Second impressions

August 8, 2007 at 8:12 pm (Clinical rotations)

As I close in on the final week of my surgery rotation, I’ve had several realizations:

1. Cell phones and cable TV are more important than health insurance. The combined cost of watching MTV while sending text messages to friends will run about $80 a month. Similarly, joining an HMO will cost about $80 a month. When given the option of choosing the latest cell phone or health care access, my patients will always pick the Razr. Nothing’s worse than seeing an unemployed patient in clinic who pulls out a better cell phone than the one I own, and then demands to speak to a social worker in hopes of finding a job. But what does he care? We’re going to see him for free anyway. So long as the students get to experiment on him, the hospital will let any abusive, drug-addicted, baby daddy walk through the door and receive free care.

2. Morbidity and Mortality conferences are the medical version of the whipping boy. In Medieval society, the discipline of royalty involved punishing a pauper for the actions of the prince. If a prince disobeyed his parents, instead of spanking the child, the king would have a substitute whipped in hopes of scaring the prince into behaving. Similarly, morbidity and mortality conferences seem to serve the same purpose in the medical world. Every week I have to watch residents get pummeled by dinosaurs for the screw-ups of the attendings. During an M&M conference, a resident will present a case of patient who comes in and receives some kind of mismanaged treatment. The poor resident then has to answer questions regarding such topics as the standard of care, recognition of treatment, and the year particular journal articles were published. Meanwhile, the attending—the person who was really responsible for the mistreatment—gets off the hook. I witnessed one case last week where the resident was continually asked why a patient was scheduled for a particular operation. How the hell would the resident know? She didn’t schedule the procedure.

3. I’m a genius compared to the people I work with. During my trauma rotation, a man came into the trauma bay for minding his own business at a party. He was shot, suffered bilateral collapsed lungs, and needed resuscitation. My intern inserted a chest tube to reinflate his lungs. A few days later, we noticed that there was a leak in the tube, as indicated by the collection box. My attending yelled. The intern wrapped petroleum jelly around the entrance site of the chest tube to seal off the wound.

Still, there was a leak. My attending yelled. The intern removed the chest tube, cut open the patient’s skin, and inserted a new chest tube.

Still, there was a leak. My attending yelled. The intern tried his hardest to wrap the entrance site for the second tube in petroleum jelly.

Still, there was a leak. My attending yelled and threatened a third chest tube. On rounds, I noticed that the tube leading to the collecting box had a tiny hole. I put tape over the hole. The leak stopped.

4. Surgeons intentionally try to be jerks. During some downtime recently, I got on a computer at the nurse’s station to read from The Washington Manual of Surgery. A resident came over to computer, said, “Move! I need to use the computer. And to show you what a dick I am, I’m going to browse away from the website you were using.” He finished his work, closed the web browser so that I would have to login from scratch, and then walked past three empty computers on his way out.

He once mentioned that he isn’t married. I can’t think of a reason why.

5. If I don’t take the initiative, no one will. I was in line at the cafeteria one afternoon trying to get lunch before the next marathon surgical case. I heard a commotion behind me and turned around to see a woman lying on the ground in the middle of the snack bar. I watched as several people walked by her, including one resident. I got out of line, grabbed a wheelchair, and then ran the woman to the emergency department. There are multiple instances of healthcare workers turning a blind eye to helping others. Naturally, I’m not going to give the homeless people outside of the hospital my loose change, but if a patient needs genuine help, I’ll be the first to jump in. I’m really saddened to see that so many of my colleagues—regardless of their stage of training—are not willing to do the same.



  1. SusyCat said,

    Jewels of wisdom. Thanks for sharing your experience with all of us. It really helps to know what’s coming.

    It’s really sad that I hear over and over how cold people get when they work in healthcare. Especially surgery. Why does this happen? I dread ever becoming like those people. Keep up the good work and don’t be discouraged.

  2. 3/4 MD said,

    Surgery sucks! I can remember waking up at 4am everyday and saying to myself “This is just wrong!” Don’t get me wrong surgery was cool for the first five minutes after which it became incredible boring. Holding retractors and starring at guts ugh!

  3. Jack Gorman said,

    I’ve read a few of your posts now and the arrogance you manage to convey through your writing is unbelievable. It’s interesting stuff, but only in a makes-you-shake-your-head-’cause-this-kid-is-so-full-of-himself kind of way.

    This is an old post and you may not even read this comment, but I hope you’re able to curb your pompous, asshole behavior before you temper yourself into one permanently. Be careful is all I’m saying…

  4. Mike said,

    Hey Jack Gorman? Sthu.

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