Back in the OR at my own hospital, I realized several other things I’d been subconsciously missing at the children’s hospital: besides a mutual recognition with the techs, nurses, and anesthesiologists, and material things like scrub sinks working the way they should, trash bins sitting where they should, and light handles that fit the way they should, I’d missed the attendings caring what I did. At the other hospital, I was very much a  migrant: they put up with me for six weeks, and now they’ll never see or hear of me again. As long as they kept me from doing any positive harm in that time, they could care less whether I learned to operate well. Here, the attendings know they’re stuck with me for several years, and I think even beyond that pragmatism they’re committed enough to teaching that they care about my learning.

This manifested itself in the attending criticizing nearly every move I made for two hours. The minute we started draping, it suddenly hit me that this was a much more complex operation than the appendectomies I’d been doing for the last several weeks, and I nearly froze. It took an effort to do simple things, things this attending long since expected me to do quickly and semi-smoothly. Him telling me to loosen up didn’t really help, but after ten or fifteen minutes I started to get in the swing of things. Back to the usual pattern of him stopping every five or ten minutes to explain why my actions were completely counterproductive, stupid, harmful, or simply inelegant.

That may sound like a complaint, but really it was good (and even better when done with) to have the attending take the time to talk about technique. This attending likes to repeat, “You should do every case as if the patient was your own mother.” Personally I find the metaphor a little disturbing, but he’s teaching professional attention to detail at all times.

At the end, I found that in the middle of all the stress and criticism, he was actually letting me do more than he ever had before – which was why he found so many things to teach about.

And that leads to a last humbling conclusion. I have so much more to learn about surgery before I will even begin to be a surgeon. Now I begin to get the hang of where an operation needs to go, what the next step needs to be; but on my own, I go so slowly, hunting and pecking my way through. I don’t have the confidence in my plan to jump in, and push, cut, tear, burn things to get where I’m going. And that’s what it is to operate: to know so thoroughly where you are, and what needs to be done, that you can cut without hesitating.

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