Second Thoughts

[Celiac Plexus]

The other night on call, I was just getting KILLED in the ER handling trauma after trauma after trauma. Now I admit, I am not a big fan of trauma at all... especially since I assisted an I&D of a perirectal abscess early in the evening and could not get that horrible anal pus smell out of my nose... Every breath I took through my nose I could smell that ass pus. And when I finally found my way to the call room at around 2:00AM and started to doze off I got called BACK TO THE ER.....

Anyway, I realized that after 8 weeks of my internship, working my ass off, not getting to the OR much, and getting reamed by a certain maniacal attending on a daily basis (funny at first and now quite the opposite), not seeing my girl hardly at all, and my family/friends even less... well I asked myself the dreaded question: Was gen surg the right choice?

Don't get me wrong, there have been moments of sheer ecstasy when I bounce down the hallways feeling awesome... like when I placed three unassisted central lines in a row in about 90 minutes, or when I got to do a lap choly basically all the way through, or when I spent one call night with four other interns just f***ing around the hospital all night.

But I am beginning to believe that this career is going to snuff out all of my other interests, and subdue each and every one of my personal relationships. I may possibly become a great surgeon... that's true. But at what cost? I do not feel that giving up that much is worth it. But then it just may be too early to make a judgement like that. Perhaps I am just going through some intern-type emotional crap. Or maybe I'm just not cut out to be a surgeon. I don't have that answer right now. This is seriously bothering me.

Anyway, I have decided to give it six months. I am going to focus solely on my internship, and not worry about anything else. At the end of six months though I am going to seriously look at my life, my satisfaction level, the sacrifices, and in general do some real "soul-searching" (man I hate that term), and then basically re-evaluate the Grand Plan of The Life of Celiac Plexus.

I mean, I love surgery, and I really do value the privilege of being able to have the opportunity to be a surgeon. However I know that I am not comfortable with giving up everything else in my life.

One of the chiefs here has turned out to be a real friend, and one night he was feeling expansive, and expressed that he had given up all of his other interests to his career choice. He is really cool and funny, and he is not the stereotypical type A analboy that people joke about. He is kind of wacky and fun. He is also generally acknowledged as being one of the, if not the, best residents in the program. But as he was rambling on about all he had sacrificed, I really listened hard. I didn't say anything because I was waiting for him to say something like, "...but it has definitely been worth it." But he didn't. He just finfished it off with a snappy little remark like, "Ya gotta grow up some time!" And kind of laughed off his statements.

Man. So many questions... no answers.

---

Members don't see this ad.

 

[Apollyon]

Originally posted by Celiac Plexus
I mean, I love surgery, and I really do value the privilege of being able to have the opportunity to be a surgeon. However I know that I am not comfortable with giving up everything else in my life.

You have been brusquely slapped in the face by the "jealous lover" of medicine.

Just like a lover, though, you have to evaluate it. Thankfully, you have looked ahead, and have given yourself a cushion of time. Intern times are downers.

If you do indeed love surgery, look to the bigger picture of whether the good outweighs the bad. Like any relationship, it can take some work.

And anything worth having, is worth working for.

 

[Foxxy Cleopatra]

CP, I hear you. I really love the OR and that is the only reason I don't pack my bags and drive off to the beach. The service I am on this month laughs in the face of the 80 hour workweek- I take q3 in-house and have yet to be home post-call before 6PM. I don't mind working hard, but of the > 120 hours I work, I MAY get a case a week but not much more. The attendings are generally miserable, I daily get chewed out for things beyond my control (labs not getting done fast enough, people not communicating with one another,) I spend >90% of my time doing secretarial and social work... I ask myself why in the world I am doing this?

On the other hand, I had a great first month, I operated a ton, the people were nice, and I have been reminded repeatedly that the service I am now on is the worst by far. I, too, have decided to let things run their course for a few months before looking elsewhere. Though, I would still have to pursue surgery somewhere and am trying not to fall into "the grass is greener" mentality.

Just wanted to say I hear ya- the verdict is out here; I do want to do surgery but I hate the B.S.

good luck

 

[ESU_MD]

I can relate to your feelings. 8 weeks of working just about every day, getting yelled at, pimped just wears you out. Plus it really sucks not getting to spend time with your family/friends/sig other, etc.. I despise the fact that I only see my daughter ~2 hrs a day.

OTOH, theres nothing like getting to do a procedure. Or even better, doing the same procedure the next day and being a little more deft.

After a particulary rough day of getting pimped and abused, one of my attendings took me aside and told me that one of the caveats of a surgical residency is that there is very little external positive feedback, but there will always be PLENTY of negative feedback.

I get up around 4a and get home after 7. Between 7 and bedtime I have to spend time with the wife & kid, eat, then attempt to read up on my cases, etc.. Its depressing because I know its just not getting any better for the next 5 years. And unless I consider a career as a ambulatory surgeon doing breast biopsies and hernias all day- then my life as an attending will suck too.

If you remember, I almost tried to bug out of my match because I had second thoughts about relocating, and second thoughts about surgery. However I can say I am still glad I chose to go into G Surg.

I have really tried to talk myself into "liking" other specialties like gas, or EM or even FP- but I just cant do it. Its not for me.

Next time you get to the OR and are bored holding retractors take a look over the ether screen at the gas man and realize he is making more and working less and with a better lifestyle than any surgeon will ever have. THEN imagine having to sit and do his job all your life. I think it would be torture to watch someone else operate knowing I couldnt- regardless of the better lifestyle.

Other specialties may have better lifestyles, but you have to determine if the way they treat patients is the way you want to do it. Can you see yourself doing IM, or FP? If I ever decide to leave surgery or get booted from residency, then I will have to leave the medical field altogether because I will always look at surgeons and wish I could be one.

Surgeons have to have high confidence since they practice their craft in front of a room of people, not hidden behind a curtain or in a private exam room. Most surgeons think that they are the best doctors in the hospitals, and in most cases I think its true. (probably a biased thought)

It is a long road to be a surgeon and there are no shortcuts. Will it be worth it to sacrifice everything? I just dont know. Sometimes I come home and want to call it all quits now too. family vs career satisfaction vs big time debt.

80 hrs is only a concept , and life as an attending is going to be bad too. Hang in there buddy. Most of your co-interns feel the same way.

ok I am depressed too now and 4am comes soon.

ESU_MD

 

[pelican]

OR? I've heard of those mythical places...

I haven't been in there since week one, forgot the locker room entry code and had to ask an instrument sales rep to let me in. sigh. It's all floor work (which is fine -- I gotta learn that too), but the paperwork is crazy (as are about 10 of my 30 or so patients).

Week 7-8 must be the time that interns have that transition from "what am i doing?" to "why am i doing this? and is it worth the sacrifice?"

it's too late to dwell on such deep thoughts. and i needed to be in bed about 2 hours ago...

 

[Pilot Doc]

CP,

I see how your chief?s story discouraged you, but I see some bright spots to it. For one, after four years, he is still liked and respected. He didn?t say residency has been worth the sacrifice, because thus far it has not been. He has yet to reap any of the real rewards of being a surgeon. Next year, he will have vastly more money, much more autonomy and some more free time. No one would make the sacrifices we do for a long term job working 100 hrs/wk for someone else making $50K. And there are fuilfilling 4 day/week, see your family at night jobs for those who want them; I've talked to them. They don't do whipples or make $500K, but they do nissens and colectomies and hardly starve.

The most important point is whether your chief?s sacrifices are permanent or temporary. Is his golf game just really bad or did his wife leave with the kids in tow. An attending told me once that some things bounce when dropped and others break. Catch the breakables and you can make it through. (And if you can?t, then it?s time to leave.)

That having been said, I completely identify with your feelings. There are times this year that I have definitely not wanted to be an intern, and questioned my ultimate desire to be a surgeon. But I?m on a good rotation this month and have enough sleep to be positive. Keep at it.

 

[fourthyear]

Being an intern kinda sucks in any specialty, but most in surgery. You only want to get to the OR, but when you ever do, you're just even more behind than you already were on your floorwork. You're expected to know more in less time about all your patients in comparison to other interns of other specialties. It's possible to get up before 3am, skip all meals, and still feel you didn't get half you're work done by 5pm. Yeah, it kinda sucks, but that' s the price you pay to learn how to be an amazing doctor - a surgeon who can handle lots of medical issues as well as bieng able to do multiple procedures and surgeries to really fix things. If we really want to be good surgeons we have to pay this price. And we have to appreciate the hours we have now in comparison to the past - our cheifs all had it much worse than we do that's for sure.

It's normal to feel the frustration, but if it doesn't feel worth the effort to you, maybe another specialty would be better for you. It's your choice. But realize that you're not the only one feeling you're having some rough days - I think we all have them quite often. Most of us will find a way through it and be better for it in the long run, I truly believe. When times get tough, celiac, just think of those "moments of sheer ectacy" and that will help get you through the less fun stuff. Never doubt your inner strength to get thru one day at a time.

 

[voltron]

I'm a 4th year seriously thinking about g-surg. I just finished my medicine sub-I a month ago and I realized that as an intern you get f*cked no matter what you go into. I mean as a sub-I I was carrying 9 patients, getting up by 5 to start pre-rounding at 6 and we had no one designated for short call, so I was there till minimum 630 everyday, usually more like 8. And call nights were horrible, I never slept, not even for a minute, and even an ass puss case is more interesting than a 80 year old lady whining about a dizzy episode at 4am. I mean, if your gonna get screwed and have to work 13 hours a day doing something that you kinda like, you might as well sack up and work 15 for something that you really enjoy. And you wanna talk social issues? I mean I should be a certified social worker after that last month. Second year g-surg residents have it good at my school, huge jump in OR time, chilled out as far as rounds are concerned. And most 3 and 4 th years take home call here. Hey GAS man, I think anesthesia is cool, but it seem like a very static field, a lot like OB-GYN. And it also seems hard to stand out as a good anesthesiologist. Is that true?

 

[ArrogantSurgeon]

I told you so.

Less than a few months ago I said that working even 80 hours per week is way too long if you want to have a decent family/social life. But people kept thumping their chests and boasting how they'd tough it out and wouldn't complain. And now people come here doing exactly what they never thought they would when they signed up for a general surgery residency. Not to mention proving my point that a lot of what you do during those 80+ hours is meaningless scut work that has no educational benefit at all.

 

[droliver]

A.S.,


With the perspective of experience that "scut" becomes much more important. It is during your junior years that your habits for the mundane are developed. Learning attention to detail for these things makes a disproportionate improvement in your clinical skills as you develop. You really can't learn to be a surgeon without learning pre/post-op care, & a lot of that process seems painful while you're there. The incremental knowledge you get during this initiation to the not so glamorous work pays off on the back end. It's what ends up making good surgeons into good doctors rather then just technicians. The work hours thing evens out as you progress & there are more & more buffers b/w you and many of these things in your mid & upper levels. Just have some patience & talk to people who've been there for the proper perspective

Rob

 

[dr.evil]

I believe pre and post-operative care are THE most important aspects of surgery. Knowing when to operate, when not to operate, and knowing what to do when patients don't do well on the floor are critical.

That being said, I also believe surgical training throughout the U.S. needs a major overhaul. To have an intern sit on the floor all day, do social work, paper work, and bull**** is ridiculous, outdated and inefficient. Those programs with excellent social workers, nursing staff, crna, rt, pt, ot, nutritionists and all the other ancillary help will be the best training programs in the future. Let the surgery residents focus on the medicine, the basic science, the do's and do nots, their surgical skills, etc and not be inundated with which nursing home to send grandma jane to.

I think my program has made great strides in this avenue and I operated a TON as an intern. The bonus is that you remember why you're in the hospital for 120 hours but the down fall is that you must get to the hospital a little earlier and stay a little later to take care of the floor work issues.

Celiac: My vote is to hang in there. Intern year sucks and 2nd year is much better. But in the end, do whatever will make you happy when you're 50 years old.

Off the subject a little bit: Do you guys think that more people will be dissatisifed with surgery residency because they thought the 80 hour work week would make it so much better but it really isn't making it that great? For me, I think the 80 hour work week is 100% better for my life compared to last year, but I have last year to compare it to. Anyways...

 

[hemoccult]

I think evil and others make a great point in the fact that surgery residents must also learn the pre and post-operative skills along with the fun operating skills. It has got to be frustrating as hell doing all floor work and seeing others meandering in and out of the OR.


Just curious as to what program dr. evil is from? Sounds like a good program if the interns are getting to the OR a lot.

 

[womansurg]

Originally posted by dr.evil
Celiac: My vote is to hang in there. Intern year sucks

Ditto. I barely remember my intern year, I was so psychotic from chronic sleep deprivation.

Figure out if you love surgery and want to do that for a living. Usually you know this from your clerkship experiences, before you had to sell your soul to the devil just to be allowed to participate. If you do really love surgery, then the sacrifice of this year of your life ends up being worthwhile. If not, then now is a good time to focus on a new direction. Absolutely no shame in that.

 

[md03]

Hang in there, CP. I haven't made it to the OR much either. And there are several rotations scheduled for this year in which I won't make it at all. However, the few times I have generally have been pretty good. Even one time when my chief let me take our sub I through a butt puss case. That was much better than doing it myself. He was so stoked...had never even gotten to use the bovie before.

And I felt a twing of jealosy reading your post. I did tons of lines, chest tubes, etc as a student. But none here so far. Interns are very coddled and not allowed to do much unsupervised. The one chance I had to do a chest tube in the ED the chief helped me so much that he got in my way and I couldn't do it...though I've done my last 5 or so chest tubes as a student completely unassisted.

I bet you're suffering more from scut-itis than maybe surgery isn't for me-itis. I dont' think many medicine docs get so stoked from doing lines (perhaps I'm wrong).

I am lucky here in that we have really good support in terms of the social work issues. Most of the time, a case manager does all the discharge planning and paperwork. So that takes some of the pain away. However, there have been weeks when I haven't set foot anywhere near the OR and I have thought, "I could be doing the same thing as a medince intern and be done sooner". But I would then dislike my job.

I don't love every case, and I hate to be scrubbed holding retractors, not actively involved in the case and not being able to see. But I'd rather be doing that than endless internal medicine rounds!

Hang in there, CP. Sounds like you are dealing with your stress wisely.

 

[50Cent]

CP - This self doubt happens in every damn profession. Best thing is to hang in there

 

[dr.evil]

Just curious as to what program dr. evil is from? Sounds like a good program if the interns are getting to the OR a lot.

I apologize for being so secretive about my program. I've always been that way when posting to anything internet. Maybe I'm paranoid. Ah hell, I am paranoid. I'm sure it will leak out over time. I do like my program a lot. From years 1-3 this may be the best program of any kind. When it comes to years 4&5, I'd love to see a little more autonomy with my chiefs. We tend to always have an attending at every procedure. In reality (and legally for our attendings) this is very good patient care, but when you're training, you want your chiefs to be able to walk a junior through a procedure. I've worked with many of the graduating chiefs from our program and they don't seem to have missed a beat but... Maybe I'm just being picky. We need a county hospital. Our VA experience could be better (who's couldn't?) So you see, my program is not without its faults.

Again, intern year sucks no matter how you look at it. Finish it and you will be much happier.

 

[Winged Scapula]

CP...

It happens to ALL of us. Right about now is when the drudgery starts to sink in and you don't think you can finish the year...expect that it may get worse before it gets better.

It also sounds like you're doing more than I did - you've already done more lines unassisted than I did my ENTIRE intern year and I was never allowed to take a medical student through a case until this year...and even then, the attending was still scrubbed.

Only time will tell, but I expect you've got those "intern blues".

 

[UI2003]

CP -

Hang in there! Think about the end result - I just had a chief tell us that one of the jobs he's considering *starts* at $350K with q6-7 call and 8 weeks vacation/year...and it's a group practice so you have less and less call as you gain senority. I expect for my life to be hell right now because I'm a lowely intern - even the janitor gives me **** sometimes. However, I *KNOW* you'll get into the OR more as the years wear on. You can't expect to operate all the time (unless they specifically said during your interview that interns get several hundred cases). With the first service I started on, I got to hold a scapel twice in a four week span. This rotation has me in the OR nearly every day. It just varies. Don't you know your schedule for the rest of the year? Ask the upper-levels how much you should expect to cut for those other rotations. I'm almost positive you'll have more OR time as a second year and so on. Don't pitch what will probably be a stellar surgical career over scut-itis!!

 

[vuillaume]

Ironically, I think that your moment of hesitation is actually a good thing. As much as we might respect or envy those that can hammer through the residency experience unequivocally, the surgeons I respect most are those that are human beings rather than automatons.

I think that Internship should be set aside as a distinct experience that is often painful, but necessary to negotiate the transition from being a student of medicine and a practitioner of it. Those of us who are Interns are on the steepest part of the learning curve, and its verticality includes not only the medical/surgical aspects, but learning to fit into a system where the Intern really represents where the "rubber meets the road". I agree with AS to some extent (though I think his liberality with his opinions isn't matched by enough actual experience in the surgical arena), that much of what an Intern does is unnecessary scut. But, ultimately, the point of Internship is being the point man in a complex ecosystem whose ultimate goal is to help patients. This will always involve issues that have nothing to do with fascial closures, tying knots, pancreatic pseudocysts or the staging of esophageal cancer.

I'd probably question the humanity of anyone who enjoyed every aspect of Internship, but I don't see any shortcuts around it. I'd be truly frightened for myself and my patients if I were suddenly told that I was to be a SAR tomorrow. Experience is experience, and dealing with the hypotensive cross-cover patient with a CHF history at 3 AM is mandatory.

CP, the more people like you, who work hard, but also acknowledge life outside the hospital's walls, the futility of the toxic BS upper levels can hand out, and still stick with it, the better off surgery will be. It's your decision whether the cost/benefit ratio is worth it, but here's hoping you stick around.

 

[Z]

CP- I still remember what one of the upper level residents told me when I was an intern. He was well respected, smart, and confident to the point of arrogance and generally seemed to have his stuff together. I was talking to him one day about residency and saying much the same things that you stated in your posts. He told me "Doc, if you don't seriously think about quitting at least 3 or 4 times a year then there is something wrong with you." That meant a lot to me at the time. I thought that if such a gung ho guy like him thought like that then maybe I was not unreasonable. That was 7 years ago now and I did make it. Hang in there.

 

[njbmd]

Hey CP,
Internship is hell and the clock does keep ticking. This year will come to an end. Hang in there! Your learning curve is steep and the feeling of "brain and body overload" will pass. You actually get used to functioning under a constant level of stress.

I used to think that internship was the worst thing in the world but each year has its own challenges and when I look back, I learned so much that I actually HAVE some skills to build upon.

Again, hang in there. It does get better as you make the adjustment from medical student to intern.

njbmd

 

[girlwithaknife]

I'm in the same place, CP, although I'm trying not to consider quitting yet, because I don't know what I'd do if I wasn't doing surgery. I can't convince myself to like anything else - already tried. I'm trying to take full advantage of the vacation policy at our program: one week allowed every three months. I'm scheduling my weeks off whether I have anything planned to do during that vacation or not. I'm realizing fast that those weeks may just be what saves my sanity.

I think the most dangerous thing about internship is how it makes us react to our patients when we are having a low-point. My tolerance level drops to about zero when I'm buried in floor work with really sick patients, and then a not-so-sick patient comes along and wants to demand all my attention.

 

[LaCirujana]

Originally posted by pba
1. attendings are evil. the last day of residency, i am going to go into another field or shoot myself.

2. rich patients are evil. if i ever have a lot of money i will either give it all away or shoot myself. thier families are evil too. so i guess if i ever make a lot of money i will kill everyone in my family.

dear god, i cant wait until i am at the VA.

pba

preserving for posterity

BTW, I'm at the VA. The VA sucks, too.

 

[LaCirujana]

Originally posted by pba
what about those of us who sacrificed the nothing we had to obtain what we knew would make us even more miserable? serious question... haha. oh man, i am rolling on the ground laughing, someone please kill me hahahaha

-pba

archived

 

[eddieberetta]

Originally posted by Celiac Plexus
I am going in to surgery because I love the OR. I love washing my hands in cherry-scented warm water at the scrub basin and joking around with the residents and attendings. I love the order and heirarchy of the OR. I love that sometimes attendings have to make important decisions while operating without quibbling. I love the warmth of a patient's abdomen as I run the bowel. I love identifying anatomical structures. I love cutting, sewing, and tieing knots. I love the ability to cure by cutting.

I love talking to patients in the prep room... reassuring them and listening to them. I love the intimate details that patients share with me once they know that I am part of the surgery team. I love getting called at 2am to help solve, or assist in the solution of an unforeseen problem with a patient. I love being comfortable with putting in central lines, IV access, and drawing blood. I love being comfortable cleaning out wounds that most of my peers would kill to avoid smelling. I love watching the senior residents comfortable with EVERYTHING that happens. I love being the guy who always volunteers to stay late and do the "scut" that everyone hates to do... you can learn a hell of a lot about management that way. I love it when one of my classmates, or a resident, is beat down and I ask to pick up some of their work because I can, and because I want to bust my ass for them.

I love office hours when we can briefly reconnect with our patients and check on their progress. I love it that I will never spend half an hour sitting on my butt discussing whether we should or should not "bump the dig" by 0.00005 on a patient with a-fib and CHF.

I love the camraderie of surgeons. The "hammerhead" mentality, and the bond that exists between men and women that undergo at times harrowing training so that they can achieve the skills, and knowledge necessary to be a surgeon.

I would become a surgeon even if I knew that I would work 100+ hours a week, and be one of the lowest paid doctors around. I don't care about prestige, or status. I just think that surgery, and surgeons are cool as hell, and God willing, I too will one day join their ranks.

Hang in there...or switch into radiology (who the hell am I to talk?)

 

[ItsGavinC]

Originally posted by UI2003
I expect for my life to be hell right now because I'm a lowely intern - even the janitor gives me **** sometimes.

Sounds like the re-cap from an episode (every episode) of "Scrubs". Sorry for the off-topic comment.