I-med Grand Rounds: Peewee vs. Doogie

Four days into an internal medicine rotation. I'm enjoying it, even though I will definitely hit the eighty hour cap this week. My favorite part of this gig, so far, are the ER admissions. You get paged by one of the senior residents and told to go admit so-and-so in room-x, and you just never know what might turn up. A total crapshoot, my friends...

Today's gem was a 78 year old woman with a gangrenous toe. She and her daughter had already been to another emergency room in the city and signed out against medical advice when somebody mentioned that the toe might have to come off. Through the subtext of our exchange, it became clear that the daughter knew and fully accepted the likely outcome, but remained powerless to convince her mother of its neccessity. She was just playing along in hopes we would somehow admit her mother without anyone screwing it up by saying the "A" word (amputation).

Despite being left mostly paralyzed on one side of her body by a previous stroke, this lady was Feisty with a capital F. She nearly kicked to the floor the beefy surgical resident who made the mistake of conducting a "sensation check" on the rotten toe. A Kodak moment for sure, that woman's size nine foot planted firmly in that surgeon's gut. Although it was clear to all present that she was aiming a just a little bit lower...

Least favorite part of Internal Medicine? Grand Rounds. Let me tell you why. Grand Rounds, in theory, is meant to be this golden forum for the exchange of ideas; cases are presented for discussion, and ideally, there would then be this magnificent cross-pollenization between members from the varying subspecialties. In actual practice, Grand Rounds is frighteningly reminiscent of the trainwreck of a gifted-and-talented class I was forced to endure back in fourth grade: forty minutes (conservatively) of every hour are spent while the same four or five people to try to establish that they are the Smartest Person in the Room. The leading men at this particular hospital are an attending pulmonologist the residents call Peewee Herman, and an intern who is the Pakistani incarnation of Doogie Howser.

At certain points during these exchanges, I am sorely tempted to yank aside one or other of these jackasses and scream, "Look man, don't you realize you'd actually end up looking smarter if you stopped blurting shit out?" But, of course, I've never actually done that. Mainly because I am more or less content handling the situation the way I did back in fourth grade--sitting in the back of the room telling fart jokes.

Another thing I have noticed about this rotation: even on days when I manage to get home before dark, I am completely and thoroughly exhausted. I mean, noticeably more so than with other rotations. My theory as to why? Between the staggering amount of information we are required to process and the depth of emotion kicked up in dealing with the extremely sick patients who populate inpatient medical wards, even a very enthusiastic and very competent person would be bound to be tapped by day's end. (I haven't met that person yet, but nevertheless, I'm willing to bet they're as tired and crapped out as the rest of us by the time signouts roll around...)

Tomorrow: Friday night call in the ER. Guess I better go get some rest, Pilgrims, while the beeper's still behaving itself.

Surviving Surgery, The Sociology of Alpha Dogs, and a Revolutionary New Procedure

Man, it's been forever since I've had time to update this blog. As of last Friday, I am officially done with my med school inpatient surgery requirements, and what a relief that is. (So much so that I decided to spend this weekend on the opposite coast, at a wedding reception in a biker bar. But that's a whole 'nuther story.)

Some of this finishing-up relief doubtless comes from navigating the last three months without suffering any of the really horrendous and embarrassing surgery rotation incidents you hear so much about--vomitting and/or passing out over the table, having an attending hurl instruments at me, etc. Not to say I didn't make a ton of mistakes--just nothing that will make me famous.

Photo of surgical procedure described below

The other part of the relief has to do with not just surviving those twelve weeks, but kind of enjoying them. Not that I'm a huge fan of sleep deprivation, runaway egos, or disposable hairnets, but it's always nice to leave on a good note. Suprisingly enough considering my initial ambivalnce toward all things surgical, a couple of the attendings I worked with tried to recruit me into the fold. Needless to say that was very flattering, and because of the respect I have for these doctors, I at least considered it. For several reasons, though, I don't think I'm going to take them up on the offer.

One reason is age. I'm about ten years older than most of my classmates. Although I'm pretty confident that I could successfully finish the five to seven years of training surgical training entails, where age really becomes a factor is the limited amount of time I could realistically expect to practice after completing training--fifteen to twenty years at most. I have not personally met any surgeons practicing past the age of sixy, although I hear that some do exist. Given that short career span, the sacrifices required might not make sense. Especially given that those sacrifices, for many women, include giving up any shot at a normal family life, which is something I still hope to experience.

Another (and perhaps more compelling) reason to wave off is the gut instinct that the field is not, in the long run, a good match for my personality. I suspect that at least some of the reason those attendings asked me to consider surgery has to do with the ability to put on a game face, endure physical discomfort, toss around lockerroom banter, and deal with alpha dogs. Those skills were honed while engaged in a previous career that, without getting into too many details, involved airplanes and blowing things up. Although in some ways that kind of work environment is comfortable and familiar to me, I'm pretty sure that in the long run I'd find it restrictive. (If you're reading this and half awake, you know I have a quirky side that I'm not good at keeping under wraps.)

In the course of weighing surgery as a possible path, I stumbled across a really interesting book by a Harvard anthropologist named Dr. Joan Cannell called "The Woman in the Surgeon's Body." Over the course of about ten years, Dr. Cannell spent time following thirty-four women surgeons through their workdays and talking with them about their experiences. Some of their most negative experiences, vis a vis sexism and social isolation, were eerily similar to things I went through during that aforementioned period of flying and blowing things up. Although I know I can handle those kinds of obstacles, the real question is, do I really WANT to?

I'm thinking no. If surgery were my one compelling goal in life, that sort of crap would be worth enduring. Ironically enough, if my time as a flygirl taught me anything, it's that being a happy, kind person is worth at least something. Furthering this point are two flygirl-to-doctor converts I ran into this week who decided, offers to prestigious surgical residencies be damned, they'd be most happy in Family Medicine. Maybe that's the kind of choice you can best make after you find out how little prestige has to do with being happy.



Now, on a much lighter note, the promised description of the aforementioned Revolutionary New Surgical Procedure.
A few Saturdays ago while attending a birthday party for a good friend, I was recruited one last time toward surgical pursuits. A grass skirt clad partygoer I'll call John Dole drunkenly confessed to the party's host his jealousy of the coconut bras being sported by some other men in attendance. In a move right out of Miss Manners, the host took matters into her own hands by handing me a pineapple and a knife. The procedure performed, and its stunning results, are chronicled by the accompanying photos. Eat your heart out, New England Journal of Medicine.