Today was stressful. I spent all morning in the OR doing – or rather, observing – some pretty advanced cases with one of the attendings who usually gets only senior residents to work with him. My role was fairly limited, standing and holding things, and occasionally tying knots. Even so, I was so nervous I seemed to forget all the dexterity I’ve gathered in the last few months, and fumbled every single instrument I picked up, and every knot I went to tie. I’m sure he now thinks I’m a fairly poor excuse for a surgery intern, and he would be justified, based on my performance today. I grasped by the end of the day that he routinely talks at the top of his lungs, and it’s not a sign of anger; but that also threw me off at the beginning.

I think I’ve written before about the difference between how men and women present themselves, and deal with praise or attention from others (or perhaps I’m thinking of other blogs I’ve read). When the other residents asked what I’d done for the day, I minimized everything, and focused on the mistakes I’d made. Thinking about it again, I realize that if one of the male interns had done it, he would have talked about what a sweet case it was, how complex it was, and that the attending praised this or that move that he made [however small]. We would both have been honest, in our minds, and describing the same events, but he would make it sound good, like he ought to be involved in such cases more often, and I didn’t really come across that strong.

We got another consult from the ER (among others), this time from an intern that we all know and trust. She gave me a detailed history of the patient (usually, I’d prefer a brief summary – xyears old, name of problem/possible problems, severity of presentation, number of comorbid conditions, which of my attendings are you consulting, which room is the patient in), but she had definitely talked to the patient and gathered all relevant details. She told me she knew there wasn’t much we could do for this patient with symptomatic cholelithiasis in the ER, probably no admission called for, but that was what the attending had told her to do. And the absence of labs? Her attending said they were unnecessary. I told her thanks for the thorough history, we would be down shortly, and kindly, regardless of what the attending said, please send some labs, because we personally wouldn’t dare present this to our attending without some labs (since it clearly was not an emergent issue). I didn’t ask who her attending was, because it would be too frustrating to know. If the patient had had a white count, we would have likely diagnosed cholecystitis, admitted him to the hospital for iv antibiotics (or perhaps asked medicine to admit, yes), and planned to go to the OR within a few days. Lacking a white count, it was purely an outpatient issue, with no benefit to the patient from being seen by us in the ER, something easily and properly handled in clinic next week. And of course the liver function tests would be interesting, since if they showed elevated bilirubin and alkaline phosphatase they would suggest a stone in the common bile duct, which might require intervention by GI within the next day or two. The attending didn’t want labs, but thought it was worth calling us about. . . I’m still puzzled on that one.

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