Today was wild, again. (Maybe I need to readjust my idea of “wild.” Plastics, after all, was calm compared to the other services.) We took a load of heavy consults from the trauma team early this morning. There must have been some bad stars over the city. All kinds of crazy mechanisms of injury, tragic social stories, and unusually bad results from common mechanisms of injury. There were so many new names on the list, I didn’t mind staying out of the big surgery this morning, leaving it to the medical students with the fellow while I and the assistant (who it turns out likes me) tried to divide and conquer with all the new people.

So far, so good. Then – I don’t want to go into this in detail, because what eventually happened was the attending threw me out of the OR with accusations of malpractice mixed in (because of floor management, not any actions in the OR itself). The medical students were partially involved. I was pretty scared for a while that, since he was talking like that, he might be going to call my program director, and things would get serious. I don’t think it’s actually that bad, although I have no way of knowing what he’s saying about me, unofficially, to the other attendings. Anyway, what I did was something that I had had experience with many times as a medical student and even this month. Neither the fellow, who was aware of my actions, nor I, had any idea that it could be objectionable. So oddly, I made the attending as angry as he’s been this month, and for a change I’m not beating myself up about it too much. Most of the time, we residents have such a highly developed sense of professional responsibilty -cum- fear of God (aka the attending) that the attending just has to say a few angry words, and I at least really force myself to examine my actions, find the problems, and make definite plans to do differently. But this time, there is no way that I could have known to avoid this, so I just had to keep my mouth shut, as usual. Surgery residency – or internship – is definitely good for the character. Learn to keep quiet, take correction, whether just or unjust, silently. “In the multitude of words there wanteth not sin.” “Let a wise man rebuke me. . .”

I’m not sure how to communicate this to him, certainly not in depth. The fellow I’ve been working with is absolutely amazing. He took good care of me, and taught me a lot. He managed to protect me from the attendings with the utmost reliability – when it was a misunderstanding, and I couldn’t say anything, he said it for me. When I really was wrong, he deflected them. When we were both in trouble, he took the brunt of it. At the same time, he pushed me to stand on my own as far as handling patients on the floor and in the ER. He gave me confidence in my decision-making. I don’t know how he combined those two accomplishments. He was always ready to explain anatomy, operational procedure, and clinical decisions. Most amazingly, he was never angry or impatient with me – and for the number of mistakes I made this month, that’s pretty close to sainthood. I don’t know whether the old truism, that I would do more for his kindness than for fear of the attendings, is totally true, but I would much rather do something for him.

Anyhow, it’s high time to move on to another service. This will be my first real general surgery service, which means longer hours, much less time in the OR, more scrutiny from the attendings, and higher expectations. Also, unless I’m overestimating the amount of time I’ve seen this team’s members spend in the hospital, I may have to start fiddling with my hours. There’s no way to work 14 hours a day six days a week, and take call, and round on the seventh day, without going over 80 hours. Everyone talks a lot about keeping the 80 hour week, but I can’t tell yet whether they really mean it. Of course the chiefs don’t. They practically live in the hospital, and there’s no one who can cover for them, or send them home, or give them a break. I’m not sure how the junior residents manage. I don’t want to be the only one to break out of the pattern, however they do it. I know that these residents are good, smart, and well-trained, and I intend to do things their way.

(One month done! How did this happen? It feels like yesterday that we started, but on the other hand I can hardly remember what it felt like not to be an intern. Only eleven months left. . .)

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