Please change the culture of surgery

It is December 2017. I have been on the road for the last five months, completing my five months of elective rotations. I am a fourth-year medical student aspiring to specialize in family medicine. I also want to learn procedures, so I did two months of surgery, three months of family practice electives. At the beginning of this process, I had wanted to be a general surgeon, but I ended up choosing family medicine.

Back in third year, I had very auspicious rotations in rural Appalachia where I was one on one with a few general surgeons. I loved it; the hours were not too bad and the weekend calls were thrilling. Three attending surgeons whom I loved suggested to me that I go on to a surgical residency; I went and set up two auditions to see what surgical life was truly like.

On my first surgical rotation in Pennsylvania, I was devastated, yelled at, berated. Repeatedly surgical residents told me I was not good enough, chastised me for tying a knot too tight or too loose, or one centimeter to the left. I worked over 80 hours a week, sometimes in the 100s. But still, this was not good enough for them. After hearing the vascular attending go insane because insurance denied his patient from getting a recovery enhancing blood treatment, I began to experience dissociation. Mornings became nights and nights became mornings. To the residents, I was simply a body to be used: “Hold this retractor here.” I did not move for four hours. Later, “take this paper to the nursing station.” A paper scut monkey, as they called us. After one month of being told I would be “speared and bled out” if I messed up, I finished my audition rotation, packed my bags, and vowed never to return to this town ever again.

On my second surgical audition in New Jersey, I thought I would see a better side of medicine. After all, Jersey is warmer, so maybe people would be nicer? Nope. Even worse. After a brutal week of 28-hour shifts, nights, and weekend calls, the residents took me in a room, closed the door behind me, and yelled at me for an hour straight. They told me every single mistake I made. I cried later, in the solace of the second-floor bathroom in the surgical suite. I was becoming someone I was not: I yelled at some random person’s dog on my way home and felt miserable for doing so. Where was the happy med student who had felt so successful in third year? My last day on service, I told the “friendliest” chief resident that I could not take it anymore. She apologized to me for the behavior of her residents and agreed I should not pursue surgery. So I quit.

Patients and surgeons lost a great doctor that day. As a third year I was assisting on bariatric and general surgeries, and as a fourth year, I assisted on cancer operations. My nurses loved me; my rural general surgeons loved me. I just could not see myself in a surgical residency anymore.

Fast forward to three months of family medicine auditions, and I have been so much happier. I am treated like a human. My patients love me and smile at me. My nurses talk to me with respect. My attendings let me be who I want to be. I wake up at a decent hour, and I am back at a decent hour. I have some weekends for myself. I have most nights for myself. I found some residencies that care about mental health: They have work-life balance in family medicine. Yes the salary prospects are not great, and I have nearly 250k in educational loans, but the fact remains that I probably saved myself from true death by switching out of the tunnel of gloom that is surgery. So I send the message to the surgeons out there: Please change the culture of surgery.

The author is an anonymous medical student.

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