Surgical Residency Quotes

just remember the rules of any surgical residency: Never stand when you can be sitting, never sit when you can be lying down, never use the stairs when there are elevators, never be awake if you can be asleep, and always eat and shit at the first available opportunity.

I welcomed my slavish existence as a surgical resident, the never-ending work, the cries that kept me in the present, the immersion in blood, pus, and tears -- the fluids in which one dissolved all traces of self. In working myself ragged, I felt integrated...

My beeper, silent till then, went off. In answering its summons, I slipped the yoke back around my neck; indeed, I welcomed my slavish existence as a surgical resident, the never-ending work, the crises that kept me in the present, the immersion in blood, pus, and tears—the fluids in which one dissolved all traces of self.

The surgical resident interested in learning trauma will bypass a residency at a quiet community hospital for a residency at a fast-paced Level 1 trauma center treating a high volume of trauma patients. A Level 1 trauma center residency is far more rigorous—and not particularly glamorous—but the intensive culture of a dedicated trauma center will cultivate the decisive judgment and action required of a surgeon specializing in trauma. By choice or by chance, we must actively test our limits to know our capabilities.

A 2016 study published in Proceedings of the National Academy of Sciences of the United States of America suggested that health care providers may underestimate black patients' pain in part due to a belief that they simply don't actually feel as much pain - a myth that dates all the way back to the days of slavery. For centuries, the claim that black people were biologically different from whites was 'championed by scientists, physicians, and slave owners alike to justify slavery and the inhumane treatment of black men and women in medical research,' the authors wrote. Black people were thought to have 'thicker skulls, less sensitive nervous systems,' and a super-human ability to 'tolerate surgical operations with little, if any, pain at all.' In the first phase of the study, over two hundred white medical students and residents were asked whether a series of statements about differences between black and white patients were true or false. Some of the statements were true, while others - for example, 'blacks' skin is thicker than whites' and 'blacks' nerve endings are less sensitive than whites' - were false. They found that a full half of the respondents thought that one or more the false statements - many of which were 'fantastical in nature' - were possibly, probably, or definitely true. Also, notably, many of them didn't agree with the statements that were actually true; only half of the residents knew that white patients are less likely to have heart disease than black patients are. When asked to read case studies of two patients complaining of pain, one white and one black, the respondents who had endorsed more false beliefs were more likely to believe that the black patient felt less pain, and undertreated them accordingly.

I know. I think they probably just want to see you performing the full load of a chief. It’s because they like you. Seriously.” I realized it was true: For the past few months, I had been acting merely as a surgical technician. I had been using cancer as an excuse not to take full responsibility for my patients. On the other hand, it was a good excuse, damn it. But now I started coming in earlier, staying later, fully caring for the patients again, adding another four hours to a twelve-hour day. It put the patients back in the center of my mind at all times. The first two days I thought I would have to quit, battling waves of nausea, pain, and fatigue, retreating to an unused bed in down moments to sleep. But by the third day, I had begun to enjoy it again, despite the wreck of my body. Reconnecting with patients brought back the meaning of this work. I took antiemetics and nonsteroidal anti-inflammatory drugs (NSAIDs) between cases and just before rounds. I was suffering, but I was fully back. Instead of finding an unused bed, I started resting on the junior residents’ couch, supervising them on the care of my patients, lecturing as I rode a wave of back spasms. The more tortured my body became, the more I relished having done the work. At the end of the first week, I slept for forty hours straight. But I was calling the shots:

The lowest level of this modifying intermediate network is the spinal cord. The cord still possesses many features that were first developed in the segmented earthworm. It is largely made up of neurons completely contained within it, which form bridges between the sensory and motor elements throughout the whole body. Each peripheral nerve trunk still innervates a specific segment of the body, and still joins the cord at a specific level, creating a ganglion. Sensory signals entering into a single segment may be processed by its own ganglion, and cause localized motor response within the segment; or the signals may pass to adjacent segments, or be carried even further up or down the line, involving more ganglia in a more widely distributed response. In this way, the cord can monitor a large number of sensorimotor reactions without having to send signals all the way up to the brain. Thus stereotyped responses can be made without our having to “think” about them on a conscious level. Most of these localized and segmentally patterned responses are not the result of experience or training, but of genetically consistent wiring patterns in the internuncial network of the cord itself. These basic wiring patterns unfold in the foetus during the “mapping” process of the nervous system, and they have been pre-established by millions of years of development and usage. The spinal cord can be surgically sectioned from the higher regions of the internuncial net, and the experimental animal kept alive, so that we can isolate the range of responses that are primarily controlled by these cord reflexes. Almost all segmentally localized responses can be elicited, such as the knee jerk caused by tapping the tendon below the knee cap, or the elbow jerk caused by tapping the bicep tendon. These simple responses can also be spread into other segments, so that a painful prick on a limb causes the whole body to jerk away in a general withdrawal reflex. The bladder and rectum can be evacuated. A skin irritation elicits scratching, and the disturbance can be accurately located with a paw. Some of the basic postural and locomotive reflex patterns seem to reside in the wiring of the cord as well. If an animal with only its cord intact is assisted in getting up, it can remain standing on its own. The sensory signals from the pressure on the bottoms of the feet are evidently enough to trigger postural contractions throughout the body and hold the animal in the stance typical of its species. And if the animal is suspended with its legs dangling down, they will spontaneously initiate walking or running movements, indicating that the fundamental sequential arrangements of the basic reflexes necessary for walking are in the cord also. All of these localized and intersegmental responses are rapid and automatic, follow specific routes through the spinal circuitry, and elicit stereotyped patterns of muscular response. Most of them appear to consistently use the same neurons, synapses, and motor units every time they are initiated.

The other was Atul Gawande , a surgical resident who I had gotten to know during his year at the Harvard School of Public Health . Atul later developed the surgical checklist for WHO and created Ariadne Labs, an influential collaboration of innovators, implementers, and healthcare leaders focused on quality and safety.

surgical resident with ever increasing responsibilities (the last year as Chief Resident), one was allowed to sit for the exam to

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Nearly every doctor I worked with dreamed as a child about curing disease and worked like crazy to become a doctor. They studied tirelessly to learn science, entered medical school with idealistic visions, and became the pride of their family. They entered residency with hundreds of thousands of dollars of student loan debt and initially saw the chronic sleep deprivation and verbal abuse by their superiors as integral parts of the experience—because “great achievement is born of great sacrifice.” But almost universally among doctors I have met, this idealism eventually turns to cynicism. My colleagues in residency talked often about questioning their sanity, of wondering whether this was all worth it. I spoke with successful surgeons who’d drafted their resignation letters dozens of times. Another had a recurring daydream of leaving everything behind and becoming a baker. Many of my supervising physicians were desperate to spend more time with their children. I witnessed more than one tearful breakdown in the operating room when surgical cases were delayed and led to yet another missed bedtime for their kids. Several had dealt with suicidal depression. I understood why doctors had the highest burnout and suicide rate of any profession. Inevitably, these conversations led to an insight that I believe is whispered by doctors in every hospital in America: they feel trapped inside a broken system.

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.

There was to be a six-year residency, quite literally. 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.

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

the hospital to tape it to the closed door of Dr. X’s office. I had signed it and on the way back to my bed I began to worry. What if I had done something really foolish? If the surgical resident didn’t care about such things, why should Dr. X? I was off call the next day and, exhausted, I spent most of the time asleep. When I returned to the hospital for the evening shift, the pediatric day resident told me that Immy was no better. For the next few hours I took care of whatever was most urgently needed on the service, but later in the evening I stopped by the Intensive Care Unit to examine Immy and speak with her family. I found her parents in the waiting room. Together we went to see Immy. She was still unconscious. Leaning over to listen to her chest, I suddenly noticed a medal pinned to her hospital gown. Turning 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.

[T]he definitional shift away from the medical/individual model makes room for new understandings of how best to solve the “problem” of disability. In the alternative perspective, which I call the political/relational model, the problem of disability no longer resides in the minds or bodies of individuals but in built environments and social patterns that exclude or stigmatize particular kinds of bodies, minds, and ways of being. For example, under the medical/individual model, wheelchair users suffer from impairments that restrict their mobility. These impairments are best addressed through medical interventions and cures; failing that, individuals must make the best of a bad situation, relying on friends and family members to negotiate inaccessible spaces for them. Under a political/relational model of disability, however, the problem of disability is located in inaccessible buildings, discriminatory attitudes, and ideological systems that attribute normalcy and deviance to particular minds and bodies. The problem of disability is solved not through medical intervention or surgical normalization but through social change and political transformation.

Through the lens of Bad Energy, this makes sense to me now: due to several changes in my lifestyle and stress levels as a new surgical resident, my brain cells likely did not have the power to provide me with the full spectrum of thought and emotion, nor the energy to want to keep going. There have been several reported associations between metabolic syndrome biomarkers and suicidal ideation,