It was a long day today. Not only because of hospital/ clinic work but other commitments, but having to get up at 5 am certainly doesn’t help. Rounds started a little earlier today with our new chief resident and then we went to clinic later with the attending (we were late because the schedule we were given was wrong). It was nice to be back in the clinic though. It being a surgery clinic, there were some pretty heavy conversations had. In some ways, it feels wrong for me to be there in these important moments, as a spectator/ medical student. Another part of me feels lucky to be able to be present in those moments. If I did go into surgery, I can see clinic being something I enjoy. Our attending also did a lot of patient education which I thought was nice, especially since the image of surgeons can often be kind of cold and fast paced. But I am very sleepy so that is all for now.
Today was my first weekend shift on surgery. There were no procedures, so today was just rounding on the patients who were already in the hospital or got admitted yesterday. Compared to internal medicine, handoff in surgery seems very inefficient and almost haphazard, but it also feels like there are less issues being tracked, but those issues may be slightly more volatile. The resident I worked with today is supposed to stay at the hospital until tomorrow morning. Part of me is confused as to why. Why does someone have to be on call for 24+ hours. Is it a continuity thing? Based on what I’ve seen, it’s not like being around the first half of the day makes you any better suited to care for a patient overnight than someone coming in fresh who received a strong sign-out. It almost feels like one of those archaic practices that is held on to as a source of pride, like “look at me able to withstand a 28-hour shift.” But also what do I know, I’m literally talking out of my ass. Maybe it is better for physician wellness. Maybe it is better for patient care. I bet there’s gotta be some studies out their pointing one way or the other.
Yesterday during Grand Rounds, the speaker was talking about growth mindset vs fixed mindset. At this point the concept of these mindset have been beaten to death in academic and professional development lectures and the like. Today though, I was thinking about how exposure during childhood can orient us toward one mindset over the other. Not to brag, but I feel like I’ve always had kinda a growth mindset, and I feel like watching shows like Pokémon growing up were big in fostering that. This idea of being being kinda shitty at something, but slowly getting better through hard work is a common theme throughout anime and sets up good example for kids in overcoming obstacle and pushing through adversity.
Then I thought about more western programming. Maybe I have selective memory now that I’m thinking about it in order to prove a point, but a lot of the American TV watched growing up was built more around fixed characters and archetypes. The stories were more situational than progressive. Characters personalities were fixed, and you knew what to expect out of them; how they would behave and how they would react to different situations which made for good TV for kids in its on way, but not in a way they sets up kids to be growth mindset oriented.
All I’m trying to say is anime is good for kids.
Fridays are dedicated education days so no surgery work today.
One of the tasks I assigned myself for this month was to affirm a stranger every day. It feels like a simple task, but one that has been hard to be consistent with. I’ve found that when you are trying to find something to affirm a stranger about it can be hard to come up with something, either that or I just feel too awkward about complimenting a random stranger to say anything. Uncalled for affirmations are weird, but they don’t have to be creepy. I guess my goal in assigning myself this task was to be a bit more out going and to try to look for the good in strangers. So far still needs some work.
We didn’t have any cases today, so (thankfully) I didn’t have spend any time in the operating room (even though watching surgery is cool, yesterday was just a lot of standing). So it most basically like an internal medicine day, minus the long rounds and comprehensive discussions of pathology. I actually like the residents on our surgery team. The chief is kinda scary, or just very surgeon-y, she can be kinda terse, but also very nice at times and willing to be patient with us and help us learn when there is time.
There was supposed to be a liver transplant today which I was really looking forward to but it got cancelled (perhaps for the best), so we got a chance to sit down with the team a bit more and set expectations and stuff. And we got to go home a little earlier which was quite nice.
It’s only day 3 but I think I already know surgery, as awesome as it, is not going to be for me. The giddy has mostly worn off.
I got to scrub in on 2 liver resections today. Both cases of rectal cancer with metastases to the liver. This procedure is another great example of how kinda straightforward surgery is (again, besides all the technical parts of it); there’s something wrong with part of the liver, let’s just cut that shit right out. And when we cut the liver, I was kinda expecting this clean margins, like you’d get if the thing was made of Play-Doh. Nope it looks janky as heck.
If anything see all of this is, whole organs being chopped up, tissue being burned apart and sewn back together, it’s all a testament to how amazing our bodies (and living things in general are). We can put our body through hell, and yet it find away to put things back together, more or less in the way it’s supposed to, something we often take for granted.
We’re back to the early mornings. Yesterday our intern told my fellow medical student and I to show up at 6:00 AM at the hospital. Turns how it was his first day on the the service and first day working at this hospital as well, so the morning was a bit chaotic. The intern ran off without telling us much, and then the senior resident showed up and was like wtf. She took us to go round which was a very different experience from IM; walking rounds, but very brief visits with the patients. We finished in like 30 mins and then the resident was like ok go scrub into whatever surgeries are going on. And we were like uhhhh.
This was my first time actually working in this hospital and the scrub orientation/ OR tour we had yesterday was for the county hospital. After some running around with my classmate we eventually made it to our respective ORs. I got to go to a Whipple procedure, which I was pretty excited for. It’s basically a big plumbing job (like many surgeries). As technical and difficult and high-risk these procedures are the concepts are kinda basic, just take out what you need and make sure things are connected and stuff doesn’t leak out (obviously this is an oversimplification, you need to know what you are cutting and why).
This particular procedure is supposed to take 8+ hours. I was there for only for 4. It was amazing to watch the surgeons work. I feel like I often think about internal organs as so vital and almost delicate, but watching surgery proves otherwise. Sure the surgeons work with great care and precision, but at the same time things are flopping around, getting pushed and squeezed and cut and stitched and disconnected and reconnected and then later when the patient comes to they are still able to live as a functional human. Wild.
I will say as amazing as it is to watch, just watching does get a bit boring after a while. Though I can imagine actually doing the procedure being less so.
The surgical fellow straight-up told me that if there is something else I enjoy in medicine, do that and to avoid surgery if I can help it. After what I saw today I think that may be good advice. I can’t really imagine doing what these guys do into my 50s and 60s and not being an attending till I’m nearly 40.
Still looking forward to seeing more cool procedures though.
Today was orientation day for surgery. While I don’t think I want to end up in surgery (nor am I probably competitive enough to match even if I wanted to), I am actually pretty excited for all the cool shit I’m about to see during this rotation. I’m going to be on the hepatobiliary service and I am very much hoping I will get to see a transplant. I’m honestly not 100% sure if this service does transplants or if there’s a transplant specific service because I’ve heard conflicting things. Today we had some workshop for practicing IV insertion and surgical knot tying. The practical and hands-on nature of surgery is something that has always appealed to me about surgery, so I’m excited to learn these skills and hopefully be able to use them on actual patients. It’s going to be a rough next 6 weeks, but I don’t know why I’m kind of feeling giddy about it. We’ll see how long that lasts. Stay tuned.
I’ll state the obvious: life is full of choices. Knowing that isn’t all the helpful though, despite how often people say it. Knowing that I have to make a choice doesn’t relieve any of the pain or anxiety that comes with actually having to make it. That said, I am a firm believer that every person makes the best choices that they can with the information they have available to them at a given moment, otherwise they wouldn’t have made said choice. Event when that choice turns out to be detrimental or ends up causing the person pain, in that moment or at that time, the decision served some sort of function or seemed like the right thing to do under a specific set of circumstances. We can never say for certain whether the ultimate outcome is net good or bad. Sometimes people say there are no good and bad decisions and it always depends on what you make of it, but I’m not convinced that is 100% true. But also what do I know, and maybe it simply doesn’t help to think that way.
What I like about art is that even the most hyperrealistic art, even photographs, are all still just impressions. No matter how hard you try, an artist’s character will always bleed through the medium. You can never recreate the exact moment that a piece of art was being made, and so you can never recreate any one piece of art. Yet the art itself serves an as artifact of that moment, and with that creates its own, allowing those who experience to relive that moment within their own imagination and from the lens of their own worldview.