This morning I scrubbed in a lap Nissen with the chairman. Within a minute of walking into the room, I realized how clever the junior resident had been to find something else to do today. He was micromanaging every single aspect of the setup: how the intubation was done; how the scrub tech and her student arranged their things (who had the insane idea to put a student scrub tech in with him? I at least knew what I was getting into; maybe they think it’s part of a scrub tech’s education, how to get yelled at); how I put the foley in; etc, etc.

I’ll say one good thing for him: he does let the resident do most of the case, which I have learned to appreciate as a great virtue in teaching faculty. Even if he has howling in horror at the resident’s blunders every step of the way, at least he manages to wait a decent space before seizing the instruments to do it himself.

And now, I think the main thing that he does, which is really unhealthy for the patient and the team: he treats every error as a horrible and damaging mistake. From his exclamations when I couldn’t focus the camera, or when the resident retracted a little bit in the wrong direction, you would think we had punctured the aorta, or ripped the liver in half. I don’t know how we would know the difference if we had done something serious. It wears on your nerves. I’m working on not answering. Every now and then the reflex to explain my perfectly good reason for doing xyz gets the best of me. It never helps. You should never ever excuse yourself: to a patient, to an attending, to your friends, to your family. If you were wrong, you were wrong. If they misunderstood, it only makes things worse to explain. Keep quiet, and let them think you an idiot.

That’s the lecture I have to read myself every time I get close to this chairman, or even think about walking near him. This afternoon our big liver case was cancelled, and I had to decide whether to go to another liver case which was amazingly added-on for today, or go to his office. I compromised by going up in scrubs (he abominates the wearing of scrubs outside of the OR), and asking whether he thought it was more important for me to be in clinic or to go to this rare operation. Of course he had to say, go to the OR, especially since he couldn’t stand to have me there in scrubs. (ha) But first he had to complain about my choice of words in making the request.

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