Meaning of Life

I have been meaning to write about my surgery rotation while it was still fresh in my mind, but somehow having a few moments of free time to go to my friend's wedding, drink excessively, pack, search for a new car, grocery shop, start a new rotation, exercise, reconnect with hubby and dog has taken up all of my time. Oh well, I am still going to write about it, because maybe if I can capture the horror of the rotation it will be something I can go back and read about when I am feeling sorry that I didn't do orthopedic surgery.
How do I put my finger on "the surgeon mentality." Is it unfair to catagorize a whole group of people in one way? Just as I believe that there is a little truth behind every joke (Gary hates it when I say this), I also believe that there is a truth behind every stereotype. So how and why do surgeons have this cold, abrupt, hard-driven, even malicious stereotype. What is it about their day to day interactions that causes this perception. Here are my observations for what it is worth:
1. In surgery, you dispense with all pleasantries with your co-workers. When you come into work in the morning, there are no "Hey Siobhan, how was your night? Have a good run? Any plans for the weekend?" No. Simply, come in the door and hit the ground running. If we have a free moment, mostly the surgeons just talk about their surgeries, or lack of sleep, or how much they still have to do. Occasionally, there is some disparaging comments regarding other services or the nurses.
2. Introductions? Forget about it. People come and go, and noone gives a shit who you are. You are your job. This is the Attending Dr. So and So. This is the Resident, This is the intern. You are there to do your job and know your role, and don't step over your role. Never in any situation, do you bypass your resident and ask the attending a question directly.
3. Surgeons pride themselves on their short notes. This bugged me. Why can't I have a note from a consulting service that actually says what the hell we are supposed to do? This seems incredibly important to me since when you page a surgeon they rarely answer (because in the OR I assume). This causes a lot of patient discharging problems. It is very hard for an intern to know the discharge plan on a neurosurgical patient's spinal fracture and herniation.
4. Surgeons avoid patient contact at all cost. It wastes valuable time. In their defense, they do have precious little time. They have to do surgeries all day, which I understand. So many times during my rotation, I am called to a bedside of a patient (that I don't know because I am cross-covering and on call), and the patient is being discharged and they have no idea what is going on. The conversation goes something like this. Patient: "I had no idea I was being discharged today, then the nurse brings in my discharge papers and I have never even seen a doctor." Me: "Oh, I'm sorry about that Mr. Smith, let me just go check in the chart and I will let you know what is going on." I go to the chart, which says nothing. I page the consulting physicians with no reply. I go back to the room "Bullshit, bullshit, bullshit, follow up in 1 week, blah, blah, blah, I have no real idea because I'm an intern, make up some more stuff, I apologize you have not seen a physician until now, reassure, reassure."
5. Surgeons have a sense of pride about how much they work. The more work they do, the longer they stay in the hospital, the better doctor and better person they are. They also brag about never sleeping and not needing sleep. They think "balance" is a 4 letter word.
6. Surgeons don't eat. At least, not sitting down. Somehow, their supreme intellect and capacity to save lives have rendered them impervious to malnutrition. This may account for their lack of need to urinate or defecate.
7. Surgeons like to say things like: "Why is this taking you so long, it should take 2 minutes." "End of discussion, there will be no debate about this." "That is why they are nurses and we are doctors" "Get someone over here who knows what they are doing."

Well, I was going to write 10 things, but now my little Lander is causing a commotion and I need to take him out. This should be enough to remind me, that though surgery is "cool", nothing is that cool.

Viper

We don't see many children at UCSD hospital. Occasionally in the emergency department someone will bring their kid in, but usually most parents take their kids to Children's hospital if they can. However, I just saw a 7 year old kid in trauma clinic. All of our patients have a follow up appointment 1 week after discharge. This kid was in a car accident on Easter. His father was driving home from the grandparents when he fell asleep at the wheel. He wasn't drinking. When a patient comes into the trauma bay, they are given a code name. A random word plus a #. For example: Apple, 16. The reason is that often you don't know their real name and you need to identify the patient somehow. This kid and his father were taken into UCSD hospital, he had 2 siblings in the car as well, sister and brother, who were much more injured and were taken to Children's. The kid was given a trauma name: Viper, 56, and he wasn't hurt. He had a tiny laceration on his forearm that we superglued. He was put into a cervical collar and admitted and observed overnight and received CT scans to make sure there were no other injuries. He was a very cute and brave kid and he loved his trauma name. When I saw him in the morning which was the first time I met him, I asked him his name, which he said, but then added "you can call me Viper if you want to." I had heard through the grapevine that his siblings were much worse off, but then after I discharged him in the care of his father (who was also admitted overnight with minimal injuries), I hadn't thought much about him until today. He was brought in by his grandmother, and was doing well. He still loved to be called Viper and said that it is his new nickname. I was glad to hear he was doing well, and asked about the welfare of his brother and sister. The news was terrible. His sister had broken her back and was paralyzed, and may not make it. His brother had multiple injuries and had broken his neck and other bones but it didn't sound like he was paralyzed. I didn't press for details. Since this visit, I havent been able to keep that poor family out of my mind. Viper's sister who will never grow up into the woman she could have been. Viper's father who will never forgive himself, Viper's mother who will always wish she would have been there to keep the dad awake. Treating children is very different than treating adults. The emotional factor is undeniable. While I feel very sad about the man who fell off the cliffs while drinking and broke his neck and is now paralyzed, I feel a real anguish for this family. I wanted to hug Viper and his grandmother. He is so young and doesn't realize yet that his life will be forever changed now after this one incident. The fragility of life was very tangible today, and yet it made me want to be a part of a child's life. In some way that I can't explain even to myself, it made me want to be a mother. I felt like I wanted to protect this child who wasn't even my own; I wanted to make everything OK for him. Maybe that is a true instinct. The desire to protect and care for a child. He doesn't know yet what a loss this will be for him, and his innocence about it all, made me want to weep.

home sweet home

Gary and I are taking a dramatic step...don't worry, not too dramatic. We are moving from condo living into a house. Slow down a second, you say? It has only been 11 years, why rush anything? Well, having our little Lander has made us grow up a bit, I think. Plus, it is just a pain in the ass to take Lander outside all the time while living in a condo. It is more than that though, we also just don't want to be living on top of people all the time. We need some SPACE! So I am pretty excited about it, although it is pretty crazy the amount of rent we are going to pay here in San Diego for a house. We found a cute one, with a lot of character, near the bay and also right on a canyon for running. Should be perfect! I can't wait to move. I have definitely outgrown this place, but i will miss the pool and hot tub and gym! That is all that is new in my world. I am still getting up at 4:30 am for my trauma rotation. It has gotten a little more sane as supervising physicians have changed, but I am simply exhausted all the time. I am also much more short tempered. Gary was surprised the other night when I honked at some people who were taking their sweet time to get out of a parking spot! Lack of sleep, exercise and socialization does something to a person. No wonder surgeons are how they are. I would be miserable too if I had to do it longer than a month.

simplicity of an apple

These last four days have been rough. I started trauma surgery rotation on Monday, and I have been warned by all my co-interns who came before me that it was tough, but you just can't prepare for this. I show up on my first day at quarter to six, everything is a mess because there are no medical students on the rotation to do all this necessary scut work. The result is, I don't know which patients I am supposed to see until nearly 7. I then have less than 1 hour to round on 7 patients that I don't know and 2 of them just transferred from the ICU. Blah, blah, blah. Then I meet the surgeons. Whoa! All I can say is that I am SO glad that I didn't choose to go into surgery. The personalities are so intense and dramatic and egomaniacal that all I can do is laugh. I am constantly exchanging glances with a co-resident of mine on the team right now (also an EM resident) while on rounds when something extremely absurd happens. The interaction is comical. The atmosphere is simply malicious. There is always a hierarchy in medicine, but nowhere is it so profound as in surgery. Ok, I could go on, but in reality I am just venting and I could never capture the misery of the rotation.
Sometimes when I want to reconnect with Gary, I ask him: What was your high today? What was your low? So my high today was an apple. I was walking back to my car, and I was lucky enough to be walking while there was still daylight. No sunshine, but still light outside. There was a slight breeze, and I had an apple. I left the hospital and bit into a little bit of heaven. I walked the 8 blocks back to my car, eating my perfectly crunchy apple. It was amazing!
oh wait, I just now hear a fire roaring from the living room. I may have to change my high for today.