Monday, January 29, 2007

Shaka and Surgeons

I have read (though it may not be true) that Zulu fighting regiments killed their own wounded if they were no longer able to keep up with the relentless pace held by the impi. And relentless it was. Zulu regiments would cover 100 miles over three days of campaigning, with a large battle thrown in there somewhere. The point here though, is not military history. The point is, anyone who doubts this capacity to turn on one's own, those who have fought and endured beside you, has never sat in the surgery intern's call room in a large hospital while the occupants discoursed on their brethern.

It is often true in surgery programs than not everyone makes it. Many programs accept more interns than they intend to graduate, realizing that not everyone can hack it. This used to be institutionalized, with the programs stating up front that they would not allow all the interns to progress, turning the already stressful intern year into a competition between, say, eight hapless souls for five spots. Thankfully, this is now illegal, but still, surgery programs do not have a 100% graduation rate.

As the interns warmed to their subject, they became very specific, pointing out the faults or strengths they saw in their classmates who had dropped out, or even in the residents and staff ahead of them. Most of the faults were unsurprising, and it was fascinating to see how willing how willing these doctors were to forgive almost any fault in someone decisive and thick-skinned. Dr. Neversmile, for instance, came up and was "pretty damn talented" or "gotta respect him." Even my former chief resident, aptly decribed by one of the interns as having his "default set to hating people" was not castigated further, because he is a "solid surgeon." But one of their classmates who dropped out was described in language that was ridiculously over the top. I've never met the individual, so I can't speak to the truth of the calumnies, but as soon as they all agreed that this person was "not decisive" and "thin skinned" anything was fair game. (full disclosure, the single vulgar word used for "thin skinned" was one I am not real comfortable typing out.)

The strongest language denouncing another resident I heard in my residency of choice was "weak." Medicine is a very intellectual specialty, so there is a lot more emphasis on thinking than on action, but more essentially medicine docs are not as "cool" as surgeons. Now medical school isn't exactly a random sampling of spectators at TRL, but there are always people everyone wants to be around, people everyone else wants to be like, people for whom an easy atmosphere of hip collegiality comes naturally. The kind of guys who can do those complicated handshakes without thinking about them, or looking awkward. At least, so it appears. And most of these people seem to wind up as surgeons.

Medicine is like high school, and you've got all the groups. Surgeons: the cool kids. Ortho: the football team. Nephrologists: the chess club. Neurologists: the Dungeons and Dragons kids. Ob/Gyn: the stuck up cheerleaders.
- a surgery resident

So it makes sense, to my mind, anyway, that the qualities praised in internists are different than those praised in surgeons. And it also makes sense that those who don't quite fit in, who are a bit more self-conscious, don't last long in this environment.

Though I've managed to get along with the residents here, sharing musical tastes and movie quotes, it has been an effort. And I'll be glad to move on. Tomorrow is my last full day here, and I won't be sad. Despite the stories, and the atmosphere I've attempted to convey, I haven't learned a great deal. At least about neurology.


Jessica said...

I found my surgery rotation to be very malignant. The residents grew more hateful by the day, hoping that patients would die to get off the service, etc. I found it really made me a bitter person, and I picked up some foul language. I felt scared that the patients were not valued as human beings. I do not understand why that attitude must exist in surgery. I just wanted to say, "Just be nice."

Still loving your blog! Your writing style is excellent!

Nathan said...

Jessica - I found the same thing, and went through a lot of the same changes. That wasn't healthy for a variety of personal reasons. Thanks though, for reading, and for the compliment.

And I should mention, to all the budding surgeons and surgeon apologists who read this (zhoen, you know who you are :) ) I don't mean to be down on surgeons constantly. I do think that the stressful environment of surgery residency tends to bring out the worst in people, and though it may be true in all residencies, I haven't seen it in all hospitals. Maybe it's just famous ones that have this much pressure. I do know, from observation, that most residents mellow once they are out of residency, at least a bit.