As I hold up the skin hooks against the rising smell of cautery on flesh, the conversation shifts to the surgeon’s work in student wellness. Three days a month, he counsels medical students in careers, academics, addictions, and legal troubles.
“You’d be amazed,” he says, hearing of my interest in psychiatry just minutes prior, “at the issues that come up in a confidential session.” He adds that while he has no formal training in counselling, he is enjoying this added dimension to his practice.
Trying to be encouraging, I reply, “As long as students have someone to talk to. Sometimes having formal training isn’t important.”
“What, you mean like psychiatry?” He winks. I smile from under my surgical mask, complicit in the joke.
For a moment, I am disoriented standing there retracting the patient’s dissected neck. Each day I do things that from the point of view of anyone not in health care would be extraordinary. I do things that I’m still trying to make sense of, like operating a laprascopic camera in a body cavity, or figuring out what I should worry about in a 92 year old woman with increasing shortness of breath. I have some amazing teachers who are invested in my learning, and some who are not. If a patient presents with X, we should investigate A B C, and offer them Y or Z. This is part of medicine’s internal logic. When reading a novel, casting a spell doesn’t seem that out of the blue after you’ve accepted the laws of a magical universe. Similarly, the extraordinary become every day as I internalize medicine’s inherent logic. People come into hospital with a sense of wonder and an expectation of healing. In hospital, I see health care providers doing their best. It’s not magic, but I’m trying to hold on to that sense of wonder in the cascade of cognitive overload that is medical training. Only on the occasion that I take a step back, exhale, can I catch a glimpse of myself in this transition from student to doctor.
I’m learning to stand straighter bearing the weight of other people’s lives.
What I’m also learning is the hidden curriculum: the ugly biases that physicians hold, despite good intentions. The most jarring conversations come from the people I respect the most. Jarring as they may be, they also provide insight into how I can do better and how physicians can be kinder to one another.
“Family doctors always have another doctor to back them up when things go south. Send them to emergency. A consult is just a phone call away. Emily, you know who I’m going to call when the shit hits the fan? Myself.” Dr. Carf begins a mock telephone call with himself.
“What are you going to do? I don’t know. What am I going to do? Shitshitshit.”
I put a deep suture into one incision while Dr. Carf is closing another. I didn’t take a big enough bite so the wound edges don’t come together as neatly as I hoped. I’ve watched dozens of deep sutures being tied, but somehow I can’t replicate it. Dr. Carf takes one look at my flimsy suture, snips it off, and takes over, closing rapidly.
Although I do not agree with everything that Dr. Carf said, the lesson on self-reliance is not lost on me. Imagining myself as the last line is a daunting future. However, I do think family physicians have their own challenges. They are the ones taking care of the needs of thousands of patients so that physicians like Dr. Carf are not getting a thousand phone calls.
A resident once told me that the purpose of a Form 1 lasting 72 hours was so that psychiatrists could get their beauty sleep before going in to assess the patient. This resident was a great teacher, all the more reason I find these conversations so jarring.
The next case we do is another ACL reconstruction. I’m getting better at anticipating the sequence of events and the rationale behind each step. Dr. Carf hands me the hammer and drill at several points.
“Isn’t this great? Being in the OR. You’re doing stuff. You’re suturing. Look how fun this is. And you still want to do psychiatry?”
“…It’s true I am learning a lot.” I lapse into silence, not sure of what to say.
“I don’t care if you’re learning. I only care if this is what you want to do for the rest of your life.” Dr. Carf declares in mock pain, half serious.
When it comes time to close, I take a generous bite with my suture, just like all the times I’ve seen the residents do it. This time, the wound edges meet neatly. I put in three more and then a subcuticular stitch. Dr. Carf is happy and he scrubs out.
In a spasm of indecision, I thought about publishing this series a) after I graduated or b) anonymously. There is something imperative about telling the story now, and that I take responsibility for its telling. Thank you to the colleagues who read and critiqued my drafts. To protect confidentiality I have altered identifying details. All names have been changed, but people are more than their story and any error or misrepresentation is my own.