Urp! There are no permalinks on this blog [Incidental Findings] but I read the entry for Wednesday 06/25/2003.

Is there just something inherent about the end of third year? That burn-out is inescapable? I remember the prophetic words of an ER intern I worked with during my trauma rotation at the beginning of the year: "I remember when I was a 3rd year, I loved every rotation and I wanted to do everything. But by the time I was a 4th year, I didn't want to do anything. I would've been happy to just bail out of medicine entirely if not for the fact that I had massive loans to pay off."

Yeah, now, given some perspective, I understand that there is something dehumanizing about the experience. The stereotype of a surgeon is for the most part antithetical to the stereotype of an internist. During my surgery rotation at the beginning of the year, it wasn't so much what we did to the patients that cause my soul to roil. It was really what we (i.e., collectively all the MDs and MDs-to-be) did to each other that filled me with outrage. This rotation is really what sparked me to formulate a lot of the rules I've been making up. Because of the goddamned gunners. Because of the evil residents. Because of the tacit permission to treat each other like absolute crap, because, goddamnit, this was surgery, and you'd best just suck it up.

For lack of a better target, though, I like to blame the evil OBGYN resident for crushing my soul. (She is, horror of horrors, now an evil attending. May God have mercy on her patients' souls.) From a purely chronological perspective, it seems that all my troubles seem to start when I first met her. The evil surgery residents I encountered last July have nothing on her. She would cause even them to wither.

I am not going to be a surgeon. Despite the fact that I got a good eval from that rotation (which doesn't necessarily mean much, as our faculty has a reputation for massive grade inflation). Despite the fact that for some sick, inexplicable reason, I love the OR. I don't know what it is. Maybe it's only because I find the constant beeping of the monitors relaxing. (Although, despite the beeping monitors, the ER and the MICU did nothing to soothe my soul.) Maybe it's the ritualism of scrubbing in, the formal way the surgeon requests instruments from the scrub nurse, the somewhat universal routines involved in bringing a patient in and then taking them out. Despite the mental instability and borderline personalities of many surgeons, even when they are completely freaking out, there is something sacred that holds all but the most psychotic instrument-throwing wackos. Maybe it's the fact that it's a completely controlled environment, that even when someone is hemorrhaging blood a liter at a time from a liver laceration and the probability that they are going to die is extraordinarily high, even then, there is a contingency plan. (The Pringle manuever, the Shrock shunt, all sorts of madness.) Even in the bleakest, most horrific hour, someone has a plan. Even when there's a 98% chance of failure, at least you can always try something. (And as an aside, how many other people find it relaxing and enjoyable when someone finds the right tissue plane, and the serosa practically just slides off of your target?)

But I am not going to be a surgeon. For one thing, it would absolutely kill me. To be in the hospital nearly all of your waking hours. To deal with psychotic instrument-throwing wacko attendings and chief residents. To have people die under your knife. To watch a 23 year old guy lie there for days on end in a hopeless coma after some massive trauma. It struck me that (well, maybe it was the hospital that I was at) most of the residents were unhappy most of the time. The only time they were truly happy was when they were in the OR, and realistically, you are in the OR for only a fraction of the time. The rest of the time you are performing your scut-monkey duties or, God-forbid, you might actually have to practice a little medicine.

Still. There is something inside of me that is a little attracted to self-destruction, making me feel an affinity to this field precisely because I know that it will kill me. (As I've mentioned, a psychiatrist told me that physicians as a group have a life expectancy 12 years shorter than the average person. I wouldn't be surprised if this is even lower for surgeons.) Thank God I have very poor manual dexterity. (I think that I have benign essential tremor.) Otherwise the decision would've been harder. In any case, the residents had me pegged for an internist from day one.

Shit. Maybe I'm just attracted to the fact that if I became a surgeon, then it would be all right for me, no, expected of me, to have a God complex.