30 July 2010


One of my favorite patients, who has become a friend, just reminded me of something terribly important.

When we are medical students, interns, residents... we LOVE the adrenaline rushes. We love the interesting patients.. the "once in a lifetime"s... We want to see and experience all of the 'wows.' We trade stories, often elaborating and honing our emphasis on this or that, to make it sound that much more dramatic, we accentuate, we underline, we really lay it on--suddenly, there is blood everywhere, guts are flying, the nurses are frantic, and then we come in and save the day. Don't get me wrong. Sadly, it really is like that, sometimes. But as attendings, it's just our day-to-day... and not the pleasant part of day-to-day.

As an intern in Michigan, we didn't have the 80 hour work week. We worked often in 36 hour shifts, to go home and sleep (hell, who am I kidding, we didn't, actually, sleep--we partied and danced), to come back and do it all over again. We RAN to codes, to see interesting patients. We stayed much past those 36 hours often, to see a rare, or "cool" case, or even just to hang around, in case one came in.

For my surgical residency, I chose to come to New York, but not some posh little hospital. Nope, I went for the hell-hole, in the middle of a crime-ridden area, which farmed us out to other crime-ridden areas in every borough (save Staten Island) and Jersey. During my 3rd year (I think) the 80 hour work week came into effect. We were threatened by our superiors to lie on the forms, as NONE of us worked fewer than 100 hours/ week... although usually more, we lost track... and most of us (yours truly at the top of the list) didn't mind lying. How else would we see all of those funky, excellent cases?!

Hand fellowship--no different. But by this point, my philosophy changed a little. I did this in the South Bronx at a city hospital. Scary place, scary patients... a lot of unethical people (hospital personnel included)--exactly what I wanted--because I knew I would train here and see the worst of the worst so that I could handle anything... Even though I hoped I would never see it again.

When we come to our own as attendings, we really love boring. We don't want to see those one in a million cases. Don't get me wrong, we can handle it, because we are wired to do so--especially as surgeons, I think we are such adrenaline junkies that we LOVE those cases as much as we HATE them. We still boast to our colleagues, all the while praying to whoever our Gods are that we never have to face that again... and going to the hospital at all hours to check up on that patient. just in case.

My breast fellowship, I approached differently. Of course, this was after a few years "out in the field." I knew exactly what I wanted out of it, and I made sure that I got it. Yes, I did see some interesting cases, and yes, I made some mistakes. In the end, the attitude was "well, now I know how to handle it, and I really hope I never see it again." (By the way, in regards to my earlier post, I met a very successful plastic surgeon, who said that he had no less than 10--TEN!!--such cases in his first year. The candidacy and straighforwardness were almost more alarming than the fact.)

So now, when I hear that my patient... my friend... had an uneventful chemo day--after too many events, too much excitement (and not the pleasant kind) on this road of breast cancer diagnosis and treatment--I am no less than thrilled.

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