It’s because you’re a woman

“It’s because you’re a woman, you know.”

I looked to my left where the commentary came from.  She gave me a sideways glance, barely breaking her stare with the computer screen.  She was beautiful, but you could tell she styled herself in earnest to downplay that beauty.  She had a slightly harsh face, but one that didn’t start out that way and developed over time.  Eventually, she grew to accept that hardness as comfortable and normal.  Her hair was slicked back in a low bun, slightly on the severe side.  She wore make up, but never enough to distract from greyish-white muted walls of the hospital surrounding her.  It was as if she tried to make herself blend into her surroundings.

She was a trauma surgeon in the hospital I worked at, and she just witnessed my interaction with the anesthesiologist and board runner for the day.

“You think you can operate with that small brain up there?” he coyly said to me.  I was trying to book an urgent case and this guy thought it would be sport to give me a hard time.

I smiled sweetly through gritted teeth. “Oh that’s right, it’s an extra effort for me with this teensy tiny little brain I have, but somehow, we women muddle through operating.”

I forced the booking slip into his hand.  He looked me up and down.  “Well, on account of you being so special, I’ll make sure you get an operating room, sweetheart.”

“Aw, why thanks, I won’t forget the favor.”  I hated myself for being so complacent.

The woman at the computer witnessed the entire exchange.  She came from a different era of training, one that was by all accounts more grueling than my own.  But the subtle, or sometimes not so subtle, tones of misogyny and sexism still run rampant.   I saw the way this trauma surgeon carried herself around the hospital.  Once, I saw her perform a thoracotomy on a trauma patient in the emergency room, place a central line, and roll him to the operating room in under five minutes.  There was nothing complacent about her.

I was mortified she was privy to this encounter.  I lowered my eyes and dashed out of the room in embarrassment.

Within the walls of the hospital, the masculinity of medicine is palpable.  Look no further than the walls of pictures of former program graduates or the rows of male professors to feel it.   I sometimes counted the women’s faces in the lineup of black and white portraits as I walked past, hoping I missed one or two the last time I looked.  But the number was the same every time; just six women graduated in 35 years.

It is no secret that surgery is a male-dominated specialty, but the additional pressure on women choosing this field to not be “weaker than” male counterparts is difficult to explain.  I often felt frustrated by the language used towards female surgery trainees, especially surrounding family planning or when a woman even remotely looked she may cry.  I swore I would work my hardest not to be seen any different than my male training counterparts.  I worried about showing emotion or that my thinly veiled defenses would not cover up that I was deeply affected by my work.  I worried that I would be deemed too “soft” to be a surgeon by my teachers.  Reinforcing this behavior, masculine qualities are subtly praised consistently throughout training.  The environment is one where you put your head down, do the work, and above all, do not let your feelings get in the way.

Living in surgical culture, this all boils down to an overwhelming feeling of needing to be masculine enough for the men, feminine enough for the women, and an expert at both to survive.

I escaped my mortifying encounter with the anesthesiologist to the women’s locker room, the one place I could think to hide.  I walked to the sink and splashed cold water on my face, trying to snap out of that moment.  I caught my reflection in the mirror and it made me pause.  I examined my face closely.  My brow was furrowed; I didn’t remember that deep line of concern being there.  It was permeant now though, a deep, settled line that would always remind me of what I had seen.  I didn’t recognize this version of myself.  The woman in the mirror was hardened and more masculine than I ever remembered.

I was happy to leave the hospital that night and desperately wanted to do something to feel like my old self again.  I was exhausted, but had plans to go for a drink with friends.  I ran home, showered, put on some make up and the prettiest dress I could find, and stepped out into the crisp winter air.

My friends were sitting at the bar when I got there.  As I walked up, a man sitting next to them turned around, caught a glance of me in my pretty dress, and flashed a smile.  I flashed one back and he turned all the way around to engage in conversation.  We started with a little banter back and forth.  He seemed witty and relatively cute.  I could see in his eyes he was interested and entertained by my sarcastic tones.  Then, the conversation turned in the usual fashion to basic life topics, such as our occupations.

“So, what do you do?” he asked.

“Oh, I work in the medical field.”  The conversation went the same way every time, and I hated this part.

“Cool! Are you a nurse?”

“No, actually I’m a doctor.”  My tone was that of an apology, as if I had to apologize for my professional ambition and diminish it to still be seen as attractive to a man.

“Really?  What kind?”

“I’m a surgeon.”

“Really?  No way!” he said incredulously.  I knew what to expect from here.

“Yes, really.” I forced a smirk.

“Ha ha, hey guys!  She says she’s a surgeon,” he said over his shoulder to his buddies.  They all laughed out loud.

He turned back towards me and as we made eye contact, he noted my stern demeanor.  His face sunk as he realized…I was actually serious.

“Oh…” I watched as that flicker of interest and intrigue in his eyes disappeared.

“Yes. Oh.” I said flatly, turning away from him and back to my friends.

I was curious what image he had floating in his mind that lined up to the word “surgeon” that I, sitting there in my dress, was so contradictory to.   I talked and laughed with my friends the rest of the night and tried to not give it a second thought.

The next day I was back at the grind at 5:30 AM.  Coffee, rounds, more coffee, and a lineup of cases in the operating room.  The service was busy, and after the events of the day before, I welcomed the distraction of bouncing from one task to the next.  I almost forgot the combination of mortification of the anesthesiologist and would-be suitor by mid-morning.  That is, until I walked around a corner and ran face first into the badass female trauma surgeon.  She looked the perfect combination of put together and stern, as usual.

“I was hoping I might run into you,” she said.

“Oh?” I tried to pretend I didn’t know what she was referring to but my embarrassment of the previous day flooded back over me.

She smiled a knowing smile.  “Yes, of course.”

I stood there with one of my six female predecessors from the wall.  I was waiting for her to berate me or tell me how stupid I was partaking in the anesthesiologist’s sexist banter.

Instead, she looked me straight in the eyes and simply said, “Don’t forget.”

“Don’t forget what?” I replied.

“Don’t forget.  You are more of a man than any of them will ever be.”  And with that, she whisked away down the hall with a strong stride and her white coat flapping behind her.

The moment she said it, I knew exactly what she meant, and that she was right.  I thought of my female predecessors and their incredible uphill battle to be seen and heard in the surgical world.  I thought of my female training compatriots.  I could think of more than one who had gone into labor on rounds, working up to the very point of child birth, just so they would be taken as seriously “as a man.”  I thought about the never-ending dedication of all of the women, both professors and trainees, that surrounded me.

I decided at that moment that I would no longer apologize.  I would no longer apologize for having ambition.  I would no longer apologize for being strong.  And I would no longer apologize for being a woman.

It has not always been easy, but I carried these lessons with me every day since.  I always strive to remember the sacrifice of the women who came before me, paving the way in the surgical field, and those around me now who continue that fight every day.  I am constantly encouraged by the young female surgeons of the world who continue to have a passion for this profession.  And I am thrilled to say, our numbers are growing by the day.

We, the female surgeons of the world, are here.  And we are not going anywhere.

Rejection

I sat on my floor, surrounded by boxes in various states of organization and disarray, sifting through a pile of papers.  I was moving for my surgical fellowship and, of course, put off packing to the last minute.  However, in the middle of the hectic and scattered process, a particular stack of papers caught my eye; I felt the need to pause and go through them.  They were old and wrinkled now, but I remember receiving each letter like it was yesterday.  I had torn open every envelope with anticipation, excitement, and nerves.  One page after the other, all with perfect professional letter head, only to unveil a crisp white rejection letter.  There were twenty-one rejections to be exact, all from medical schools.

 

My story and path to medicine is not unique.  It began when I was 17, telling my dad I wanted to be a doctor over a family pizza dinner like it was no big deal.  His response was concise, and not what I expected from a physician himself.

 

“You don’t want to go to medical school,” he said flatly.  His response bewildered me.

 

“Well, yeah actually I want to be a doctor, don’t I kind of have to go to medical school?” I said with the attitude of a typical 17-year-old.  He smiled, went about his business, and offered no explanation.

 

A few weeks later, my dad offered to arrange a shadowing opportunity with an orthopedic surgeon at his hospital. He drove me to the medical center and dropped me off at 6:30 AM sharp to watch a total knee replacement.  They sent me to immediately change into scrubs.  I had never scrubbed a surgery before. I solemnly stood at the scrub sink, washing my hands, copying every move of the attending surgeon with painstaking detail.  A cap, gown and mask felt slightly suffocating the first time.

 

They told me where to stand, where to put my hands, and anything blue was sterile.  I stood silently, watching the incision and as they progressed down to bone.  The purpose of the operation was to remove old, porous, and faulty bone and replace it with man-made shiny new titanium.  Someone shoved the suction into my hand and I used it tentatively.     At some point, I was given a piece of epoxy they used to fix the knee replacement hardware in place.  As I played with it in my hand, I felt it become exceedingly hot and then harden.  “Cool,” I said under my breath.

 

After a period of time, I realized I wasn’t feeling very well; I felt claustrophobic in the surgical get-up.  “No one told me how hard it was going to breath in this thing!” I thought to myself.  I couldn’t stand the smell of cautery, or the recirculation of my hot breath under the mask.  My knees buckled a little and I leaned on the surgical table.  “Woah there,” the attending surgeon said, watching me nearly pass out.  “Okay, you should go sit down.”

 

For the rest of the surgery, I was relegated to a stool in the corner.  Half pouting for being banished, I watched the rest of the operation as a bystander, but still enthralled by each move.

 

My dad picked me up at the end of the day.  He listened attentively in silence as I yammered about everything I saw that day the whole car ride home.  I think I even saw him crack a smile or two.

 

When I was 21, I was a junior in college and applied to medical school for the first time.  I was rejected outright.  I did not receive a single interview. “Well, maybe next year,” my dad said.  I could tell he didn’t want me to hear the disappointment in his voice.

 

I went to my college advisor to see what steps I could take the next time I applied. “You should look at the Caribbean” he said.  There were several glaring negatives on my application, one being my grade point average that was perpetually pulled down by a freshman mistake. Working my first quarter of college and thinking I was too smart to regularly attend class was a spectacular combination for near failing pre-calculus math class, a pre-med requirement.

 

“You’ll never get into a medical school in the United States and you should really just give up on that plan,” the advisor said matter-of-factly.  Caribbean medical schools are recommended for individuals deemed not fit or “smart” enough to attend in the states.  This perception is often incorrect, as some of the best doctors I know enrolled in medical schools in tropical locales.  But as a college kid in my advisor’s office, it sounded like a death sentence.  I looked him straight on, tears in my eyes, and simply said “You’re wrong.”  I walked out of his office, wishing I believed those words as much as I wanted to, with a crumpled-up Kleenex in my hand.

 

When I was 24 years old, I moved across the country to upstate New York to attend medical school.  I received only two interviews the second time I applied, and when I was accepted, I took the opportunity and ran.  As I packed for the first of many moves in my medical career, I found my stack of rejections.  I briefly sorted through them, then placed them back in the file to keep as a remembrance.  I moved 3,000 miles away from my family and friends across the country with elation, and didn’t look back.

 

At 27 years old, I found general surgery.  At first, I was afraid to admit how much I loved it.  Afraid what that meant for the rest of my life, what it meant for my hours in the hospital, and what it meant about me as a person.  I was captivated by making an incision, fixing blood, guts or both, and leaving nothing but a clean white bandage to show for the work.  The chatter surrounding me told me it wasn’t a great specialty, particularly for women.  Unless of course, you didn’t want to have a family or a life.  My nervous energy persisted until I found a few teachers and mentors at my medical school, and I started to have the slight sensation like I belonged.

 

Once I made this decision to pursue surgery, I started spending almost all my free time in the operating room with an endocrine surgeon and his chief resident.  They took the time to show me how to tie two-handed and one-handed knots.  They let me close the skin of each incision.  “Take it out, that’s not right,” the chief resident and attending would say, over and over.  They made me redo every stitch they didn’t like, but they let me sew.

 

When I was 28, I started my general surgery residency.    It was a terrifying and amazing experience, all at once.  I loved every part of it and finally felt at home.  The years went by quickly, and while I flirted with several specialties, I found what I thought was my one true love in critical care and trauma.  I had a path, and I was on it.  For the first time, I felt there was no ambiguity about which direction I would go.  It was comforting and reassuring, a feeling I was unaccustomed to in my path to surgical training.  I completed a research year and started my fourth year of general surgery residency with all the boxes checked to apply for a surgical critical care fellowship.  For once, things seemed easy.  However, no sooner was I comfortable, when the fight started anew.

 

I was 33 years old when I found pediatric surgery.  Nine hours into a tumor resection for a 10-year-old boy, we were finally closing the abdomen.  A friend of mine was a junior resident interested in pediatric surgery and came in the operating room to see what we were up to.  He asked me about my rotation and I spouted off about patients and their families, the amazing operations, and how fun it was to round in the morning.  The praise continued until he stopped me and said, “You know, you’re never going to get to do this again.”

 

His words washed over me, and as their meaning sunk in, I took a sharp breath.  It felt as though I had the wind knocked out of me and my eyes watered up.   This was the last time I was ever going to get to take care of children and do this job.  I swallowed hard, bit my tongue, and tried to push the idea out of my head.  After all, I had a path and a plan already, it was too late to change.  But I couldn’t shake the feeling I was doing the wrong thing.

 

The next two weeks were a blur.  I was having a professional identity crisis.  I talked to my attendings, mentors and program director. I argued in my own head constantly.

 

“I am a trauma surgeon, I can’t do pediatric surgery.”

“Even if I wanted to, the specialty is so competitive.”

“It’s way too late.”

 

External voices had opinions too.  I was told it was too late by my peers.  I was told it was too risky by my advisors.

 

I finally ended up in the office of the Chair of Surgery, who was a pediatric surgeon herself.  She knew why I was there, as the grape vine is small in the surgical word.

 

“Can I even do this?”  I said.

“Well…it’s fucking crazy, but yes you can do it.”   She replied.

 

It was one of the first times during my path in training that I heard yes to a question, and I am grateful for the response to this day.

 

I am now 36 years old.  I am one month from finally finishing all of my training and being able to call myself a pediatric surgeon.  It is a goal that I literally spent my entire life pursuing.  And without a doubt, I have been told no on this path more than yes.

 

My story is not special.  My story is not much different than anyone else’s.  People slip through the cracks or don’t believe in their dreams every day.  Without the people in my life who believed in me, I might very well be in the same boat.  I am thankful for my father, for sending me to shadow when I was 17.  I am thankful for my medical school mentors, who let me sew.  I am thankful for those teachers in residency, that told me I could do whatever I wanted.  I am thankful for those individuals who said yes.

 

And, I am thankful for those 21 rejection letters.  Because without them, I would never know what it is like to fight for a dream.   So, for now, I will keep them in my filing cabinet, shuffle through them from time to time, and remember the fight.

 

 

 

 

 

 

 

 

bleeding

“Fuck!”

I had just pried my eyes open and had the realization of exactly what time it was.  I was going to be late again.  I jumped out of bed as fast as my stiff and weary body would allow, threw scrubs on I was mostly sure were clean, ran a brush through my hair so I didn’t look totally disheveled when I had to look like professional in a few minutes, and ran out the door.

I was in the third year of surgery training and it was my first rotation as the chief resident.  The chief resident on service is the one in charge, so to speak.  The one in charge of the resident team’s successes and, more importantly, their failures.  Basically, it’s a “fake it until you make it” type of moment.  The majority of the time, it felt like I had no idea what the hell I was doing, but I was three weeks in, and I started thinking to myself “yes, yes, you can do this.”

Today I was late, second time in a week.  As I turned the key in the ignition of my car, I paused and made the responsible decision not to take the extra five minutes to stop for coffee.  I always, always had my coffee in the morning.  It was a physical and emotional crutch for me to make it through the 5 to 7 AM hours, and was a terrible habit.  But today, I was a chief resident.  I was going to be responsible, and try to not be late.

I pulled into the hospital and ran to rounds.  Things moved slowly that morning, like I was wading through molasses.  The synapses in my brain fired just slow enough to feel the delay, leaving the world foggy and muted.  I walked to the operating room and desperately tried to shake that feeling.

I was doing a new operation that morning, one I never performed in its entirety: a laparoscopic Nissen fundoplication.  A bunch of fancy words for wrapping the stomach around the esophagus so that people don’t get heart burn and everything terrible that comes along with that.  I had done parts of it, but never the whole thing.  It is relatively straight forward, but of course there’s a catch; right behind the esophagus is the aorta.  You have to make a space between the two to complete the operation, without making a hole in either one, especially the aorta.

The case started, same as always.  Prepare the patient.  Prep the skin.  Drape.  Take my position at the table.  Make an incision.  Everything was moving smoothly.  Then, while trying to make the space between the esophagus and aorta, it stuck.  I spread the tissue, but it would not give.  Another spread, this time with a little more strength, and still nothing.  I received a little encouragement from my attending, as he said, “That’s right, you’re almost there.”  I felt the nervous energy spike in my stomach.  One more spread, with a bit more vigor.   Then, blood…and nothing but blood.  Blood pouring out behind the esophagus, obscuring everything in view.

I immediately made eye contact with my attending.  I could read the concern, even with a surgical mask covering his face.  We stared at the monitor for what felt like an eternity, watching the pulsatile blood flow.

“Open?” I said, nervously.

“Yes,” he replied, pushing the operating room immediately into hyper-drive.  Incisions became larger.  Instruments moved back and forth.  My hands moved quickly, instinctively making motions and taking actions that were automatic.  But my head, my head was full of questions.

 

“Did I just put a hole in the aorta?”

“Will he make it out of the operating room?”

“Did I kill my patient?”

 

These questions looped through my mind on repeat as we opened the belly, cleaned out all the blood, found the aorta, and examined it so very carefully.  Except there was no hole.  We stared into this man’s abdomen, flummoxed.  Where did all the blood come from?

No doubt there was bleeding. We evacuated nearly 2 liters of blood just to see anything when we entered the abdomen.  But where was it coming from?

We meticulously examined every square inch, trying to find the origin.  “Maybe it was a small arterial branch,” my attending said.   We continued staring for what seemed like forever, until we were convinced nothing would bleed or was bleeding.

We completed the operation.  We closed the incision, still with unanswered questions in my head.  The room was very quiet, except for the white noise raging in my brain.  I helped transport the patient to the intensive care unit, staring at his blood pressure, waiting for the other shoe to drop, and the bleeding to start again.  After delivering him to his room, I walked out, eyes down.  I could feel the tears about to bubble up out of my eyes.  I had to get out of there.

No one could see the chief resident crying.  My pace increased, walking as fast as I possibly could.  People said hello to me and I kept walking, staring directly at the dingy color blocked floor, not breaking my stare until I reached a stairwell in the back of the hospital.  Once there, I could not contain it any more.  Tears ran down my flushed cheeks.  I audibly sobbed, sitting on the stairs, crying my eyes out.  It was the first time in the operating room I potentially hurt a patient.  Not only hurt, but feeling I nearly killed them.

It’s not a feeling anyone can truly prepare you for, the feeling of unintentionally hurting someone.  But it’s a feeling we all universally experience at some point in time during training.  We are human, and we make mistakes.   Tissue planes can be unclear, anatomy can be unforgiving, and complications happen.  However, what happens to the person behind the mistake?  How do you recover from that feeling of hurting your patient, the very person you took an oath to protect?

I sat in that stairwell for what felt like forever.  I had to go back to the operating room.  We had another operation to do, another patient that needed care and my undivided attention.  Eventually, I picked myself up, and composed the liquid pile emotions on the floor back into the rigid chief resident I was.  I took a deep breath and walked back into the light of the real world.

I ran into my attending in the hallway outside the next operating room after I’d collected myself.  Unprompted he said, “You know, you didn’t do anything wrong.”  I could feel tears start to well up again so I swallowed hard, bit my tongue, and nodded my head silently in recognition of the statement.

“You know, I never had my fucking coffee this morning,” he said, “And I always have my coffee.  You want a cup?”

I started to laugh.  Yes, of course I wanted a coffee.  While they were prepping our next patient, we sat in the operating room lounge, sipped on slightly burned coffee in Styrofoam cups, and talked about life.

It might have been the most delicious cup of coffee I’ve ever had.

 

Numb

“Do you think we are numb?”

 

We sat in the office of the intensive care unit under fluorescent lights, both staring at computer screens covered in vital signs and labs. It was the summer of my second year of residency, and I spent it entirely in the intensive care unit.  There were two of us on call at night.  Half the nights we would spend shooting the shit about life, and the other half we spent running around trying to pretend like we knew what we were doing.   One year as a doctor, and we were the front lines in the ICU with the sickest patients in the hospital.  The learning curve is steep, to say the least.  I could feel the pressure of that every day.  I could also feel myself changing.  The soft edges of my personality had ever so slightly started to harden.  A change perhaps imperceptible to anyone but me, but I could feel it.

 

“What do you mean?” He replied.

 

“Do you think all this stuff we see changes us? Do you think we even feel anything anymore?”

There was a pause in the conversation.  We sat there in silence, with no answer to the question, for what seemed like forever.  The empty space and inability to answer spoke volumes in and of itself.  The silence was finally broken by my all too familiar pager beeping.

“Fuck. It’s a 911.”  The pages came across our screen in a type of code to denote how severe the injuries or how sick a trauma patient was.  And a 911 code was the most sick and injured type of patient.  And usually meant a night without sleep.

“Maybe it’s just another old lady who fell down and hit her head.  It’s probably nothing.” He said, and went back to scanning data and numbers on his computer screen.

I grabbed my stack of papers and pagers and started walking the quarter mile down the hospital halls to the Emergency Department.   We never ran to codes, we had to keep our composure.  So I walked at brisk pace through the blank white washed hospital halls, half frustrated that I might be up all night and half excited by the idea of some good trauma action.

As I walked in the back of the trauma room, all I could see was a street sign post, a stop sign, sticking straight up from where the patient’s gurney would be, and a crowd of people.  I couldn’t get a good look.  Frustrated, I wove my way through the crowd as much as I could until I saw the man lying there exposed, breathing tube in place, paralyzed.  My eyes widened as I could finally see the stop sign entering flesh and bone, impaling his left hip.  This fell into the category of good trauma action for sure.

The room was a combination of people actually working and spectators, gathered to see the exhibition of such a thing.  While the workers were circling and buzzing getting the patient ready to go to the operating room, the spectators were spectating.  Someone said in the back of the room, “Didn’t he read the sign?”  Half the room chuckled and half the room groaned at the dark and distasteful slant of the joke.   The base and sarcastic side of me laughed with the spectators.  After all, if I couldn’t laugh in dark times I was never going to survive residency, I told myself.   I looked at the patient’s face as he rolled out of the room.  Through the breathing tube and blood, I could see he was young.  Younger than I expected.  But despite the young nature of his face, he had lines around his eyes for days, like he just went through life smiling at the joy of being alive.  I wondered if I would ever get lines like that as I watched him roll him out the door to the operating room.  I walked back down the white washed halls of the hospital the quarter mile to the ICU, and waited.

A couple hours later they brought the patient back to the unit bandaged up, looking clean and almost human again, stop sign removed, and dropped him off in his room for me to take care of.

“You know they say he’s a drummer. Pretty good one I guess. Has a couple kids too.  They are young I think.”  I heard the nurses in the unit gossiping.  I didn’t particularly like knowing more about my patients’ and their life story.  It made it more difficult somehow.  So I put my head down, tuned out the conversation, went back to pouring over data.  We drew labs, we checked vital signs.  Everything appeared reassuring.  He was going to be ok, and I could feel myself slightly relax.

Thirty minutes later, the nurse called me to his room.  His blood pressure had just dropped precipitously.  We started rapid infusions of fluid and blood.  Something was wrong.  I lifted the sheet and looked at his leg. It was purple and blue, cold and lifeless.  Something was definitely wrong.  I called the resident more senior to me to come and take a look.  He raised the sheet, took a quick cursory glance at the leg, didn’t even flinch at the gory appearing nature of the limb, and set the sheet down.  He walked swiftly to the desk and made a phone call. I heard him mumble “We need to go back to the operating room” and then “yes” and then a “no.”

“Package him up.” That was all he said to me as he glided out of the intensive care unit, white coat flapping behind him.  I sat on the red biohazard bin in the corner of the patient’s room waiting for the operating room team to come get him.  My knee jiggled up and down at a rapid pace nervously.  I stared at the monitor above the patient’s bed watching the green, blue and red tracings carefully.  I only had to keep him alive a little longer, and then they would take over.  Empty blood packages sat on the ground next to me in a pile, each one life saving for about fifteen minutes, then we had to give another one.

After what felt like forever, the operating room team finally came and rolled him out the door.  I was relieved.  Abdicated of responsibility for the moment, I could feel the adrenaline that had been pumping through me slowly dissipate.  The bedside nurse put her arm around me and gave me a hug, like we had survived something together.   It was now 5 am.  My shift was almost over, and I had survived.

We all sat in the office and laughed about the night.  I was recounting the story of the stop sign to my co-residents with wide eyes when the phone rang fifteen minutes later.  “We are bringing him back. There’s nothing else we can do.  Call the family.” Click.  I could feel my heart sink to a low pit in my stomach.  I did not understand.  How could we not save him?  We could fix anything right? What do you mean call the family?  There was no opportunity for questions or explanation, this was an order.  I walked over to the nurse and said “He’s coming back.  We are done I guess.”  A look of sadness and horror came over her face.  I could feel my face and tone of voice were both blank, like those white washed walls of the hospital, absent of emotion or feeling.

I dialed the number to the patient’s mother.  And then his sister.  I could hear myself speaking but did not connect with the words.  They felt empty and flat.  I could hear myself saying the preselected script “There is nothing else we can do” and “I’m so sorry.”  I tried to remain detached.  I needed to keep up that wall.  I went about the motions of notifying the family that their loved one was about to die, because we, as doctors, could do no more for his injuries.  Because sometimes even surgeons cannot fix wounds inflicted.   It felt like I was moving in slow motion.  The rest of the ICU was going about their business, ramping up for the day, and I sat in the office making phone calls in an isolated and muted bubble.

We kept him alive until the family could gather at the patient’s bedside.  About fifteen people came, one or two at a time.  I watched as they walked by the resident office, eyes directed to the floor, filled with grief, anger, and disbelief.  They all huddled around his bed.  Some held his hand. Some touched his face with care.  Others stood with a distance in the corner of the room.  I watched from outside, exhausted and spent, each moment passing I could feel myself become softer.  I could feel the walls crack.

I was about to leave when the sister of my patient came out of the room and asked to talk to the doctor who took care of her brother.  The nurse directed her towards me.  I stood there in the hallway, exposed to the rest of the care takers in the unit.  The other residents, nurses and surgeons saw her walking towards me and I could feel their eyes on us as the conversation unfolded.   I grew tense, trying to hold on to my last ounce of composure and fortitude.  I had to keep it together.  I did not want to be called soft.   Tears streaming down her face, she looked me straight in the eyes and said, “I know you did everything you could do.”

That one sentence disarmed me in a way I didn’t know I could be anymore.  I cried with her, for the impending pain and loss of her brother.  I sobbed in front of my peers, mentors and staff.  She gave me a huge hug and then invited me into the room to be with the family while her brother died.  I couldn’t do it.  I said thank you and good bye and rapidly walked out of the unit. I went home to my small and cozy apartment, blood shot eyes and stuffy nose, and slept for what felt like days.  When I woke up, I felt strong again. The walls were patched and repaired, and I was ready for another night in the ICU.

So, I guess the answer is, we always feel.  We feel everything.  Maybe we just put up walls to make it easier.   We leave our emotions trapped and hidden below a strong exterior so we can remain professional.  Sometimes our feelings are deflected with sarcasm or a poorly placed joke.  But every now and then, those walls crack, and we show our true feelings.  Feelings we weren’t sure we even had anymore.

Introduction

I have had so many thoughts over the past eight years.  So many times that I thought I should sit down and write.  To try to somehow put into words even a small fragment of a day I just experienced, or the multitude of emotions it embodied.

I am currently a surgery fellow, and before that, a general surgery resident. Before that I suppose a medical student, and on and on.  I don’t think I can remember a period of my life that I wasn’t defined by my educational goals.  What started out as “I want to be a doctor” turned into “ I am a doctor” which quickly evolved into “ I want to be a surgeon.”  And now, nearing the end of my training, I am learning to identify with the words “ I am a surgeon.”  I am learning to stand firmly behind those words and have felt the weight of what they mean on my shoulders.   I am learning, and starting to embrace, the hardness that it brings to my demeanor.   I am starting to understand how to use that hardness as a strength.

This process, the training and the job, it changes people, in ways I did not fully understand at the outset.  And there are choices you can make along the way about how you allow these experiences to affect you.  I am definitely not the same person I was eight years ago, no one could be after this, but feel like I have managed to hold on to the core of who I am.   I have had amazing attendings, fellow trainees, and patients, who have taught me both about life and about the complexities of being a surgeon.  They have helped to carry me through these eight years.

I had particular thought tonight as I drove home in the dark in a slow moody drizzle. I have left everyone I know and love behind for my current job.  I moved here for a dream.  And while I might be tired, and sore, and exhausted, I still believe in that dream.

That thought stayed with me tonight for some reason, rather then vanishing as it has in the past.  It stayed with me as I sit here on the couch, a glass of wine in one hand, and my cat sleeping next to me.  His purr hums in the background, a constant droning buzz that attempts to calm my racing brain.

And so.  Here I sit, still, with my multitude of thoughts.  But now, I am letting them finally spill out of my head and on to paper.  To share the hardship, the experience, the dream, that this job is and the immense gratitude I have for this profession.