Walking into the conference room for grand rounds, I took a deep breath. I was terrified. My biggest fear was that I would hate it — hate the time spent in neurosurgery, hate the American health care system and even just hate surgery over medicine. I have spent a long time imagining and planning for my future career as a neurosurgeon in the United States. Becoming a surgeon is a major part of how I define myself. If I hated this first exposure to neurosurgery, what would I do next?
I was afforded the opportunity to spend six weeks in the United States as part of a research component my school in Ireland requires students to complete in our third year. Although the aim of the six weeks was to complete a research project, I also wanted to see as much neurosurgery as possible. I didn’t need to worry. Within a few hours of meeting the staff in the neurosurgery department, I was certain that my career decision was the right one. Standing in the operating room watching the surgeon complete a decompression of a brain tumor, I knew there was nothing else I wanted to do with my life.
1. It’s all English…
In Ireland, we call qualified surgeons “Mr.” or “Mrs./Miss,” a tradition that dates back to the mid-19th century when surgeons trained by apprenticeship and were not required to have a university degree. I am so used to it that I didn’t think about it until I went to Missouri. Here, everyone is “Dr.” This seemed like it would be much easier to remember, but I spent a shocking amount of time mentally correcting myself before I spoke to anyone for fear of causing offense. Now that I am back on clinical rotations in Ireland, I find myself regularly biting my tongue before I address my consultant (i.e., attending) as “Dr.” Apparently, it takes 21 days to break a habit; I have only been home 15 days. I should finally have my act together by next week.
Another piece of terminology led to one of the funniest email exchanges I have ever had. Trying to set up a time to watch surgeries, I emailed a secretary to ask if my time in the theatre had been approved. It was only when she asked me if I was going to see a play that I realized saying “theatre” is not commonplace in the States. I quickly asked people around me what they thought I was talking about when I referenced the “theatre.” They all admitted they had not heard it before, but knowing I was Irish and given the context I usually said it in, they realized what I meant. It made me pause and consider how the words we take for granted as “everyday” can be misconstrued, and that this would be a point of consideration when using medical jargon with patients.
2. No Scrubs
Coming from a nursing background, there are some things that are sacrosanct. In Ireland, one of these is wearing a nursing uniform outside of the hospital — it is strictly forbidden. Though you will, of course, always see nurses doing it, it was one of the most heavily labored points during our training. The risks are twofold: carrying germs from the outside world to the vulnerable patients in our care and carrying pathogenic organisms home to our loved ones.
Our first day in the American hospital we were given two pairs of scrubs: light blue and dark blue. Dark blue scrubs were for strict indoor use and going to theatre. The light blue scrubs were for “everything else.” I am sure my look of confusion was similar to Captain Von Trapp’s when Maria mentions “play clothes” for the children. I just didn’t get it. “Everything else” turned out to mean our time spent completing research between the different buildings on the hospital campus. I quickly realized that people wore scrubs everywhere: walking to and from work, out to coffee shops at lunch and around Whole Foods while picking up groceries. Walking outside in scrubs for the first time felt like I was breaking a million rules, but I began to appreciate the light blue scrubs that saved me so much time wondering what I should wear.
3. In the wee hours of morning
When I found out the neurosurgery rounds started at 5 a.m., I balked. It seemed unnecessarily early. Not to mention that my accommodation was a full 30-minute walk from the hospital. “How would anyone maintain that pace?” I wondered. The residents came in nearly always before 5 a.m. and would stay until past 6 p.m. most evenings. In Ireland, an under-pressure health system means junior doctors work long hours as par for the course, but these hours in America seem to have been accepted as a routine, everyday part of life for residents of all years.
I understand the benefits: rounding at 5 a.m. allows residents a chance to examine their patients and hear how they got through the night before surgeries start. There is time to simply be with the patient before the stresses of the new day take over. In Ireland, start times can vary wildly between specialties and hospitals. I’ve been to ward rounds which start at 7 a.m. sharp. However, I have also arrived early for a day in the operating theatre only to find the first procedure didn’t begin until closer to 10 a.m.
In America, the surgeries start promptly at 7 a.m. This was my favorite aspect of my placement: the total, reassuring organization of the days. Surgeries started at 7 a.m., and you could spend your entire day seeing new procedures. There were also more than four times as many operating theatres than I was used to at home. The residents did not attend clinics but spent their days in theatre, learning from attendings and honing their craft. Although Ireland may have held on to the medieval apprenticeship titles of ‘Mr.,’ it was America that held most firmly on to the apprentice style of surgical training.
The six weeks I spent in the States were invaluable in confirming for me that I am firmly on track with my 10-year life plan. It was eye-opening and a confirmation that the U.S. is where I hope to complete post-graduate training. Now to conquer the next hurdle … the USMLE Step 1. Wish me luck!