Things were going ok till this afternoon. Then, two attendings, the chief, and a fellow decided to educate me, in the usual surgical tradition; spurred on a little, I think, by having had a long and frustrating case in the OR. They asked what I wanted to do about a patient with a problem. I suggested a solution – the wrong one of course, and I realized it the minute the words were out of my mouth, but too late. The attending wanted to know why, so I gave him my best shot at a reason. He then in an ironical and speculative tone of voice mentioned several other very pertinent facts which pointed to a completely different course of action. Since he was right, I said that we should do his idea instead. And then he laid into me for changing my mind, and gave me a very nice lecture (but one which I’m afraid I didn’t appreciate at this juncture; about a year from now I’ll appreciate his phrases) about how in surgery one has to be decisive: pick the right thing to do, and follow through, because if you hesitate at every cut, you’ll never get through a surgery. (The fact that I’m currently extremely depressed about never getting to do surgery this year – and yes, that’s an exaggeration – didn’t make this meditation any more enjoyable.) We proceeded with rounds, and the fellow came along in the back, whispering to me quantities of evidence-based medicine demonstrating the fallacies of every single action I’d taken all day. All in great good humor and fellowship. Once the attendings had left, the chief and the fellow settled down to finish the lesson. They had me repeat every reason I could think of for my original idea, and then explained in detail why that was so wrong. So I said I’d do their thing, and suggested a medication dose, the usual one. Nope. Wrong answer. Another long inquiry into the mechanism of action of the drug, side effects, and why it’s dangerous for this patient. We settled on a tiny dose, which I’ve never seen used. I’m sure, after all that, it will work like a charm. (And that was, after all, the whole point of the fellow’s conversation: not to do something just because you’ve seen it, but because you’ve investigated, and know why you’re doing it, and how it will work.)
At the end of all that, they got to discussing another patient. I finally snapped, and made a smart-aleck remark about sexual anatomy, just to disagree with them about something – it was not dirty, quite a propos, and relevant to patient care. But since it was me making it, they knew I was angry, and they thought it was hilarious. And I feel guilty – for being angry, for saying that, for not taking better care of my patients, for letting myself care about not being in the OR.
On further consideration, that’s the most attention I’ve ever had paid to me by so many attendings and seniors. So I guess actually it means they think I’m worth teaching. I suppose that’s good.
PS. I remember when I was a medical student I used to feel really bad watching this happen to the interns and residents. So I’m glad the students weren’t around today. Because really, I’m most upset not because they taught me; that was good. I’m upset at myself for giving the wrong answer to start with, and for not knowing more about all of my patients and all of their problems. The fellow and the chief know so much because they study; they weren’t born that way – I think.