Nonsurgical challenges in surgical training

Surgical cases dramatized in popular culture are loosely based on reality, but surgery is decidedly less glamorous on a daily basis. Saving lives from the brink of death is relatively infrequent; more often, it’s navigating barriers to modest attempts at improving quality of life. It’s a marathon that also happens to be a daily sprint.

Before embarking on my own surgery training, I mentally prepared myself for the long hours and expected demands of caring for sick surgical patients, but looking back, the lessons I remember most came from small, quiet, and often unexpected moments.

Why is surgery training so grueling? Aside from the obvious—taking care of the ill is challenging—many of the pressures arise from one of a few buckets:

(1) You don’t want to hurt anybody—but you also don’t want to look incompetent.

For a young doctor, these two are often in direct opposition. My first day as an intern, I was tasked with drawing a patient’s blood. I’d phlebotomized patients as a medical student and thought I was good at it, so I approached the patient confidently, explained what I was doing, and went for the vein.

No blood. I apologized, tried again, and missed again. I felt the anxiety rising inside, thinking, do I call my senior already? I’ve been an intern for two hours; I can’t admit defeat and look so helpless so soon. Do I continue to stab this poor patient (who, thankfully, truly was being patient with me and my failed attempts)?

Solution: humble yourself.

I could have called a senior at that moment, and probably should have. As I stood there struggling to decide, the patient care technician, who was a quiet older woman, approached with a fresh needle. Without a word she took the patient’s arm, swabbed it with an alcohol pad, and deftly hit the vein. The tube filled with blood, and she handed it to me. I was so shocked (and humbled) that I could barely say thank you. She nodded and went back to her work.

Despite being a doctor on paper, there was so much I didn’t know, and that encounter helped me realize that the sooner I started seeing barriers as opportunities to learn how to be a doctor, instead of trying to overcome them just to prove I was one, the sooner I would become a good doctor.

(2) Everything is urgent, and everything is (seemingly) important.

Knowledge of human pathophysiology and basic science seems laughably irrelevant when rounding on 30+ patients with your team, constantly running to catch up, frantically jotting down orders dictated by your seniors, mostly clerical: book this patient for urgent laparotomy. Repeat labs on bed 2. Make sure Mr. Tan gets orange jello instead of red so I don’t have to hear him complain about it. Don’t forget to document the abdominal exam.

Solution: prioritize.

It’s so easy to get overwhelmed. Sometimes you’re criticized no matter what, but in the grand scheme of things, missing the jello order is probably a smaller sin than not getting the sick patient to the OR. Figure out a method to capture your to-dos (write in a notebook, use a smartphone app, scrawl on your scrubs in pen), and prioritize. I would constantly construct and reorganize the Eisenhower matrix in my head throughout the day, mentally placing tasks in different quadrants, asking myself: is this urgent? Is it important?

(3) Training is physically and emotionally demanding, and sometimes you lose sight of why you chose it.

Nothing fully prepares you for this, and sometimes it feels like everything is against you. One night, I was called by the ER to see a toddler with a broken feeding tube. It was midnight, and I’d been in the hospital since 6 am, had maybe eaten crackers at some point, and couldn’t remember the last time I’d used the bathroom. Impatient and irritated since there were “real” overnight emergencies, (i.e. cases that would take me to the operating room), I quickly assessed the patient and found that part of the tube needed replacing. I tried temporizing it to allow the child to receive her feeds until the part could be replaced. I couldn’t. I called the operating room to see if they had the same type of tube. They didn’t.

Over the course of the next eight hours on call, between checking in on sick patients and seeing new consults, I tried to figure out a solution. I sneaked into the OR supply room myself to confirm the feeding tube component wasn’t there. I went to central supply, deep in the bowels of the hospital basement. No luck.

Solution: remind yourself.

At some point I realized there was one person whose night was worse than mine: the child’s mother. I’d spoken with her intermittently when giving her updates. She was alone raising a kid who couldn’t eat normally and probably never would. My frustration at trying to fix a broken feeding tube was a fraction of what she endured every day. Yet she appeared completely calm, and her compassion and understanding surpassed mine, when it should have been the other way around. Seeing how she dealt with the situation gracefully in the face of distress reminded me that as physicians, we always have and must offer compassion and empathy to our patients even when we can’t cure their disease or solve their surgical issues.

Performing surgery is only part of being a surgeon—you’re a doctor first, which often means wading through the weeds to take care of your patients.

One day as a senior resident, I was on my way to the OR when I saw the tech who’d helped me that first day. I thought about how much I’d learned in the years since then, and wanted to tell her I was still truly grateful for her help that day. Oddly, I also wanted her to be proud that I was about to scrub a complicated operative case when the last time we’d spoken I didn’t even know how to draw blood. And although she didn’t know it, I couldn’t have gotten to where I was without her, and all the other unexpected teachers I encountered over the course of my residency who taught me invaluable lessons and skills beyond the surgeons who trained me in the operating room.

Featured image credit: Surgery hospital doctor by sasint. Public Domain via Pixabay.