From the Wards
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The Third Year Surgery Clerkship: Medical Students and Murphy’s Law

If the analogy between medical training and a fraternity is true, then medical students are the pledges.

For many, the most grueling part of this pledge process is the third year surgery rotation where the modified Murphy’s Law is applicable almost daily: anything a medical student can do wrong, a medical student will do wrong.

In a fraternity, pledges can do no right. Correctly answered questions are criticized for being said too slowly or without conviction. Several correctly answered questions in a row are almost certainly followed by harder and more esoteric questions until the senior questioner stumps the junior trainee.

The same goes for the surgery clerkship.

Attending surgeon: “Which part of the intestine are we holding?”

Me: “Uhh, the small intestine?”

Attending surgeon: “Good. What is this yellow material attached to it?”

Me: “Uhh, the mesentery.”

Attending surgeon: “Good. What is the name for this specific little piece of fat (that looks identical to everything else)?”

Me: “Uhh…”

Even the smartest student will be tested to his or her limits. On this occasion, my limit happened to be the ileocecal fat pad of Treves.

In a fraternity, pledges have menial responsibilities such as alphabetizing anything alphabetizable, cleaning the bathroom and organizing bookshelves. During the surgery clerkship, medical students are responsible for similarly minor tasks. The tasks are important enough to make the student feel included in the case but subjective enough to be criticized.

Even the most basic skills, such as cutting string or ripping tape, become unusually difficult in this pressured setting. The timeline of a standard operation typically goes as follows:

  1. Me: “Hello, Mr. Smith, my name is Brad Lander. I’m a medical student on the surgery team helping with your operation today.” Mr. Smith: “You’re just going to be watching, right?”
  2. After wheeling the bed to the operating room and seeming to bump into every corner en route, I dance around the room trying not to contaminate anything already sterile.
  3. I go to scrub and then while putting the gown on, my fingers manage to get stuck in the gloves. Every time.
  4. The operation starts. The surgeon begins to quiz me. I am averaging about 70 percent correct answers. Not bad for basketball. Not good for surgery.
  5. I use the retracting device to expose the abdomen for the surgeon to see. “You’ve got to pull harder, don’t give up on us now,” the surgeon says.
  6. The surgeon stitches the tissue together and instructs me to cut the suture. I do. “You left it too long,” he says.
  7. The surgeon stitches more tissue together and instructs me to cut the suture. I do. “You left it too short,” he says.
  8. As the surgeon cauterizes the tissue, I earnestly use the suction tube to suck the rising smoke out of the field of view (and smell). The surgeon notes: “Your instrument is blocking my view.”
  9. We begin to close the skin at the end of the operation. “Here, Brad, you suture this small one-centimeter incision.” It’s my first time suturing, and I immediately develop an essential tremor. I somehow leave the patient with two centimeters of cosmetic imperfection.
  10. We finish the operation. I can sense the surgeon’s impatience, so I hurriedly bring the bed in from the hallway to transfer the patient from the operating table. The anesthesiologist glares at me: “The patient is still intubated.”

Despite being a victim of Murphy’s Law repeatedly during the case, my attention shifts.  I realize that we just removed a grapefruit sized mass from a patient’s abdomen. Cosmetically, he looks much better. His confidence in his appearance will increase and his pain should subside within the next few days.  In the span of a few hours we substantially improved the quality of this patient’s life — a reality that I know matters much more than whether I correctly answered the intraoperative questions directed to me.

The similarities between the surgical clerkship and the fraternity pledge process become more apparent at their conclusions.

In fact, the shared experiences during fraternity pledging serve as a bond for the brothers long after we are inducted as full members.  We reminisce on our assigned tasks and are able to laugh at them retrospectively. We know that all of our predecessors completed the same process and all those who follow will do the same. We earned our way with no shortcuts.

Similarly, the third year surgical clerkship is a shared experience among physicians, regardless of whether surgery is our ultimate career path. I recently spoke with two of my uncles about my experience, one is a pediatrician and the other is an ophthalmologist.

They both asked me, “So, did you cut the suture too long or too short?”

Author’s note: This article was previously published on KevinMD.

Bradley Lander (1 Posts)

Contributing Writer Emeritus

Case Western Reserve University School of Medicine

Bradley is a medical student at Case Western Reserve University School of Medicine.