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.



“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.


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.