The only resident I met in medical school who made me seriously reconsider my interest in surgery was rotating on trauma. In fact, he seemed to have stopped rotating, and have come to rest in the trauma unit. Between the summer transition, and the vagaries of scheduling, he was spending three or four months consecutively on trauma, either days or nights. He was not happy at all. In fact, he was downright bitter. I think his wife was giving him grief about never seeing him, but he also hated the trauma unit in itself.

“Do anything else at all, just don’t do surgery.” “I would never do this again.” “If there’s anything else you could be happy doing, don’t do surgery.”

I remember watching him walk around the unit, running from one disaster to another, placing one feeding tube after another, changing central lines all night long, his face growing longer and grimmer the whole time I knew him. He was pleasant enough to the medical students when he remembered our existence, but most of the time he was too morose to even acknowledge our presence. He was a good teacher, when he had the time, but mostly he was too overwhelmed with work to explain anything about critical care.

I remember wondering what exactly was bothering him so much. To me, it looked he was doing a lot of procedures, was saving the lives of some critically ill patients, and was perfectly at home with pressors and complicated ventilator arrangements.

Now I understand that lines aren’t as much fun when you’ve got five of them to do, and only enough time for three or four, or when they keep going bad on you the day after you struggled to get them in, or when the attending comes in the next morning, criticizes your choice of location, and insists on it being pulled out and replaced elsewhere immediately. Feeding tubes are no fun when you’re going to spend three hours walking around the unit in circles putting them in, waiting for an xray to show that you’re in the wrong place, and trying again, while the patients complain. Disasters are no fun when they keep on coming, and for most of them (folks, if you’ve got to ride motorcycles, please wear helmets) success means you’ve saved someone to live without word or motion for another five or ten years.

Most of all, I understand the frustration of having every day a different attending come through the unit, require you to defend your reasons for doing xyz to any patient, rip you apart, and insist on doing the opposite (ie, the opposite of what the attending yesterday told you to do).

All I’m hoping for is to be a little more cheerful, at the end, than that resident. I know I’ve got the long face, and I’m snapping at people, and I’ve given up on being nice to the medical student; now I just use him as another pair of hands to get the interminable amount of work done. (He’s gone at the end of the week, and from there on the work force shrinks and shrinks, till I’ll be completely alone at the end of the month. It keeps getting worse.) It’s a good thing this is the last rotation of the year, otherwise, like that other resident, I would be seriously thinking about quitting. As it is, I can’t throw away a whole year’s work just to escape another two weeks of this; but the prospect is attractive – just to walk away from this whole game, and leave the attendings to deal with it by themselves.

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