The chief is not only teaching the students, he’s teaching me. He’s trying to make me act like a junior resident instead of an intern. So far, it’s been rather painful for both of us. I’m not sure at all what the boundaries are, and so far I’m erring by doing way less than he wants, rather than more. I’m just afraid that he’ll like it even less if I really start doing things on my own. But, with great patience, he persists in assigning me jobs that I think are beyond me, and refusing to just do them himself and get it over with.

This is particularly altruistic on his part, since he’s not going to be here next year. I could see why the current third and fourth years might have an interest in me being well prepared for July, but this chief has no personal benefit from this experiment – except, I guess, if I learn fast enough to be useful to him before the end of this month. I suppose that ought to happen.

I’m not enjoying having all the rules I’ve learned for interns swept away suddenly like this, but I do enjoy the fact that he’s also giving me the operations that belong to a junior resident, instead of parcelling them out to more senior residents from other services, as he could do. (The relationship of the junior residents to the OR schedule is rather peculiar: the residents as a whole are responsible for making sure that one of us is present for every case performed by an attending associated with the residency program. As a student, I saw this as meaning that the residents just picked what cases they wanted, and went, rather as a right. In practice, the chiefs own the whole case list, and they bestow particular cases as they see fit. Being sent to the OR by the chief is a privilege, not a right – especially for the more junior residents.)

He gave me a case today, similar to ones that I assisted at many times a few months ago. In all that time, the attendings never let me do the surgery, only assist. By the end, I was a little frustrated, because it didn’t seem that complicated, as operations go, and I tried to calm down by telling myself that (as is so often the case in this business) it must be much harder to do than it looked. Today the attending motioned me to the surgeon’s side of the table, as a matter of course, and told me to get started. He didn’t quite have his arms folded, but it felt like that. Beyond pointing to where he wanted the incision, he didn’t say anything. I got started, but kept waiting for him to give directions, to say something. He didn’t, just assisted, but in such a nonspecific way that it gave no clue about what I should do next. So I kept going, and going, and going, and found myself having done the whole thing, and answering his question that yes, I was satisfied, everything was in order, we were done. He did look then, to doublecheck. But I did the whole thing. It was indeed simple, but that was first time I did an operation almost without direction: deciding what instruments I needed, where to go next, which part of the procedure to handle first. It was tremendous, fun as well as nerve-wracking. I love the attending, I love my chief, I love surgery. Time to go study.

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