Surgery Residency Quotes

Neuroscience tells us that it is highly improbable that we have souls, as everything we think and feel is no more or no less than the electrochemical chatter of our nerve cells. Our sense of self, our feelings and our thoughts, our love for others, our hopes and ambitions, our hates and fears all die when our brains die. Many people deeply resent this view of things, which not only deprives us of life after death but also seems to downgrade thought to mere electrochemistry and reduces us to mere automata, to machines. Such people are profoundly mistaken, since what it really does is upgrade matter into something infinitely mysterious that we do not understand. There are one hundred billion nerve cells in our brains. Does each one have a fragment of consciousness within it? How many nerve cells do we require to be conscious or to feel pain? Or does consciousness and thought reside in the electrochemical impulses that join these billions of cells together? Is a snail aware? Does it feel pain when you crush it underfoot? Nobody knows.

I had seen that once before, bleeding water. A little baby I worked on as a resident in training. That poor kid had been shot as well—his father had blasted away the top of his head with a shotgun—and we couldn't begin to stop the bloodletting in that case. "Looking pretty thin down here," I hollered when the stuff coming out his wounds was no more than pink salt water. That baby's heart stopped, started, stopped and started a dozen times before it finally gave up the ghost and we pronounced him. I could have read a newspaper through the watery stuff coming out his veins by then.

Surgeons are independent doers, ready to act. They prefer not to ask for help, thank you, or to place trust in much outside their own abilities. They work hard, expect perfection, and do not accept excuses. To the residents, some surgeon mentors were decent human beings; others were tyrants. Personalities aside, the central fact was this: Surgeons use their hard-earned physical skills to get results in the operating room (or create their own problems). They rely on themselves for success or failure. They are the captains of their ships. They do not need or want to rely on medication or another person to improve the quality of a patient’s life. Surgery is a specialty of instant gratification, for patient and surgeon alike.

Expertise is the mantra of modern medicine. In the early twentieth century, you needed only a high school diploma and a one-year medical degree to practice medicine. By the century’s end, all doctors had to have a college degree, a four-year medical degree, and an additional three to seven years of residency training in an individual field of practice—pediatrics, surgery, neurology, or the like. In recent years, though, even this level of preparation has not been enough for the new complexity of medicine.

WWPP ('WODEA Witness Protection Programme') ni Programu Maalumu ya Ushahidi ya Tume ya Dunia ya kuwakinga mashahidi wa kihalifu kwa kuwapa makazi mapya, majina mapya, kazi mpya, historia mpya ya maisha, na sura mpya, kuwakinga na Sheria ya Kitalifa ya Kolonia Santita. Ukivunja Sheria ya Kitalifa ya Kiapo cha Swastika cha Kolonia Santita utauwawa, tena utauwawa kinyama, wewe na familia yako.

At the residence of my first veterinary job in New England, I passed by the surgery suite just in time to see my boss pulling a long stretch of a cassette tape out of a dog’s intestine. “What in the world would entice him to eat this?” he muttered. He then rationalized a plausible explanation to himself which did not necessitate my reply. “It must be country music. Nothing else could possibly be worth the agony of all of this,” he mumbled continuing to pull loops and loops of tape from the dog’s inflamed intestines.

By the century’s end, all doctors had to have a college degree, a four-year medical degree, and an additional three to seven years of residency training in an individual field of practice—pediatrics, surgery, neurology, or the like. In recent years, though, even this level of preparation has not been enough for the new complexity of medicine. After their residencies, most young doctors today are going on to do fellowships, adding one to three further years of training in, say, laparoscopic surgery, or pediatric metabolic disorders, or breast radiology, or critical care.

As we’ve seen, up to 25 percent of employed seniors from our top universities are heading to financial services each year. Our financial services industry (and to a lesser extent its attendant legal industry) plays an equivalent role to the oil industry in Saudi Arabia in terms of talent attraction. You can see a similar dynamic at work in other fields with fixed slots. There were 682 orthopedic surgery residents in the United States in 2012. That number is set because there are only so many funded residency slots in teaching hospital programs throughout the country.4 If I were to kick butt in medical school and get one of these residencies, I would be on the way to becoming an orthopedic surgeon, probably the most coveted residency due to money, lifestyle, low morbidity of patients, gratification from restoring mobility, and other factors. But let’s say that I didn’t make it and fell short—there would still be 682 orthopedic surgeons five years from now because the next guy would have gotten that slot. We’re all competing to fit through the same finite gate. The value difference if I perform really strongly and get one of these coveted spots is not one more surgeon—it’s the gap between me and the 683rd person who didn’t get it (and perhaps went into a less prestigious or less lucrative specialty). From a value creation standpoint, it’s not ideal for a massive level of talent to be going to existing enterprises that have captured large economic rents or where people are fighting for a set of finite slots. The rents and slots will stay essentially constant. Contrast this with new business formation. If I were to say, “There are only going to be 682 new successful businesses started in the United States next year,” people would instantly regard that as ridiculous. It’s unknown and unknowable. But we all know that if another enterprising team comes along and starts a cool company, that number goes up by one.

Vicente Bernabe DO graduated from Des Moines University with his Doctor of Osteopathy degree. He went on to intern at Doctors Hospital and completed his residency in Orthopedic Surgery at Ohio University at Cuyahoga Falls General Hospital. Vicente Bernabe DO has performed over five thousand orthopedic surgeries.

We expect that life will be better once we are done with premed, medical school, and residency. But it doesn’t get better. It will stay the same … unless you change your mentality. Enjoy the now. Enjoy studying for the organic chemistry test if you are a premedical student. Enjoy rotating through general surgery as a medical student. Enjoy working 80-hour weeks as a resident. If you do not enjoy your current situation, you will not enjoy your future one.

Halsted founded the surgical training program at Johns Hopkins Hospital in Baltimore, Maryland, in May 1889. As chief of the Department of Surgery, his influence was considerable, and his beliefs about how young doctors must apply themselves to medicine, formidable. The term “residency” came from Halsted’s belief that doctors must live in the hospital for much of their training, allowing them to be truly committed in their learning of surgical skills and medical knowledge. Halsted’s mentality was difficult to argue with, since he himself practiced what he preached, being renowned for a seemingly superhuman ability to stay awake for apparently days on end without any fatigue. But Halsted had a dirty secret that only came to light years after his death, and helped explain both the maniacal structure of his residency program and his ability to forgo sleep. Halsted was a cocaine addict.

Trained Obstetrician and Gynaecologist in Dubai Dr Elsa de Menezes Fernandes is a UK trained Obstetrician and Gynaecologist. She completed her basic training in Goa, India, graduating from Goa University in 1993. After Residency, she moved to the UK, where she worked as a Senior House Officer in London at the Homerton, Southend General, Royal London and St. Bartholomew’s Hospitals in Obstetrics and Gynaecology. She completed five years of Registrar and Senior Registrar training in Obstetrics and Gynaecology in London at The Whittington, University College, Hammersmith, Ealing and Lister Hospitals and Gynaecological Oncology at the Hammersmith and The Royal Marsden Hospitals. During her post-graduate training in London she completed Membership from the Royal College of Obstetricians and Gynaecologists. In 2008 Dr Elsa moved to Dubai where she worked as a Consultant Obstetrician and Gynaecologist at Mediclinic City Hospital until establishing her own clinic in Dubai Healthcare City in March 2015. She has over 20 years specialist experience. Dr Elsa has focused her clinical work on maternal medicine and successfully achieved the RCOG Maternal Medicine Special Skills Module. She has acquired a vast amount of experience working with high risk obstetric patients and has worked jointly with other specialists to treat patients who have complex medical problems during pregnancy. During her training she gained experience in Gynaecological Oncology from her time working at St Bartholomew’s, Hammersmith and The Royal Marsden Hospitals in London. Dr Elsa is experienced in both open and laparoscopic surgery and has considerable clinical and operative experience in performing abdominal and vaginal hysterectomies and myomectomies. She is also proficient in the technique of hysteroscopy, both diagnostic and operative for resection of fibroids and the endometrium. The birth of your baby, whether it is your first or a happy addition to your family, is always a very personal experience and Dr Elsa has built a reputation on providing an experience that is positive and warmly remembered. She supports women’s choices surrounding birth and defines her role in the management of labour and delivery as the clinician who endeavours to achieve safe motherhood. She is a great supporter of vaginal delivery. Dr Elsa’s work has been published in medical journals and she is a member of the British Maternal and Fetal Medicine Society. She was awarded CCT (on the Specialist Register) in the UK. Dr Elsa strives to continue her professional development and has participated in a wide variety of courses in specialist areas, including renal diseases in pregnancy and medical complications in pregnancy.

You can change careers, friends, and even partners, but the body always comes with you. You cannot emigrate from your body. Cosmetic surgery may be capable of removing the pockets from under the eyes—at least for a few years. […] The body is the house that we always reside in. […] When we talk about self-worth, we are not just referring to some inner “ghost in the machine.” We include hands, feet, legs, belly, chest, and shoulders. Whatever age these parts of us may be, whether they are too big or too small, too long or too short, even healthy or sick, when can we make peace with each vital part of ourselves and recognize its intrinsic value?

I covered her with her blanket and got her a coffee. I plugged in her phone, made her eat half of a tuna sandwich. Family began to show up and they huddled around the waiting room, whispering and crying. Brandon’s mom prayed in Spanish over a rosary. I sat next to Sloan, feigning emotion, doing all the motions. Looking somber and rubbing her back but feeling empty and removed because my crisis response was still in effect. Now that the rush was gone, the velociraptor paced. I couldn’t shut off my brain and the need to be doing something. But the only thing to do was wait. I bounced my knee and picked at my cuticles until they bled. I texted Josh and kept him posted. They’d found a replacement for him at work, but he couldn’t leave until 8:00 p.m. Then, ten hours after the accident, the doctor came out. Sloan bolted from her chair and I followed, ready to absorb what he said with an accuracy that I would be able to transpose onto paper, word for word, two days later. Brandon’s mom wrapped her sweater tighter around herself and stood shoulder to shoulder with Sloan. Brandon’s dad put an arm around his wife. I tried to figure out the outcome from the doctor’s lined, angular face, but he was unreadable. “I’m Dr. Campbell, the resident neurosurgeon. Brandon is out of surgery. He’s stable. We were able to stop the internal bleeding. I had to remove a large piece of his skull to alleviate the pressure on his brain.” Sloan gasped and started sobbing again. I put an arm around her, sandwiching her between Brandon’s mom and me as she breathed into her hands. The doctor went on. “The good news is there’s brain activity. Now, I can’t say what his recovery is going to look like at this juncture, but the tests we ran were promising. He’s going to have a long road ahead of him, but I’m feeling optimistic.” The room took a collective deep breath.

As an outsider looking in, an x-ray of the Michaels family would look something like this: Cassidy Michaels-Harrington: Oldest child, snob, interior designer, mother of two hellions I loved dearly, and married to an attorney who, if possible, was an even bigger snob. Tyson Michaels: The baby, snob, finishing the last year of his plastic surgery residency and apparently re-engaged to an orthopedic surgeon who was not a snob, but in a lot of ways, he was by association because he put up with, and often encouraged, my brother’s behavior. And then there was me, Bowen Michaels: blissfully normal accountant, stuck in the middle, wondering how in the hell my cool-ass parents had given birth to me and the co-mayors of Snobville.

We have no illusions about this. ... When an attending physician brings a family member in for surgery, people at the hospital think hard about how much to let the trainees participate. ... Conversely, the ward services and clinics where residents have the most responsibility are populated by the poor, the uninsured, the drunk, and the demented.

to live until she was big enough to undergo extensive open-heart surgery. She had been followed since birth in our Pediatric Cardiology Clinic at the New York Hospital, and many of the pediatricians knew her and her family. Despite her physical difficulties she took full possession of all the hearts around her, including mine. When the time for her surgery finally came, her parents were deeply anxious. These were early days for many cardiac surgery techniques, and the risks were considerable, but without surgery, she would not survive childhood. As the senior pediatric resident, I met with Immy’s parents before the surgery to do an intake interview and summarize Immy’s long story. They were committed and ready and very pale. As we spoke, they sat close together holding hands. Afterward I took them

The medal had been moved from her shirt to her hospital gown. It had seemed so important to her parents that I mentioned it in passing to the cardiac surgery resident as we sat writing chart notes in the nursing station on the evening before the surgery. He gave me a cynical smile. “Well, to each his own,” he said. “I put my faith in Dr. X,” he said, mentioning the name of the highly respected cardiac surgeon who would be heading Immy’s surgical team in the morning. “I doubt he needs much help from Lourdes.” I made a note to myself to be sure to take the medal off Immy’s gown before she went to surgery in the morning so it wouldn’t get lost in the OR or the recovery room. But I spent that morning in the emergency room, as part of

Immy spent the next day or two undergoing tests, and I saw her several more times. The medal had been moved from her shirt to her hospital gown. It had seemed so important to her parents that I mentioned it in passing to the cardiac surgery resident as we sat writing chart notes in the nursing station on the evening before the surgery. He gave me a cynical smile. “Well, to each his own,” he said. “I put my faith in Dr. X,” he said, mentioning the name of the highly respected cardiac surgeon who would be heading Immy’s surgical team in the morning. “I doubt he needs much help from Lourdes.” I made a note to myself to be sure to take the medal off Immy’s gown before she went to surgery in the morning so it wouldn’t get lost in the OR or the recovery room. But I spent that morning in the emergency room, as part of

team working on two children who had been thrown from the back of their father’s pickup truck onto the roadway. By the time I reached the floor, Immy had been taken upstairs to surgery. The surgery had lasted almost twelve hours, and things had not gone well. The bypass pump, a relatively new technology, had malfunctioned for several minutes and Immy had lost a great deal of blood. She was on a respirator, unconscious and unresponsive, in the Intensive Care Unit. On the day after surgery, Immy’s mother told me in a shaking voice that Immy’s gown had been removed in the operating room and thrown into the hospital laundry. The medal was gone. Concerned, I called the surgery resident and told him what had happened. “Why are you telling me this?” he asked me.

to her parents in relief, I asked if it was another one. “No,” her mother said, “it was the same one that was lost.” Dr. X had come that afternoon and brought it to them. I told them how glad I was that it had been found. “Yes,” her father said. “We are too.” Then he smiled. “She is safe now, no matter what happens,” he told me. The following morning, the surgery resident told me how the medal had been found. On the previous day, Dr. X had made his patient care rounds much as usual, followed by a dozen of the young surgeons he was training. But instead of ending the rounds in the ICU, he had taken them all to the laundry department in the subbasement of the hospital. There, he explained what had happened, and then he and all his residents and fellows had gone through the pediatric laundry from the day before

neurosurgeon. I graduated from the University of North Carolina at Chapel Hill in 1976 with a major in chemistry and earned my M.D. at Duke University Medical School in 1980. During my eleven years of medical school and residency training at Duke as well as Massachusetts General Hospital and Harvard, I focused on neuroendocrinology, the study of the interactions between the nervous system and the endocrine system—the series of glands that release the hormones that direct most of your body’s activities. I also spent two of those eleven years investigating how blood vessels in one area of the brain react pathologically when there is bleeding into it from an aneurysm—a syndrome known as cerebral vasospasm. After completing a fellowship in cerebrovascular neurosurgery in Newcastle-Upon-Tyne in the United Kingdom, I spent fifteen years on the faculty of Harvard Medical School as an associate professor of surgery, with a specialization in neurosurgery. During those years I operated on countless patients, many of them with severe, life-threatening brain conditions.

There’s a ritualization to some of these recovery modalities that shouldn’t be overlooked. In a recent editorial, Jonas Bloch Thorlund from the University of South Denmark deconstructed why arthroscopic surgery for meniscal tears remains popular, despite compelling evidence that these procedures are essentially placebos, no better than sham surgery.11 Thorlund notes that surgery represents a ritualistic activity that fosters expectations, much like the way shamans do. There’s the journey to a healing place (the hospital), anointment with a purifying liquid (the presurgical skin prep), and an encounter with the masked healer. As I read this description, I felt a glimmer of recognition, thinking about my experiences visiting recovery centers. In each case, you’re greeted by an empathetic caregiver who walks you through a series of rituals that require various forms of preparation and waiting. It makes me wonder how much power resides in the simple act of putting your trust in a healer and taking part in the ritual on offer.

Why in the world would any woman reject this modern technological machinery? You research the literature and discover that while you were trained to use the electronic monitor in medical school and during your residency, that, actually, babies do not benefit when electronic monitoring is used. Babies do just as well when only the stethoscope is used. But mothers don’t do as well when they are on electronic monitoring. They are greatly harmed by suffering a tripled rate of cesareans. Since the babies don’t benefit by this monitoring, then this increase of surgery represents unnecessary surgery.