Sunday, March 15, 2009

Eye Opening...

'What was practicing general surgery like?'

"Horrible!! Absolutely horrible. The ER would call with "this old lady has non-specific belly pain...I'd like you to come lay hands on her?" As if my hands are magical. As if I can really tell what the hell's going on. The ER doc is just trying to cover his ass (which is necessary in a society where patients see a 'normal, expected complication' as an opportunity to get rich), so it makes my workload that much heavier. So, I got lots of these CYA calls. Also, I was oncall every 4th night. And sometimes that would increase if a member of our group was ill, or otherwise absent. The money was pathetic, especially for the amount of time you're available...I couldn't even have a glass of wine with dinner, for fear I may be called in. I wouldn't make promises to attend events, or meet other obligations (that may be more meaningful to my life and well-being), just in case I got called in...or happened to run late on a case. This is a big imposition on your life..

Basically, your life is unbalanced. You miss tons of things that are important to you. You go thru life sleepy and tired...chronically. Your health isn't optimal...and it's all for what? To be called 'a surgeon.' That will get old as your children begin acting out in school....or choose grandpa over you for comfort and snuggles. When they seem to not like you very much...and you feel excluded from their lives. When you have a mild, dull headache from lack of sleep (or some other vital ingredient to a healthy body), on that 1 day off you may have in 10. And, low and behold, if you get 2 consecutive days try to make-up for lost time. Guess what? You *cannot* make up for lost time. So, do you really want to spend your life doing this? And if not, why torture yourself for a decade, give up your 20s/30s, when you could be building something more sustainable....mentally, and physically?

'Any advise for those who may be trying to decide on a specialty?'

Shouldn't students pursue something they'll enjoy rather than a choose based on lifestyle? I agree that you should do a medical specialty that you (think you'll) enjoy. But, how long will you enjoy a miserable lifestyle? Is the practice of 'that specialty which brings you joy' going to be *enough joy* to off-set the absence of life outside of work? Like seeing your kids play little league. Being there at your daughter's dance recital. Taking your kids to a puppet show in the middle of the week at the local library. Sleeping in late on Sunday morning, then going out to brunch, spur-of-the-moment with your wonderful family. Drinking until you're tipsy, and then having great sex with your spouse. Just having time for creative flow of energy, and silence to obtain inner peace!! These things may not be possible if you only get one day off a week...and you have a ton of basic life stuff to attend to. For the rest of your life...imagine 'not having enough time.'

Who runs your household? Grandma or mother-in-law? That may be better than a nanny, but it's still not ideal. A mom who's in her 30s - 40s is a lot more attentive, active, and better able to deal with toddlers/tweens than a grandma. Besides, Grandma has raised her kids...and now it's time for her to be a *Grandma.* It's one thing for Grandparents to be intricately involved, and to hire a nanny for supplemental support as needed. But, if they're raising your kids instead of'll have to consider the consequences of that (for both you, your family, and your children).

Would you rather pay someone to be the Mommy while you're the doctor...or would you rather be home doing the mommy (or daddy) thing yourself? Would you rather have other kid's fathers who have time to coach flag-football on Saturday mornings teach your son how to throw a football, or otherwise be present as the male figure in your son's life....while you're at work being the 'greatest surgeon ever?' It's no wonder that so many old men end up saying "Rosebud" as they lay dying, alone, on their deathbed.

You'll need to nurture your marriage, or it won't last. People (including spouses) will only tolerate so much. Even if you think your wife is "happy staying at home" one gets married to be alone.

You need to be present while your kids are kids. In 12-15 years, they won't need so much of your time...and a large part of your influence over them (your parental guidance) is over.
Are surgeons so cool? Yes and no. The work is like no other. It's exhilarating when you can cut someone open, and fix the problem. It's easy to get an ego...which is almost a requirement if you want to survive the process of training. If you're to compete, and not become an emotional shield yourself from criticism with an enormous ego. This translates to the rest of your life....and your personal relationships will become antagonistic. At times, the only thing in your life going as planned So you hold on to that. Surgeons are as diverse as the population. I'm sure there are some who get off on being a surgeon because everyone says "ooohhhh." But, most people are just as impressed when you say "I'm a doctor." Nothing special (or even distinctive) about being a surgeon to much of the population. So, who are you really trying to impress? Other doctors? Your partner? Yourself? And that ego, that desire for respect and accolades, keeps 'em coming to surgery....even if it's not the right career choice for them. That thought of 'surgeons are so cool.'

Criteria used to decide:I say, decide *overall* what's important to you...and find a way to make those things fit together. This may mean choosing "your second favorite medical/surgical specialty" instead of your dream specialty...if you want a *dream life* overall!!


Anonymous said...

If you are already showing so much anger and bitterness while you are still a resident, it sounds like general surgery is not the field for you. Your indicia of a lack of compassion for injured patients and ER drs. who need a consult are scary.

Orthoprax said...


First, this is a linked reference from a once general surgeon turned vascular surgeon because the life of a general surgeon is as rough as they come.

Second, I am a medical student trying to figure out whether I should go into surgery or not. I am in fact neither bitter nor angry but I fear that I may become so one day. When the 'coolness' of surgery becomes routine will my job just become a difficult obstacle taking me away from my family and extracurricular activities?

Third, you obviously have zero clue about the reality of medical practice where it is beyond common for ER docs or medicine docs to call an already overworked surgical resident to consult on a patient just for the sake of CYA protection and/or without the proper work up. I challenge you to find a surgical consult resident who isn't bitter. You do not understand what it means to be on call for 24+ hours in a row with nary a 15 minute span without your beeper calling.

And last, this may shock your naivete, but talking frankly and objectifying patients is standardly done throughout all medical fields. When you're overworked and overtired and you have a dozen patients of questionable necessity to see before you can go home, feigning compassion among your colleagues is the first thing that goes. The job is to objectively assess and deliver proper care - getting emotional hinders those goals. I am not condoning or condemning this - it's simply the reality.

Garnel Ironheart said...

So take some advice from a veteran physician, why don't you.

1) Any medical speciality eventually gets routine if you see the same things over and over again. That lap chole you were so thrilled to assist on last week? It's boring by the time it's your 333'rd.

2) As an ER doc, I dread calling the surgeon as much as you dread me calling you. I generally don't like to but at some point that RLQ pain with the tachy and temp has got to go your way. I don't want to bother you but I didn't invite them into my department either.

3) Feigning compassion is hard but you have to do it. The next patient you see isn't part of some greater conspiracy to try and drive you crazy (took me a while to figure that one out when I was where you are now). He's just a guy with a problem looking for help.

But I agree with your last line the most.

Orthoprax said...


Thanks for the input - I'm really not meaning to put down ER docs generally, it's a tough job as you undoubtably know, but I bet you know a bunch of ER docs who'll call in the surgeons for stuff they could perfectly well handle on their own.

In general, how long have you been in practice as an attending? Is life how you expected it to be? Any regrets? Did you ever consider surgery as a career?

The Leader, Garnel Ironheart said...

In order:
1) I've been out in practice for 12 years this summer.
2) Life is way better than I expected it to be. The practice of medicine is full of change, growth and opportunity. I'm doing stuff in both my family practice and ER work that didn't exist when I started. There's no end to learning, new experiences and challenges. In short, it rocks.
3) Regrets? Well there was that cute nurse on ward B... But seriously, I sometimes wonder if a full time career in ER would have been better than splitting my time between Family Medicine and ER. On the other hand, I know that if I had to choose one or the other, I wouldn't be having as much fun. Each complements the other.
4) No, I never did consider surgery for a couple of reasons. One is that I like variety and surgery is a limited field. My own preference is to dabble in lots of things as opposed to being a major expert in just one area. For another, there was the lifestyle. Both Family Medicine and ER let you have one but surgery is a mericiless mistress.