Brad’s version of the established and respected surgery practice of critiquing your juniors rudely in front of a large audience during stressful moments made for a rather unsettling night. At one point I found myself standing outside a room with two nurses (we having all been found fault with, loudly, me most of all). One of them said, “I’m just going to defuse some anger here before going back to my other patients.” I told her, “Then one of us needs to move away, because this cubic foot of air doesn’t have room for all of our anger.” Six hours later, I can tell myself that the attendings speak to the residents this way all the time, in the middle of the OR, during both elective and emergent cases. Seniors to juniors is quite normal, as well, I suppose. You copy your role models. This is surgery, a side I haven’t had much experience with yet, but it’s probably not too late to start.
There was a ruptured AAA tonight, and I got to scrub in and help. I saw the red mass of hematoma accumulating in the mesentery, and the attending’s deft discovery of the right spot for cross-clamping, more by feel than by sight. I learned that everyone’s hands shake with adrenaline – including the attending’s; but that doesn’t need to keep you from sewing neatly. And the whole OR listened to the chief being chewed out for not doing x y or z more efficiently. It comes with the territory. I guess.
Bottom line, my patients are all still alive. The nurses were right, and the certain knowledge that the attending is going to be angry with Brad and me because of what happened doesn’t give us the right to blame the nurses for doing their best.
One more night this week.
October 26, 2007 at 8:51 pm
Reminds me of the ER episode that aired last night (10/25). Neela had a new intern, and her superior told her she had to be really strict and firm and basically mean to him in order for him to learn. Why? That doesn’t make sense to me!
October 27, 2007 at 5:48 am
Well, not to excuse the extent that Brad and that vascular attending carry it to, but you learn best under pressure. At least, that’s the way medicine has been taught for two centuries, and I’ve found it true for myself. You learn more when there’s someone constantly demanding that you know more and do better, than if they’re holding your hand all the time. If you feel too safe with your superiors, you can get lazy. Until you develop a reliable built-in drive to be perfect for the sake of your patients, the external drive helps.
But what’s ER doing with a new intern now? It’s October; interns were fresh four months ago. 🙂
October 30, 2007 at 12:08 pm
The surgery department chair, the silver haired, silver-tongued Dr. Silver, encouraged me to go into surgery after I scrubbed on a AAA rupture with him. He calmly asked the residents what instrument should be used to stop the hemorrhage, as the patient bled profusely, and I stuck my finger on it. A lesson I have used thousands of time since in the ER.
October 31, 2007 at 3:59 pm
Good story. One of my colleagues in medical school got to do that: hold the aorta while the surgeons struggled to get control of the bleeding.
November 4, 2007 at 5:01 am
i am totally against the tried and tested education by humiliation. i will not do it! there are better ways. having said that, if you are at the bottom end of the system, all i can say is hang in there. don’t let them get to you. and do not perpetuate it downhill. when i was where you are, the buck always stopped with me. i never passed the crap to my subordinates.
November 4, 2007 at 1:18 pm
I try to be good to the med students, and I think they know it. But I’m slightly disturbed by the realization of how hard it is to understand or remember what it feels to be on the receiving end of things. What seems like a good joke to me may not seem as funny to the med student. . .