My poor patient is going to have his lower leg amputated today; I’m studying in the library waiting for his add-on slot on the surgery schedule. It’s very purple and quite cold by now. Surprisingly, the main sentiment he’s voicing is not anger, but impatience for it to be gone, so he can get back to using the other leg. I don’t know what else he thinks to himself.

This morning I found the chairman scheduled to do a laparoscopic para-esophageal hernia repair – which would be a fascinating surgery in its own right; but since I need to get a letter of recommendation from him, I figured I’d better scrub in on this one, since there are no other students assigned. So I guess now we’ll find out how much weight my apparently impressive board scores (judging by the reaction of all the advisers who’ve found them out) will carry against my manifest inability to handle interpersonal and surgical details. Thus: He has a rather abrupt manner, which I don’t mind, but I can’t tell what to say to him. I usually figure the best thing to do is to keep quiet, but then it turns out he wants an answer of some sort. . . To my intense joy, he let me hold the camera the whole time, even though he had to keep giving me instructions about it the whole time (and although the resident kept subtly offering to take it over). Half the time in surgery he was asking impossible questions (like, what’s the esophago-phrenic ligament? I had never heard of it, and guessed that it was one of his made-up ones; no, it’s a vital ligament connecting the, duh, esophagus and diaphragm, and prevents symptomatic hernias when it exists; I don’t think it’s visible or identifiable on cadavers, but I didn’t tell him that), and the rest of the time discussing books about the Mayflower, and the Shaara Civil War books and movies, and I Love Lucy. I could never guess exactly when he wanted plain agreement, and when he wanted a discussion. Sometimes he seems pleasant and egalitarian, and sometimes he wants almost courtly deference; I can’t keep track. And keeping quiet, my final line of retreat, didn’t work well either.

So overall, I was just as pleased to let the other gunner student, the one who wants to do ortho, elbow in and take my place for the second case of the day. Before I got away, the chairman noticed my “Surgical Recall” pocket study book, and chose to give both the students a lecture on the value of reading real textbooks, not those cramming tools. The other student could not restrain himself from arguing the impossibility of carrying Sabiston or Townsend (2000+ pp) around in one’s coat, and the equal impossibility of studying for the SHELF from it; I was glad to someone else get caught in the attending’s unpredictable conversational tango. Actually, one of the pleasures I imagine when I graduate is to use some of my first residency pay to buy a couple of large textbooks, the kind that are way too detailed for medical students, but which the residents seem to have memorized.

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