Thursday, January 12, 2006

The underappreciation of the surgery resident

One of my personal new years resolutions was to start blogging more. Not really for any particular audience, but to at least keep personal tabs on my thoughts, emotions, and ideas at the time. Well, I already am starting behind on this resolution (let's not even start about the running everyday resolution) - I guess I'm always playing catch up.

These past few wees I've been rotating through a SF hospital to get some training in Transplant Surgery. Now I wanted to do transplant surgery when I started residency, but my relative wishes to be there for my wife and future chi clones (yes she refuses to let my genes be any part of it) have made it less probable. I now know why I can't do Transplant for long. To give a clue as to how my week starting last wednesday goes... I'll document it here.

Wednesday
Get called at 3AM to be in the OR by 430am for kidney/pancreas recipient operation (kidney transplanted INTO patient). Wake up, shower quickly drive 30 mins to hospital and go to OR where I'm told we have a second kidney/pancreas recipient operation. 16 hours later (yes each operation takes 8 hours), with no water or food, and completely tired legs, I stagger out of the hospital. OF course during the whole 16 hours I get berated by the head surgeons, whose idea of education comes from an Army Drill Sergeant's Basic Training manual I think. Its not that its inappropriate - I need to learn, but dammit do they need to yell at full volume and demean us surgical residents? For Christ sake's I'm 30 (which is young for surgery standards but still old compared to my friends).

Thursday
Luckily its a day off so to speak. I go to educational meetings/conferences in Oakland that start at 7am and last till Noon. But I need to read the rest of the night to prepare for our annual in training exam that lets us go on to the next year.

Friday
I get called 1AM in the morning - 4AM start time for a kidney transplant. Another 7 hours of an operation and more of that Officer and a Gentleman type of yelling (I need to make sure they get Louis Gossett Jr's kin for my life story). Again, no lunch, just a splash of water and I'm in a pancreatic tumor removal for the next 6 hours. I stagger home again, tired.

Saturday
I get called AGAIN at 1am int eh morning for a 7am start on a kidney transplant. I get there, and of course, noone tells me that it got delayed to 11am. So I go back home and come back later. I don't get out of the hospital till 5pm. I'm officially a little tired by now.

Sunday
Day off... but I get these horrific fevers and chills when I wake up... not a good sign at all. Of course at 1245AM (mind you, my wife wakes up everytime my crazy ass pager or cell phone goes off) I get a call to come by at 8am at the ambulance entrance to go on a donor run (meaning we get the organ's from the patient who is now brain dead and is an organ donor).

Monday
I wake up in horrible condition. My nose is stuffy, I have a horrible dry cough, and I have muscle aches all over. Not to mention that headache that feels like somebody stuck my head next to a Harley Davidson exhaust all night. I drug myself up with heavy prescription doeses of Ibuprofen. 8am I'm at the ambulance entrance and they pick me up. Oh yeah, did I mention, we're flying to Redding CA to pick these organs up? This doesn't bode well for my now climbing temperature which I last recorded at 100. We fly there and we need to wait for the lung team from Canada to come (organs go to different places depending on which patients need them - we're here to harvest the liver and kidney/pancreas, Stanford came to get the heart).

We start at 11am and finish by 5pm. We then get transported back to the learjet that took us there (which I'd never flew on before but damn those private jets are tiny) and now I'm in full shivering/feverish/coldish/achish mode. Not looking good for the home team at all.

Get home at 830pm and eat (I love my wife - she got me anything I wanted and took care of me all through this). And dive under a million blankets but can't warm up. I didn't get into bed until 10pm.... which sets me up for another call at ... you guessed it 2am in the morning. "Rich we have a kidney transplant starting at 3am...." My reply, "Hello, no speaka english? No really, I'm going to make it, but I feel horrible... I had a temp of 102 last night." No sympathy from the other end other than, "Well maybe you should just stay home." But I'm a stubborn son of a bitch, so I go anyways.

Tuesday
After answering the phone, I nearly fall over, completely sick, fatigued, and dizzy. I probably didn't drink enough fluids the night before. I get in the shower to wake me up and it just doesn't seem hot enough no matter how high I turn it. I get out, throw on some scrubs and head to the hospital. I think I only had enough energy to drive at theat point and the Butterfinger I always keep on hand for a quick boost of energy didn't do anything for me. I was nauseous. The entrance to the hospital is up a two story hill and I actually had to stop and rest halfway I couldn't make it up. Once I entered the hospital the security guard actually said that I looked sick and the ER was straight ahead... I told him no, I'm here to operate. To which he laughed. Thanks.

I struggle up to the OR and the attending and the PA are there, who immediately look at me and say nothing. Its like some unspoken rule that as a senior person, you can't tell someone to go home, you have to leave it up to them to stay or not. Because of my valor or stupidity, I wont' leave. I love operating. I scrub in and I proceed with the 6 hour operation, which I do well during simply running on pure adrenalin. Operating is an adrenalin rush that I can't compare with anything else. But when we're done, I nearly collapse. My knees are weak, my arms fall listless by my sides.

I get home and collapse on teh floor. I wake up 30 mintes later shivering and proceed to have a fever of 102-103 the rest of the day an night. Luckily no cases occurred ove rthe next few days and I've been able to stay at home and rest with what is now the flu.


In retrospect, I probably should have just stayed home. But in surgery, that's seen as weakness. Seriously. I've gotten IV fluids in the hospital before while I was sick just so I could do the work. Nobody will tell you, "You look and sound horrible you should go home." Well maybe a select few would - but they are few and far between. Moreover, the senior surgeons are so cynical, some actually think that residents would fake illness to not come in. Which, in my case, is entirely not true. I feel absolutely HORRIBLE about not being at the hospital and taking care of patients. Its my duty to be there for them and to learn from the senior surgeons.

But at some point, the senior surgeons should balance that innate desire of surgery residents with common sense. If they are a danger to themseleves (driving while being dizzy, nauseous, and lightheaded is not good) then no good can come of them being there and the senior surgeons should step in and tell them no.


I sometimes think that people don't realize the hardships surgeons face and overcome. They don't realize the work we put in, the pain we endure, and the sacrifices we make to provide the community with care. All they see is Dr. 90210 and a few documentaries here and there and stereotype that to all surgeons. They think that surgeons all live the glamorous life and that we roll in the dough. That's not true at all.

Surgeons are slowly losing pay in the bay area. Not to mention malpractice and loan repayment, their pay is woefully inadequate for what they do. Of course, someone will say, why should you complain, you'll be making 6 figures. Surprisingly some surgeons dont' anymore, for one. Second, who else trains for 13 years after college, making less than minimum wage for half that time, works 80-120 hours a week with no break, and endures the life or death stress that we do? Third, shouldn't society as a whole attract better doctors/surgeons by raising their wages? Or will we have what we have with schoolteachers, who perform an incredible societal function but get paid nothing? Finally, do you really want to underpay the person who may be your only option for savior down the line?

It strikes me as funny that some will completely revel in real estate agents' bankroll during the boom and yet look at doctors with disdain when they complain about money. Why is that? Will a real estate agent save your life? Isnt' what they do resolutely selfish? It sounds arrogant, but I save lives weekly - sometimes emergently sometimes over a longer time period. Yet, outside of my medicine friends, my wife, and Jimmy, no one expresses any appreciation for what I do or feels proud to know someone like me.

I just wish there was more support for doctors in this country. Not that we need it, but we're human too and we'd like just a little notice that someone out there is supporting us instead of looking to sue us for a quick buck. If not, we're going to lose the good talent and truly good people to other fields, and our healthcare will regress. Ugh, I need to get off my soapbox now... and go call the hospital to see if I need to come in.

2 Comments:

Anonymous Anonymous said...

What is underappreciated, underpaid, overworked and overtired? Well, that would be my husband, of course-- and his fellow residents. I may not be one myself, but my contribution to society is to ensure that my husband's altruistic nature and dedication to humanity aren't compromised by the large volume of ignorant buffoons who believe those shallow, uneducated, clerical-support-by-day-real-estate-dynamos-by-night are the standard they deem worthy. My husband's contribution to society will outlast his humble being-- the rest be damned.

10:28 PM  
Blogger Richard said...

Thanks you guys. Andy, I'll send an email out shortly.

6:52 PM  

Post a Comment

<< Home