Surgery Versus Medicine

In High School there are the jocks and there are the nerds. In medicine, there are the surgeons and there are the Internists. Surgeons are doers. Internists are okay wringing hands and waiting for their tests and medicines to work. I was always looking up to the jocks in high school. I wished I was the high school quarterback. Alas, I was only 5 foot 4 and 125 pounds. So in medical school when 3rd year comes along and you are making final decisions on your specialty of course I was drawn to the surgeons. In their glamorous scrubs and their cocky attitudes. I had to be one of them. So when my surgery rotation finally came along I was really excited. I chose to do a Trauma Surgery rotation. To me, the most glamorous of the surgeries. It was toward the end of my third year. During the third year of medical school, after 2 years of classroom learning, you spend the year training with each of the major specialties.  I had done a whirlwind of all the specialties and was savoring the chance to experience surgery. To feel the OR, the adrenaline of saving a life.

Trauma Surgery is glamorous. When a Trauma patient is brought into the ER, the Trauma Surgery Team, is paged into the ER and arrive in hero fashion. Everyone clears out. Funny enough, they even clear out for the medical student on the Trauma team. They are loud and boisterous and call out commands. They are there to save the patient and it needs to be done right away like a TV show. They are awesome.

I was in Heaven. I thought I was the high school quarterback. We were saving lives and could do it within minutes. I thought I found my specialty. During my rotation, every 3rd night I was on call. The thrill of the pager going off was exhilarating, running into the ER to meet the patient. But by the end of the month the thrill of near death had become mundane. I had seen it all. I had seen a man who was in a machine shop accident and all his intestines except for 3 feet were eviscerated. I had seen tons of motorcycle accidents, and car accidents. One man had been shot right  through the tip of his nose. The bullet traveled through the center of his brain missing everything important. He was monitored over night and discharged the next day when there was nothing wrong with him.  I had seen one man who lived on the streets and was run over by a street sweeper. He had every single rib and hips fractured. The stories went on.
That rotation ended. I did another month of surgery, and then my fourth year began . I was obviously still interested in surgery so I started it with Trauma Surgery again (we get to choose at that point).

And then it happened, I remember being on call one night when the pager went off.  Glossy eyed I made it to the Trauma Port as EMS was rolling in an eighty year old man who had just been in a car accident. He was moaning. He could have been anyone's grandfather, or father and was actively dying. We all knew it and there was no magnanimous surgery to save him. But there was no emotional connection to him. We were all too tired and had been through too many of these episodes. Xrays were taken and I remember all of us on the team met in the Xray reading room to review the patient.

Our leader that night was a 4th year Surgery Resident. I don’t even remember his name. But at that stage many of them are jaded and worn.
 “Good old grandpa out for a Sunday drive” He said with disdain. This man was dying but it was said as if this man was troubling the Resident for waking him up. “Can’t they just take their licenses away or something?” we all laughed.... And then I paused. I had laughed too. We were all exhausted and something like this mans death was mundane. It was becoming a burden for me. That moment I realized,  I don’t want to become that Resident. I don’t want to lose any form of my compassion. In those months I had met many compassionate and caring surgeons, but I realized that I could and really already was becoming jaded and worn. I realized my love for surgery was some of the less surgical aspects. I was glad I realized it early on and moved on to be the nerd of the profession, the internist.

What is funny to me is that  I think I ended up one of the furthest specialties away from Surgery as a Geriatrician. I hold my patients hands at least once a day.