Monday, August 22, 2011

Residency vs Life After - Part One

How are residents supposed to prepare for real life as a surgeon if they can’t even work twenty-four hours straight now?

I hear this complaint about once a month from a someone trained in the Golden Age of hazing. Outside of anecdote, we’ll never know if surgeons are better trained now or twenty years ago, or fifty. But it’s too painful to imagine every-other-night-call wasn’t of critical importance.

Residency resembles the real life of a surgeon in important ways, but working thirty-six hours straight all the time isn’t one of them. You pick your lifestyle after residency. The frequency of your thirty-six hour days is determined by this choice, not by the commitment you made as a third-year med student.

Besides the work routine, other pleasant surprises awaited me after residency. The first was a return of cognitive function. The second was the freedom of choice. Third was that a surgical career was not like managing a patient factory.

Part One - My Coma

For me, chronic under-rest was like living with a head injury. The bits I recall went like this:

Chief, grabbing unfamiliar chart on rounds: Who’s this patient? Porter, did you admit Mr Jensen?

Me: Nope. Must’ve been the off-service intern.

Chief, pointing at admission note in my handwriting: Isn’t this you?

Me: Uh, yes. Hold on.

I’d pull a half page of scribbled notes on Jensen from my pocket to jog my memory. Still nothing. I’d read straight from my notes for three minutes, having no independent recollection of the two hours I’d spent with the man.

I’d walk in the room with the chief, see the patient’s face and boom - oh yeah, this guy. He’s the owner of the Chili’s on Woodward. His wife is worried he’ll miss his thirtieth class reunion. Every time he gets a lab draw somebody wants to work him up for polycythemia vera, which was ruled out at Mayo in the eighties.

End of the day, our team is reviewing our patient list.

Chief: Porter, anything new on Jensen?

Me: On who?

Chief: The diverticulitis patient you admitted, that you couldn't remember this morning.

Me: That must’ve been the off-service intern...

Later, I open my Schwartz textbook to start a chapter I’d been meaning to read. Finding yellow highlighter streaks all over, I wondered: Who the hell..? I turned to the cover page to make sure the book was mine. Sure enough. So I started again with blue highlighter. A month later, pink.

When residency mercifully ended, I spent two months doing no thinking whatsoever. For fun, I resumed my old college summer job as a whitewater guide. I’d leave my neomammalian brain behind at headquarters and we’d go out camping and splashing for a week at a time. There was absolutely no call for higher cortical function in the rapids of the Middle Fork of the Salmon. Brainstem, spinal reflexes, and some parahippocampal gyrus and you’re good to row.

When summer ended, I started my surgery job and hit the books in prep for boards. I felt like Charlie in Flowers for Algernon: I'd picked up about thirty IQ points over the summer. Not only did I recall having highlighted Schwartz the day prior, I remembered the topic and some of its substance. And my patient list was almost superfluous - I remembered admitting them, their names, their labs.

Can I do residency again, I wondered, in a better-rested environment? It would be nice to recall what I’d learned.


  1. This is great to hear actually. I really like surgery. A lot. But I'm terrified that I either have to pick surgery or having some semblance of a life outside the hospital. So it's true that after residency I can work more normal hours? Or does this depend on the surgical specialty you choose?

  2. K8,
    Many subspecialties of gen surg (colorectal, endocrine, breast, plastics) provide better work/life balance. Other factors such as the size of the group, employed vs private practice, and location play a role as well. I expect we will soon see job-sharing as an acceptable model - makes good sense to me. Granted, you'll always need flexibility and understanding from your family, whichever practice you choose. Sometimes you just have to stay and re-operate, stabilize, talk with a patient's family, etc.

  3. Great Blog.

    I'm getting through the archives. So much anticipation in your narrative, I find myself reading quickly to find out what happened.


  4. For doctors, residency would not difficult. Just they have need to proceed properly.

  5. We should be aware of the fact that our competition often uses professional help and timely manner.