My preceptor’s voice was unmistakable. We had just finished our first case and I had momentarily left to get some coffee.
“This is getting unacceptable, someone needs to bring this up to the board!”
I had never seen him so worked up after having worked with him over the course of the week. Whatever this issue was, it clearly had been festering for while. From the sounds of it, the person in question has had a habit of this particular behavior.
“I agree, he keeps getting away with it and figures someone else will be there to pick up the slack,” said another anesthesiologist.
“It’s a typical surgeon’s mentality, they all just want to operate and then not deal with patients afterwards,” chimed in a nurse who was on her break.
“Whoa, I operate and see my patients plenty,” said one of the orthopedic surgeons. “Don’t lump us all into the same group here.”
It was getting a bit uncomfortable in the staff room, especially for a visiting medical student who had only been here for a week.
“I think I’ll go check on our next patient,” my voice rasped. This was a bit of a lie as I knew the next patient was not in the pre-op room; I just needed a parachute and, in turn, I hurried out.
As the day continued, I heard more and more snippets of what was happening. Putting all the parts together, it seemed like the commotion was about a particular surgeon who allegedly went ahead and booked a patient for an operation at the end of the day, even calling to tell that patient to come down to the hospital without informing anyone else ahead of time. People were frustrated with having to work longer, rescheduling other cases on the trauma list and just the blatant disregard for process.
At the end of the day the surgery did occur but the surgeon in question did have a reason for his actions: his patient was riddled with widespread metastatic colon cancer. The patient and his family had different views on how to move forward on treatment, with the family wishing for palliation while the patient was still hoping for a cure. Finally, this surgeon agreed to conduct an exploratory laparotomy on the patient to see if there was any portion he could possibly resect or at least definitively ascertain the prognosis. Unfortunately, there was nothing to be done because the abdomen was riddled with tumor. Following the operation, the surgeon phoned in the family and stayed near the patient’s bay until the patient and the family was ready to hear the news.
This experience reinforced the notion to me that there’s always more than one side of an experience in medicine. It’s easy to craft and follow stories that have clear “heroes” and “villains” but when does reality ever exist in such distinct dichotomies? All too often, easy short cuts are applied in the hospital setting which lead to labeling people, for example the “cold” surgeon or the “whiny” patient. One of the most important reasons to further explore the narratives in medicine is that doing so breaks past initial labels and allows us to better understand patients, how their experiences have shaped them and where they see themselves in our care.
The clerkship experience can be the definition of tumultuous. As we’re suddenly tossed into the wards, it’s easy to become caught up in the shuffle as we move through our service rotation. These posts try to take a step back and become “a fly on the wall” observing and reflecting on the overall movement through clerkships.