My workload somehow tripled in the last week, but I don’t care, because half of it results from the fact that the chief suddenly started assigning me ORs to cover. The result is similar to the predicament of the Israelites, obliged to make more bricks with less straw. Because the attendings are operating so much, we have a million patients to take care of, manage, and discharge – and we have a quarter of the time free during the day to do it. When I was on call, I spent all night just trying to finish what I’d missed during the day. (Doesn’t work too well; there’s a certain hour past which patients don’t take kindly to being woken up and asked to sign consent forms.)

But it doesn’t matter. They’re letting me do surgery. I’m on top of the world. The promise made nearly a year ago, when I matched in surgery, is coming true. I couldn’t quite believe they would really do it: give me the instruments and let me do almost the whole case. The hardest part really is keeping my mouth shut: not saying “oops” every thirty seconds, or “are you sure you want me to do this?,” or “I’ve never done anything like this before.”

It’s a completely new experience to feel like I’m needed, not just by the nurses on the floor to sign orders, but by the attending to help get the surgery done. Once, my beeper went off for some truly insane inquiry. The circulator helpfully tried to relay messages between me and the phone to sort things out, but the attending got quite upset: “Get whoever that is off the phone. I need her to pay attention here, and you’re distracting her.” I apologized to the nurse later for getting her yelled at, but mostly I’m just thrilled that he actually thought my attention mattered. It’s quite a change from being merely the retractor-holder, when I could literally fall asleep standing up, and as long as I held the retractor still, nobody would notice or care.

Now of course I’m encountering one of the prime frustrations of surgical residents: attendings who do the exact same thing quite differently: two days, three attendings, the same general procedure over and over again, and every time I try to predict their next move and help with it, I’m wrong. “I know Dr. So-and-so does it like that, but personally I prefer . . . ” (Of course, that’s good training: we get to compare several different approaches, and eventually pick for ourselves the ones we like best.) And now I know why the residents have such decided opinions about the technical capacities of the attendings. I thought you had to be at least halfway able to do it yourself before you could criticize the attending’s technique. Not really. You just watch three different people do the same thing, and it’s pretty easy to see who’s really comfortable with the instruments and has a streamlined approach to getting the job done, and who seems to be rediscovering both the instruments and the procedure anew every time.

I stayed several hours past the rules, on next to no sleep, to do a case (because, naturally, the attending wanted me to see it done his way once before letting me touch anything, and if I’d left I’d have lost that accumulation), and it didn’t matter, because I was doing surgery.

I’m starting to repeat myself here. It’s time to go bed. I know I’ll be replaying this procedure in my dreams all night. I can’t believe they really let me do that. They’re letting me do surgery!