjoying the country roads and the green of the May foliage on the way back to the city. I would have to go in on the weekends and write notes. Of course, most of the times I went in on the weekend ended up being a scutfest, but for some reason, every time I made it into the hospital, there would be a case. The OR on the weekend was eerily empty, quiet, with a few patients in the recovery area. It was nicer that way, though. The attendings were on weekend time – they appreciated the medical student’s presence, despite their condescension. Driving home through the suburbs with the springtime air rushing through the windows made it worth it.
