Let’s see: two scalpels, two Debakeys — or wait, were those Adsons? Are there lines on the sides? Are they toothed?!
Jesus Christ, Christina, get it together.
Three wet laps, two dry, one protected needle and…inhale. What the hell is wrong with me?!
I focused on my breathing and continued to count the surgical tools that I saw laid out on the sterile tray. One of the interns earlier in my rotation advised that this helps if you experience an ‘episode’ while being scrubbed in.
It wasn’t working.
My eyes shot back to the laparoscopic monitor.
This isn’t gross. There isn’t even pus! They’re dissecting the freaking mesentery!
And yet, the tingles started: first at my feet, and then up to my knees. I wiggled my toes, made sure my knees weren’t locked and cracked each knuckle in my hands.
Nope. This was not going to work.
I quietly coughed out an attempt at a “hey,” mouth dry from hours of standing still. I whispered to the intern next to me (who was also fully scrubbed in but also just standing), “Hey, do you think I could scrub out really quick? I need to use the restroom. I wasn’t expecting the surgery to take this long.” She darted a look at the attending and senior resident next to her; they were deep in conversation about the approaching splenic flexure. She nodded her head quickly. I stepped back, quietly slipped off my entire scrub outfit in one motion, and disappeared into the shadows of the operating room (OR) and out the back door.
As soon as I let the door close quietly behind me, I turned to face the glaring, rude fluorescent lights of the OR foyer. I felt my pupils constrict against their offensive shine as I ripped down my mask to suck in as much oxygen as my deflated lungs possibly could.
The OR charge nurse looked at me, then through me, the moment she saw the gray ‘Medical Student’ tag dangling below my photo ID on my scrubs.
Well… at least I can’t embarrass myself if I don’t exist, I thought. For some cursed reason, I began feeling all normal sensation return to my toes and fingers — dizziness subsiding, breaths relaxing.
And you want to be a surgeon, Christina. Yeah, okay.
The first two years of medical school were fairly straightforward: Here’s a ton of information. It’s literally impossible for the human brain to know this much. But, here you go, try your best. Then take a test so that we can make sure you’re not too dumb to do this. See ya on the other side!
We pass our tests (after shaving a few years off our lives) and are immediately thrust into an entirely new, entirely high-stakes clinical environment. On the wards, we are told to “go forth and learn, my children!” The problem is, we arrive at the hospital devoid of some nonclinical yet critical preparatory knowledge. See below.
Things I did not learn in the first two years of medical school that would have been the most valuable information on Day 1 of clerkships:
1. Where to stand
2. How to stand (also what do I do with my hands?)
3. When to sit
4. When to absolutely not sit
5. What to touch (answer: nothing)
6. What to not touch (answer: everything)
Instead, we learn this all — painfully — starting on Day 1. And much like the fear of death that baby sea turtles feel while frantically scuttling to the shoreline before a seagull scoops them up, we scuttle through the hallways, dodging seagulls left and right. It’s just embarrassing all around.
While we all saw this coming to some extent, contextualizing these faltering moments within the purpose of clerkships is much harder than I could have expected. When does the stress, anxiety and uncertainty mean ‘I shouldn’t do this’ rather than ‘this is hard, new or different’?
Making that distinction isn’t always clear, and nobody really even tells us that such a distinction exists. Before I knew it, there I was: bumping my way through the halls of the hospital with no idea if I was doing anything right. And, more importantly, I wonder, “Am I ever going to be good at this?”
Since before we even got into medical school, we were told that objective failure or poor performance meant we weren’t cut out for it. Objective measures included pre-med grades and MCAT scores; and then in medical school, course grades, Step 1 scores, shelf scores — it goes on and on and on.
So, if every metric used to measure our ‘ability’ thus far has been numeric and has an option for failure, why wouldn’t we apply the same standard to the more qualitative things we do? I totally get it. But it’s also totally ridiculous.
If we came into medical school knowing how to log patient notes electronically, or how to maximize blood flow to our brains during a six hour-long surgery (still looking for advice on this), or how to ace a patient history and physical exam, well then we wouldn’t need clerkships.
And this is what I tried to tell myself, standing in the hall of the OR foyer. I recognized the ridiculousness of my situation on a personal level as well as how actually insignificant it was to the bigger operation (pun intended) around me.
Nobody cares that I’m out here. Nobody understands the severity of this moment as it sits in my brain. If anything, I’m only taking up valuable floor space in this hall right now.
I wondered if I should go back in straight away.
Wait, can I go back inside? Am I allowed to rescrub? I rolled my eyes at the ceiling as I leaned against the wall with nurses zipping past me and lights buzzing angrily in the background. Well… shoot.
I ended up going back inside and scrubbing in without issue. Nobody even noticed I was gone. Of course, it could’ve gone the other way. I could’ve been asked to leave or told I made a grave mistake by scrubbing out somehow.
And honestly, that would’ve been okay too. Because, from what I’ve learned in my short time working in the hospital, we’re going to mess up. Hard. It’s going to be embarrassing. And we will have not just a few but dozens of mistakes and ‘oh crap’ moments to pepper our experiences in clerkships. We have to remember, however, that this is how the process works. We just aren’t really trained to think in that way.
So, what do we do? I suppose now is as good a time as any to start retraining our brains in the same way we retrain our legs to handle standing for six-plus hours at a time. There’s a peace, however initially awkward, that comes with the ability to feel comfortable with the uncomfortable. It’s certainly not a switch we can flip overnight. It’s hard work learning to be okay with failure and shortcomings, but getting there pays off.
Suddenly, the fear that plagues us on our journey becomes a question we can answer or an area in which we can improve. Made a mistake? Great! What was it? Why did it happen? How can we avoid this next time? Alright, let’s try again.
We need to divorce ourselves from the idea that failure means we do not belong or that we are not good enough. If you talk to any resident or attending physician, you’ll find that their journeys were just as peppered with miserably embarrassing experiences as ours. The only difference is that it’s worn as a badge of honor rather than a scarlet letter.
Don’t get me wrong: I don’t wish a miserable, embarrassing medical school experience on anyone. Instead, I implore us to consider the limitations of contextualizing those experiences in a negative way. We should take our experiences for what they are and elaborate on those that help us or bring us joy. Let’s use our embarrassing moments in surgery to fuel a desire to grow — or alternatively, as excellent and funny stories to tell friends and family.
After all, these moments of uncertainty and failure are inevitable. So, let’s inhale, focus, and repeat. Standing for six hours straight isn’t natural, but I’ll be back — just this time with compression socks.
While nontraditional paths to medicine come with their own unique perspectives and hurdles, often overlooked are the nontraditional experiences that color our paths once we make it through the medical school doors. Whether it’s questioning our motives or finding purpose while blundering through the hospital halls, the off-book lessons we learn as med students are often the most valuable, and deserve some time in the spotlight. With this in mind, Christina’s column seeks to unpack the anxiety and find the humor in pursuing a notoriously tough career path.