Surgical Training Quotes

A trained surgeon is also a potential killer, and an important bit of the training lies in accepting the fact. Your intent is entirely benign - or at least you hope so - but your are laying violent hands on someone, and you must be ruthless in order to do it effectively. And sometimes the person under your hands will die, and knowing that . . . you do it anyway.

The thing about being barren is that you’re not allowed to get away from it. Not when you’re in your thirties. My friends were having children, friends of friends were having children, pregnancy and birth and first birthday parties were everywhere. I was asked about it all the time. My mother, our friends, colleagues at work. When was it going to be my turn? At some point our childlessness became an acceptable topic of Sunday-lunch conversation, not just between Tom and me, but more generally. What we were trying, what we should be doing, do you really think you should be having a second glass of wine? I was still young, there was still plenty of time, but failure cloaked me like a mantle, it overwhelmed me, dragged me under, and I gave up hope. At the time, I resented the fact that it was always seen as my fault, that I was the one letting the side down. But as the speed with which he managed to impregnate Anna demonstrates, there was never any problem with Tom’s virility. I was wrong to suggest that we should share the blame; it was all down to me. Lara, my best friend since university, had two children in two years: a boy first and then a girl. I didn’t like them. I didn’t want to hear anything about them. I didn’t want to be near them. Lara stopped speaking to me after a while. There was a girl at work who told me—casually, as though she were talking about an appendectomy or a wisdom-tooth extraction—that she’d recently had an abortion, a medical one, and it was so much less traumatic than the surgical one she’d had when she was at university. I couldn’t speak to her after that, I could barely look at her. Things became awkward in the office; people noticed. Tom didn’t feel the way I did. It wasn’t his failure, for starters, and in any case, he didn’t need a child like I did. He wanted to be a dad, he really did—I’m sure he daydreamed about kicking a football around in the garden with his son, or carrying his daughter on his shoulders in the park. But he thought our lives could be great without children, too. “We’re happy,” he used to say to me. “Why can’t we just go on being happy?” He became frustrated with me. He never understood that it’s possible to miss what you’ve never had, to mourn for it.

I was wearing my bathroom-cleaning costume of shorts, surgical boots, and gloves but no shirt. “Wow.” She stared at me for a few moments. “This is what martial arts training does, is it?” She appeared to be referring to my pectoral muscles.

Let me get this straight. You and I are in the Brotherhood's mobile surgical van, on our way to the training center because you were shot and now have a tube in your head to reduce brain swelling...and you're coming on to me?" "My gray matter isn't the only thing getting bigger." "You're like the indestructible slut, aren't you." "You know, to most people, slut is an insult." He tried to lift his had to make the point. And failed. "I personally take it as a compliment. Shows commitment to my work.

Surgical Talk As we look at the insides of humans, We find the inside of ourselves And each other. What lies beneath us? What do we believe About the world and our place in it? We cut down layer upon layer And dissect the inner life.

McKusick's belief in this paradigm-the focus on disability rather than abnormalcy-was actualized in the treatment of patients in his clinic. Patients with dwarfism, for instance, were treated by an interdisciplinary team of genetic counselors, neurologists, orthopedic surgeons, nurses, and psychiatrists trained to focus on specific disabilities of persons with short stature. Surgical interventions were reserved to correct specific deformities as they arose. The goal was not to restore "normalcy"-but vitality, joy, and function. McKusic had rediscovered the founding principles of modern genetics in the realm of human pathology. In humans as in wild flies, genetic variations abounded. Here too genetic variants, environments, and gene-environment interactions ultimately collaborated to cause phenotypes-except in this case, the "phenotype" in question was disease. Here too some genes had partial penetrance and widely variable expressivity. One gene could cause many diseases, and one disease could be caused by many genes. And here too "fitness" could not be judged in absolutes. Rather the lack of fitness-illness [italicized, sic] in colloquial terms- was defined by the relative mismatch between an organism and environment.

Righteous anger invites change. It can envision what the other might look like if the arrogance controlling the heart was pierced. Anger is a surgical weapon, designed to destroy ugliness and restore beauty. In the hands of one who is trained in love and who can envision beauty, the knife of righteous anger is a weapon for restoration.

Bach-y-Rita developed a program for people with damaged facial motor nerves, who could not move their facial muscles and so couldn’t close their eyes, speak properly, or express emotion, making them look like monstrous automatons. Bach-y-Rita had one of the “extra” nerves that normally goes to the tongue surgically attached to a patient’s facial muscles. Then he developed a program of brain exercises to train the “tongue nerve” (and particularly the part of the brain that controls it) to act like a facial nerve. These patients learned to express normal facial emotions, speak, and close their eyes—one more instance of Bach-y-Rita’s ability to “connect anything to anything.

The most extraordinary story of appendectomy survival that I know of occurred aboard the U.S. submarine Seadragon in Japanese-controlled waters in the South China Sea during World War II when a sailor named Dean Rector from Kansas developed an acute and obvious case of appendicitis. With no qualified medical personnel on board, the commander ordered the ship’s pharmacist’s assistant, one Wheeler Bryson Lipes (of no known relation to the present author), to perform the surgery. Lipes protested that he had no medical training, did not know what an appendix looked like or where it was to be found, and had no surgical equipment to work with. The commander instructed him to do what he could anyway as the senior medical person aboard. Lipes’s bedside manner was not perhaps the most reassuring. His pep talk to Rector was this: “Look, Dean, I never did anything like this before, but you don’t have much chance

The thing about being barren is that you're not allowed to get away from it. Not when you're in your thirties. My friends were having children, friends of friends were having children, pregnancy and birth and first birthday parties were everywhere. I was asked about it all the time. My mother, our friends, colleagues at work. When was it going to be my turn? At some point our childlessness became an acceptable topic of Sunday-lunch conversation, not just between Tom and me, but more generally. What we were trying, what we should be doing, do you really think you should be having a second glass of wine? I was still young, there was still plenty of time, but failure cloaked me like a mantle, it overwhelmed me, dragged me under, and I gave up hope. At the time, I resented the fact that it was always seen as my fault, that I was the one letting the side down. But as the speed with which he managed to impregnate Anna demonstrates, there was never any problem with Tom’s virility. I was wrong to suggest that we should share the blame; it was all down to me. Lara, my best friend since university, had two children in two years: a boy first and then a girl. I didn’t like them. I didn’t want to hear anything about them. I didn’t want to be near them. Lara stopped speaking to me after a while. There was a girl at work who told me—casually, as though she were talking about an appendectomy or a wisdom-tooth extraction—that she’d recently had an abortion, a medical one, and it was so much less traumatic than the surgical one she’d had when she was at university. I couldn’t speak to her after that, I could barely look at her. Things became awkward in the office; people noticed. Tom didn’t feel the way I did. It wasn’t his failure, for starters, and in any case, he didn’t need a child like I did. He wanted to be a dad, he really did—I’m sure he daydreamed about kicking a football around in the garden with his son, or carrying his daughter on his shoulders in the park. But he thought our lives could be great without children, too. “We’re happy,” he used to say to me. “Why can’t we just go on being happy?” He became frustrated with me. He never understood that it’s possible to miss what you’ve never had, to mourn for it.

Give us an idea of…” Noya Baram rubs her temples. “Oh, well.” Augie begins to stroll around again. “The examples are limitless. Small examples: elevators stop working. Grocery-store scanners. Train and bus passes. Televisions. Phones. Radios. Traffic lights. Credit-card scanners. Home alarm systems. Laptop computers will lose all their software, all files, everything erased. Your computer will be nothing but a keyboard and a blank screen. “Electricity would be severely compromised. Which means refrigerators. In some cases, heat. Water—well, we have already seen the effect on water-purification plants. Clean water in America will quickly become a scarcity. “That means health problems on a massive scale. Who will care for the sick? Hospitals? Will they have the necessary resources to treat you? Surgical operations these days are highly computerized. And they will not have access to any of your prior medical records online. “For that matter, will they treat you at all? Do you have health insurance? Says who? A card in your pocket? They won’t be able to look you up and confirm it. Nor will they be able to seek reimbursement from the insurer. And even if they could get in contact with the insurance company, the insurance company won’t know whether you’re its customer. Does it have handwritten lists of its policyholders? No. It’s all on computers. Computers that have been erased. Will the hospitals work for free? “No websites, of course. No e-commerce. Conveyor belts. Sophisticated machinery inside manufacturing plants. Payroll records. “Planes will be grounded. Even trains may not operate in most places. Cars, at least any built since, oh, 2010 or so, will be affected. “Legal records. Welfare records. Law enforcement databases. The ability of local police to identify criminals, to coordinate with other states and the federal government through databases—no more. “Bank records. You think you have ten thousand dollars in your savings account? Fifty thousand dollars in a retirement account? You think you have a pension that allows you to receive a fixed payment every month?” He shakes his head. “Not if computer files and their backups are erased. Do banks have a large wad of cash, wrapped in a rubber band with your name on it, sitting in a vault somewhere? Of course not. It’s all data.” “Mother of God,” says Chancellor Richter, wiping his face with a handkerchief.

Lowry found himself writing letters to strangers at academic institutions that would begin like this: “Dear Dr. Brender: We spoke on the phone several months ago about ‘fist-fucking.’ At that time you mentioned two surgical articles.” There was no academic term, so eventually Lowry made one up. “I Googled it recently,” he told me, “and found over 2,000 hits. Made me chuckle.” † Simon refined his technique on cadavers, rupturing a bowel or two along the way, and then began offering training seminars. Cadavers were replaced with live, chloroformed women, thighs flexed on their abdomens. “A large number of professors and physicians” flew all the way to Heidelberg to practice “the forcible entrance.

In the story, Ivan Ilyich is forty-five years old, a midlevel Saint Petersburg magistrate whose life revolves mostly around petty concerns of social status. One day, he falls off a stepladder and develops a pain in his side. Instead of abating, the pain gets worse, and he becomes unable to work. Formerly an “intelligent, polished, lively and agreeable man,” he grows depressed and enfeebled. Friends and colleagues avoid him. His wife calls in a series of ever more expensive doctors. None of them can agree on a diagnosis, and the remedies they give him accomplish nothing. For Ilyich, it is all torture, and he simmers and rages at his situation. “What tormented Ivan Ilyich most,” Tolstoy writes, “was the deception, the lie, which for some reason they all accepted, that he was not dying but was simply ill, and he only need keep quiet and undergo a treatment and then something very good would result.” Ivan Ilyich has flashes of hope that maybe things will turn around, but as he grows weaker and more emaciated he knows what is happening. He lives in mounting anguish and fear of death. But death is not a subject that his doctors, friends, or family can countenance. That is what causes him his most profound pain. “No one pitied him as he wished to be pitied,” writes Tolstoy. “At certain moments after prolonged suffering he wished most of all (though he would have been ashamed to confess it) for someone to pity him as a sick child is pitied. He longed to be petted and comforted. He knew he was an important functionary, that he had a beard turning grey, and that therefore what he longed for was impossible, but still he longed for it.” As we medical students saw it, the failure of those around Ivan Ilyich to offer comfort or to acknowledge what is happening to him was a failure of character and culture. The late-nineteenth-century Russia of Tolstoy’s story seemed harsh and almost primitive to us. Just as we believed that modern medicine could probably have cured Ivan Ilyich of whatever disease he had, so too we took for granted that honesty and kindness were basic responsibilities of a modern doctor. We were confident that in such a situation we would act compassionately. What worried us was knowledge. While we knew how to sympathize, we weren’t at all certain we would know how to properly diagnose and treat. We paid our medical tuition to learn about the inner process of the body, the intricate mechanisms of its pathologies, and the vast trove of discoveries and technologies that have accumulated to stop them. We didn’t imagine we needed to think about much else. So we put Ivan Ilyich out of our heads. Yet within a few years, when I came to experience surgical training and practice, I encountered patients forced to confront the realities of decline and mortality, and it did not take long to realize how unready I was to help them. *   *   *

He believed that surgical intervention into the brain to treat psychological disorders did not require the extensive surgical training that neurosurgeons spent years acquiring. Though

Teamwork may just be hard in certain lines of work. Under conditions of extreme complexity, we inevitably rely on a division of tasks and expertise—in the operating room, for example, there is the surgeon, the surgical assistant, the scrub nurse, the circulating nurse, the anesthesiologist, and so on. They can each be technical masters at what they do. That’s what we train them to be, and that alone can take years. But the evidence suggests we need them to see their job not just as performing their isolated set of tasks well but also as helping the group get the best possible results. This requires finding a way to ensure that the group lets nothing fall between the cracks and also adapts as a team to whatever problems might arise.

extends from the region

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.

Where regular forces provide martial muscle, the special forces are surgical and skilled, trained to be “the most potent weapons one can use”: Attacking the means of production and communication—disabling factories that made the machines that fought the war, annihilating the ability to communicate troop movements over distances—was the most advanced thinking in military planning.

LACKLAND AIR FORCE BASE sits just southeast of the U.S. Route 90 and Interstate 410 interchange, in the dead center of San Antonio, a city better known for its River Walk and Mexican food. It is bisected by Route 13 and its Gateway Hills Golf Course occupies a significant portion of the property. It is home to one of the largest Air Force training facilities in the United States and hosts the Wilford Hall Ambulatory Surgical Center, one of the country’s four major referral centers for advanced medical care. In more recent years, Lackland had become part of Joint Base San Antonio, home to the 16th Air Force.

Bandages and Supplies 50 assorted-size adhesive bandages 1 large trauma dressing 20 sterile dressings, 4x4 inch 20 sterile dressings, 3x3 inch 20 sterile dressings, 2x2 inch 1 roll of waterproof adhesive tape (10 yards x 1 inch) 2 rolls self-adhesive wrap, 1/2 inch 2 rolls self-adhesive wrap, 1 inch 2 rolls self-adhesive wrap, 2 inch » 1 elastic bandage, 3 inch » 1 elastic bandage, 4 inch » 2 triangular cloth bandages » 10 butterfly bandages » 2 eye pads Medications 2 to 4 blood-clotting agents 10 antibiotic ointment packets (approximately 1 gram) 1 tube of hydrocortisone ointment 1 tube of antibiotic ointment 1 tube of burn cream 1 bottle of eye wash 1 bottle of antacid 1 bottle syrup of ipecac (for poisoning) 1 bottle of activated charcoal (for poisoning) 25 antiseptic wipe packets 2 bottles of aspirin or other pain reliever (100 count) 2 to 4 large instant cold compresses 2 to 4 small instant cold packs 1 tube of instant glucose (for diabetics) Equipment 10 pairs of large latex or nonlatex gloves 1 space blanket or rescue blanket 1 pair of chemical goggles 10 N95 dust/mist respirators or medical masks 1 oral thermometer (nonmercury/nonglass) 1 pair of splinter forceps 1 pair of medical scissors 1 magnifying glass 2 large SAM Splints (optional) 1 tourniquet Assorted safety pins Optional Items If Trained to Use 1 CPR mask 1 bag valve mask 1 adjustable cervical spine collar 1 blood pressure cuff and stethoscope or blood pressure device 1 set of disposable oral airways 1 oxygen tank with regulator and non-rebreather mask Suturing kit and sutures Surgical or super glue If you have advanced training, such items as a suturing kit, IV setup, and medical instruments may be added.

The issue I have with the current discussions about the Metaverse is that the conventional wisdom narrows the focus on the Metaverse to the next increment to social media or the next step beyond a Zoom call. Where's the vision? Think beyond. When Boeing leverages a digital twin for airplane design/modelling, is that a form of the Metaverse? How about Da Vinci which is a robotic surgical system? Have you ever been on Flight of Passage at Disneyworld? Shouldn’t AI training (like for autonomous cars) be more like the Metaverse? Conventional wisdom might say no, those are not Metaverse. I say, forget conventional wisdom and forget the social media/office use case for Metaverse. The use cases are there to extract value from the current state of Metaverse technology, but they are not within the scope of the current conversations.

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I’m Jay Powers, the circulating nurse”; “I’m Zhi Xiong, the anesthesiologist”—that sort of thing. It felt kind of hokey to me, and I wondered how much difference this step could really make. But it turned out to have been carefully devised. There have been psychology studies in various fields backing up what should have been self-evident—people who don’t know one another’s names don’t work together nearly as well as those who do. And Brian Sexton, the Johns Hopkins psychologist, had done studies showing the same in operating rooms. In one, he and his research team buttonholed surgical staff members outside their operating rooms and asked them two questions: how would they rate the level of communications during the operation they had just finished and what were the names of the other staff members on the team? The researchers learned that about half the time the staff did not know one another’s names. When they did, however, the communications ratings jumped significantly. The investigators at Johns Hopkins and elsewhere had also observed that when nurses were given a chance to say their names and mention concerns at the beginning of a case, they were more likely to note problems and offer solutions. The researchers called it an “activation phenomenon.” Giving people a chance to say something at the start seemed to activate their sense of participation and responsibility and their willingness to speak up. These were limited studies and hardly definitive. But the initial results were enticing. Nothing had ever been shown to improve the ability of surgeons to broadly reduce harm to patients aside from experience and specialized training. Yet here, in three separate cities, teams had tried out these unusual checklists, and each had found a positive effect. At Johns Hopkins, researchers specifically measured their checklist’s effect on teamwork. Eleven surgeons had agreed to try it in their cases—seven general surgeons, two plastic surgeons, and two neurosurgeons. After three months, the number of team members in their operations reporting that they “functioned as a well-coordinated team” leapt from 68 percent to 92 percent. At the Kaiser hospitals in Southern California, researchers had tested their checklist for six months in thirty-five hundred operations. During that time, they found that their staff’s average rating of the teamwork climate improved from “good” to “outstanding.” Employee satisfaction rose 19 percent. The rate of OR nurse turnover—the proportion leaving their jobs each year—dropped from 23 percent to 7 percent. And the checklist appeared to have caught numerous near errors. In

been designed to research the spread of the Spanish flu. Comparing that disease with YARS was a fascinating exercise, as was comparing the world it devastated to the one that existed today. The very name “Spanish flu” was just another lie foisted on the world by America. The truth was that the disease had first taken hold in Kansas City military outposts. It killed more U.S. troops during World War I than combat, spreading easily in the cramped conditions that prevailed on ships, battlegrounds, and bases. The initial reaction of the medical community had been slowed by its focus on the war, but when the scope of the threat was recognized, the country had pulled together. Surgical masks were worn in public to slow the spread of the disease. Stores were prohibited from having sales to prevent the congregation of people in confined spaces. Some cities demanded that passengers’ health be certified before they boarded trains. There was no denying that the United States and its citizens had been strong in the early twentieth century—accustomed to death and hardship, led by competent politicians, and informed by an honest press. So much had changed in the last century. The American people were now inexplicably suspicious of modern medicine and susceptible to nonsensical conspiracy theories. They were selfish and self-absorbed, willing to prioritize their own trivial desires over the lives of their countrymen. Their medical system, designed less to heal people than to generate profits, would quickly collapse as it was flooded by desperate patients and abandoned by personnel fearful of being infected. And during all this, America’s politicians and media would use the burgeoning epidemic to augment their own power and wealth. That is, until the magnitude of the crisis became clear. Then they would flee. The sound of a truck engine pulled him from his contemplation and he turned. His people, disinfected and wearing clean clothing, climbed into the vehicle and set off into the darkness. Halabi bowed respectfully in their direction, acknowledging their sacrifice and the enormity of the journey ahead of them. After the long drive to Mogadishu, they would board a private jet that would take them to Mexico. From there they would be smuggled across the northern border.

The Japanese invasion of Manchuria in 1931 triggered a renewal of forces in Hawaiʻi. This happened again when the Empire of Japan waged an undeclared war against China in 1937. Signs of impending war with Japan were looming, and all sorts of pressures were building up to an eventual outbreak of conflict. Such pressures would be materially reflected in the lives of Hawaiians as well, including annual blackout drills and exercises for Hawaiian civilians in Honolulu. Civil defense units and outposts began to spring up in rural areas and surrounding military installations. Further, emergency disaster preparations began in 1940, with Honolulu women being tasked with surgical dressing and wound bandage production. There were also first-aid training sessions held by the local Red Cross. Honolulu saw the establishment of a blood bank, and the city’s Schofield Barracks would grow to become one of the largest US Army installations in the world, hosting and fielding over forty thousand troops by 1941. The primary objective of such a large force was to hold and defend Pearl Harbor and, by extension, Hawaiʻi from Japanese raiders and invaders. Incidents like the bombing of the SS President Hoover, the flagship Augusta, and the sinking of the USS Panay were strong indicators that Hawaiʻi was going to be sandwiched between two political and military bulldozers.

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.

After this meeting, she was heading straight to the closest Victoria Secret and buying them out of thongs—lacy ones that probably itched and would take a highly trained surgical staff to remove.

What remained of that Baghdad, I wondered? The Baghdad of fountains of knowledge. The Baghdad at the centre, the fulcrum of a globalized culture that went on to humanize Europe: the Baghdad that taught Europe the distinction between civil society and barbarism, the difference between medicine and magic, and the importance of experimental method; the Baghdad that trained the West in scholastic and philosophic method, drilled it in making surgical instruments, told it how to establish and run hospitals and provided it with the model of a university complete with curriculum and syllabus, terminology and administrative structure; the Baghdad that schooled Europe in the importance of biography, the novella, the history of cities and historical and textual criticism. In short, the Baghdad that gave Europe its most prized possession: liberal humanism. By what intellectual conjuring trick had Europe self-servingly made the reality of its cultural debt disappear into a fairy-tale dream of Sinbad, Aladdin, harem ladies in diaphanous veils, the subject matter of pantomime and other such dissembling misrepresentations?

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.

There is a significant lack of evidence that cross-sex hormones and surgical procedures, such as mastectomies, that attempt to chemically and cosmetically alter biological sex are effective solutions to young women’s difficulties. Transgender medicalization is an experiment that might have dire consequences on the future of our children and society.

Dear Mom and Dad, I am training to be a surgical nurse now. I want to be good at this more than I’ve ever wanted anything. It’s a good feeling to love what you do.