Friday, July 9, 2010

Sesame Street, it ain't

There are so many aspects of medicine and hospitals that you forget over time, until something reminds you. I did radiology as my last rotation, followed by vacation, so to some extent I had forgotten how to examine a patient thoroughly and write a basic note. I had forgotten how the smell of electrocautery (burning flesh) in the operating room wakes me up like coffee, and how looking at abdominal fat makes me crave cheeseburgers. I had forgotten how much I like talking to patients and finding out how they are doing, and watching them get better with time.

I also forgot how political and territorial medicine can be. I had a very minor yet unwelcome reminder this week, as I finished up my gynecology rotation. We finally had a case booked, a simple hysterectomy, and I read up the night before on pelvic anatomy and practiced my two-handed knot tying.

On our service, the gynecology intern has a family practice senior resident to call if there are any issues or questions which are too menial for the Ob-Gyn attending. I called to let her know that there would be a case, and she stated an interest to come. I didn't think anything of it, but the next morning, I discovered that the case was actually a tag-team case involving general surgery as well. This meant that I now had a more direct educational stake in the procedure, especially since it was something I had never seen before, an abdominoplasty.

Since both attendings were scrubbing the case, they said they only wanted one resident at a time scrubbing to assist. I deferred to my senior resident, thinking that the senior had "seniority" for the case (ie, more right to scrub than I did, as intern). I didn't think too much of it, although I was disappointed not to scrub into the case. But after the case was done, multiple general surgery residents approached me to find out why I had not joined the case. When I said that my senior resident had scrubbed instead, suddenly everyone was not happy.

As it turned out, the gynecology intern is supposed to scrub all cases, and the senior resident is just there to help out on the floor as needed. Especially because I was a surgery intern, my surgery seniors felt that I had the right to be there while my senior family practice resident did not. Unbeknown st to me, this particular resident had previously expressed an interest to join surgery and was not accepted, and so her actions were interpreted by the surgery residents as trying to get into where she did not belong. The surgery chief resident discussed the situation with her, for future clarification, and the whole thing was resolved relatively painlessly.

But the divisiveness of the whole thing surprised me. Suddenly, I was "team surgery", so to speak, and my seniors were looking out for me even though I am not to join surgery service for several weeks. The other residencies in our hospital were "they" or "them", with guesses as to motivations, wants and needs. It was nice to have someone stand up for me and my education. It was my only case for the entire gyn service, and I actually enjoy gyn, so I would have liked to be a part of the case and maybe even get to help. But I felt a little bad that it was at the exclusion of someone else. It just wasn't very warm and fuzzy.

On the other hand, last year I was so aggressive with my showcasing for surgery that I would actively kick lowly third-year students out of good cases so that I could use the few weeks I had on service to demonstrate my skills to attendings and hopefully score an interview. One student even called me a b**** and tried to complain to a resident, only to get smacked down for disrespecting my seniority. I'm not exactly Fozzie Bear myself.

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