Friday, October 1, 2010

Surgery, A Siren That Will Break Your Heart And Crush Your Soul

Continuing my autobiography of why I became an anesthesiologist, I will now recount My Lost Years as a surgery resident. This is a long sad story of lost opportunity and spirit crushing rejection. So let's get started, shall we?

Let me just say right off the bat that surgery residency was probably the hardest thing I have ever experienced. Internship is just a blur of calls, rounds, scutwork, more rounds, more scutwork, and getting pimped and yelled at a lot.  Few things in life compare to the dejection of getting up at 5:00 AM to pre-round on your 10-20 patients then round on them again with the team in time for the senior residents to make it to the OR. After rounds, I was usually left with about 50-75 items I needed to get done on my scut list before afternoon rounds around 5:00.  After that there was usually another list of things that had to get finished before going home. If something didn't get done, the usual question was "Why not?", not "How can we help you?" It was not excusable to say the Radiology File Room couldn't find that one CT scan that was vitally crucial for this patient's surgery the next day. Or why the lab results haven't come back. Or why lines haven't yet been put into a patient, despite the fact that I've been running around like a rabied dog trying to get as much of the scut completed before tackling a time consuming line placement.

This certainly wasn't as much fun as I remembered as a student. Of course as a student I was shielded from all this tediousness. We got to go to the OR after rounds to watch the cases. When we were done in the afternoon all the work had been magically completed by the interns. I never paid enough attention to the dark side of surgery training. The few times I actually got to do cases were not that much fun either. Every surgery intern remembers their first case. Mine was a butt pus. I remember being on call and getting summoned to the OR at 2:00 AM to perform an I+D of a perianal abscess. The case took all of five minutes, but the stench will last me a lifetime. When the senior resident asked how I liked my first surgery, I had to force an eager smile and enthusiastically announce, "Great case!" then trudge back to the call room to try and get a few more minutes of sleep before getting up again to preround on my patients. Not a great start.

Okay, so internship isn't the surgical career I had envisioned. If I make it through internship, things will get better, right? I'll go to the OR and actually perform real surgeries my second year, correct? While I did start doing lots of cases the next year, sadly the overall residency experience was not an improvement. This was in the days before all the rules against residency abuse. There were rotations where I was on call every other day for months at a time. And it wasn't just 24 hours on/24 hours off. No, this was more like 36 on/12 off. You see, I couldn't just leave the hospital at 7:00 AM post call. I still had to round to explain to the team what happened overnight, which took hours. Then there was usually an emergency that required I stick around to help out before I could leave. I recall one time I didn't get home until 2:00 PM. I just collapsed into bed after an all night session of traumas and other emergency cases. I suddenly woke up and looked at my clock, which read 7:00. I panicked and jumped out of bed, ready to throw my scrubs on and try to explain to the team why I was late for morning rounds. It was not until I was halfway out the door that I realized it was 7:00 PM. Then I crawled back to bed and slept until the following morning.

All this stress took a physical toll on my body. I gained about 20 pounds. You would think so much running around will cause one to lose weight. But just the opposite happened. I didn't get any proper exercise. Every chance to eat was quickly wolfed down in about five minutes.  I developed anal fissures because I was so uptight all the time. I had a bad case of irritable bowel syndrome, particularly right before M+M Conference. That's where residents were publicly grilled and humiliated in front of the whole surgery department, particularly if you weren't a Chosen Resident, someone who could perforate the left ventricle while putting in a chest tube and still not get shredded by the faculty wolf pack. One time I was so exhausted post call that while riding in an elevator my pager went off. In my sleep deprived haze I looked around asking people "Do you hear that noise? Where is that coming from?" They looked at me like I was an escapee from the Psych ward.

Okay, so surgery residency was exactly what everybody warned me about. Well, it will be better once I'm an attending, right? While several of my fellow surgical residents bailed out into anesthesiology, plastic surgery, and medicine, I was going to tough this out. I've never quit anything I started in my life and it was not going to happen now. But the higher I got through residency, the more I could see what a horrible lifestyle surgeons suffer. Sure it was still fun to do cases in the OR; by then I'd done hundreds of lap choles, appendectomies, and assisted multiple CABG's, Whipples, and AAA's. But as I moved away from the scut, I could see how the attendings lives were miserable. Being in the OR only constituted about 30% of their time. The rest of the time they were in their offices seeing patients, or doing consults for clueless internists, or being called to the ER. I saw how irritated and tired they were when they were operating all day and being paged constantly by their office, a floor nurse, or the ER. There is nothing more miserable than finishing a long line up of cases at 8:00 PM then having to go see three consults in the ER and the ICU. Do I want to have that kind of lifestyle for the rest of my medical career?

Plus surgery isn't all just acute disease either. Sure it's exciting to rush a patient to the OR to fix an acute abdomen. But there is a lot of chronic diseases that are overseen by surgeons, which was why I didn't want to go into Medicine to begin with. We had the Diabetic Foot Clinic. You've never seen so many black toes or nonhealing foot ulcers in your life. Then there was the Breast Clinic. For hours we were palpating large sweaty stinky breasts to find breast cancers. Sometimes they came in with advanced Stage IV massive breast masses that were oozing pus and blood because the patient neglected this thing for the last nine months. Then who could forget Colorectal Clinic, otherwise known as Butt Clinic. If I never had to do another anoscopy and hemorrhoid banding in my life it would be too soon.

I think the final realization came when I started looking longingly at the happiness of the anesthesiology residents. I remember an incident where my patient coded in the ICU. The anesthesiology team came down and intubated the patient. Then they were off on their merry way while I had to stay up the rest of the night to stabilize the patient and explain to the team why he went into arrest. "I wish I could just walk away like that," I thought.

Finally I was at a crossroad. With constant delusion and denial I had completed FOUR years of clinical residency. But now I wasn't sure I wanted to be a surgeon. Just stick with it, I was told. I only had one more year to go then I can get boarded in Surgery. But what's the point of going through one more year of surgery residency then studying like a madman to pass the surgery boards when I didn't want to be a surgeon anymore? The surgeries were still fun. However the constant paging by the office and hospital, the long unpredictable hours, and the chronic anxiety made surgery much less glamorous than I had envisioned. Do I still want to live like this when I am fifty? That's when I made the hardest decision in my whole life. I told my chairman I wanted to quit. He asked me what I wanted to do. Urology? Plastics? "No," I said. "I want to go into Anesthesiology."

Continue here.

10 comments:

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  3. I could understand your feeling, but anyway being an Anesthesiologist is also a satisfying job.

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  4. Your story of your experience in surgical residency was very insightful to read; and scary, too, because it is identical to mine, down to (almost) the minutest detail. I am very happy with my decision, and my life, and it appears you are, too, and I wish you all the best.

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    Replies
    1. Did you end up switching to Anesthesia from surgery? I am debating getting out of surgery, as well, and I need some advice from people that have done it! Scared to take that leap, but I know it's the right thing to do.

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  5. Im a 3rd year student having a hell of a time trying to figure out what to go into... Its kinda comforting reading your blog and knowing that Im not alone... even though it was written a while ago .... thanks

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  7. Of course you had to denigrate other specialties, like all surgeons seem to do - lets pop you into medicine rounds and see how you fare.

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  8. This guy sounds like a true coward

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  9. My wife (and essentially myself through her experience) recently switched to Medicine after two hellacious years of surgery residency. I cannot believe what they put these people through.

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