This orthopedic attending starts at 6 or earlier in the morning, and stays in his office dictating till 11pm. I don’t know how he does it; and I don’t know what incredible bad luck the other girl and I had to be in his office. The other guys are getting out at 3 or 4 in the afternoon, seeing lots of fractures and hip surgeries. I think Dr. W is a good guy, but he’s difficult. This morning he was doing a spinal fusion on a girl with scoliosis. The screws kept getting in the wrong place (he repeated all day, I put in fifty screws in spinal fracture cases over the weekend, and they all went right the first time; I don’t know what’s wrong today), and then to top it off, when he tried to screw the rods down, the screws kept breaking, the threads coming off. He had to go back and replace some of the first screws, they got messed up so badly. At one point, one of the circulating nurses leaned over to the other student and I and whispered, “He may be about to blow up. Have you ever seen him get really angry? No? It gets pretty rough. Just try to stay out of his way, I don’t want him to chew you up, and if he says anything to you, just keep quiet.” I’ve seen some angry surgeons, and some who made a habit of it, and no one had ever felt a need to warn the students before. I didn’t think it got too bad. He was cursing, and slamming the instruments onto the tray, but he didn’t throw anything, and he didn’t say anything really personal to anyone in the room, just to the instruments. I don’t know whether that was his worst, or not.

In between all this, the scrub nurse I think really hates having students around (they don’t usually have students in surgery at the children’s hospital). She didn’t want us to scrub at all, till the attending said we should; she kept warning us and riding us about sterile technique, much more strictly than I’ve ever seen it enforced before, and obviously ended up saying I had broken it, and needed to be gowned again. But for as tense as things were, she was fairly reasonable, and juggled all the complicated ortho instruments impressively.

I’m afraid I’m hurting the other student, by being assigned with her. She unfortunately is not very fast, and I’m too fast; so I will always give a stab at the answers, and I can read the doctor’s mind better than she can, and I give a better impression of being enthusiastic with extra assignments and unreasonable expectations. So he sent me to see patients in clinic by myself, and not her. I don’t know what I can do; I can’t stop being enthusiastic, and she’s so slow to take hints, every time I try to point her where he’s going, she just asks me loudly what I’m trying to say, and that doesn’t help. She asks lots of questions, unfortunately sometimes dumb questions; whereas I’ve learned to figure things out by osmosis and context. If I wait long enough, most of my questions get answered by the general discussion, and then I look smart by knowing things without asking. Not necessarily better on my part, just “wardsmanship.”

In the scoliosis clinic today there were two homeschooled kids, whom I recognized right away. The last one has a pretty bad case, and I feel so bad for her and her family. The doctor’s style of encouragement is to intermingle stories of patients who did horribly (dead at 25) with stories of patients who did remarkably well (champion cheerleaders, college football players, etc). It sounds frightening to me; I don’t know how these girls handle it.

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