Ever wondered what it’s like to be a heart surgeon? Since my last blog post, I’ve gotten a chance to find out. I am doing my surgical rotation on the Cardiothoracic service. I haven’t settled on how I feel about it. Over the last two weeks I’ve gone from absolutely dreading it…to pure enjoyment.
My team is small. Just myself, my resident (R3) and our attending–the only cardiothoracic surgeon at our institution. Partly out of necessity since my first morning I’ve been pushed into the role of “acting” sub-I/junior resident. At first having such high expectations thrust upon a meager 3rd year med student was terrifying. I felt as if I was failing at every step (and I was). My confidence crumbled as my inadequacies were brilliantly pointed out every morning. This was my first introduction to intensive care medicine. I knew nothing about management of drains, chest tubes, cardiac output monitors, ventilation settings, etc. I stared wide-eyed during am rounds as I had never even heard of most of the things my resident asked me to do. She pushed me at every opportunity. She knew exactly how uncomfortable she was making me. And she did it with just that purpose. Here was a person who was interested in seeing me grow. She was dedicated to my education.
So often as medical students we are given an easy pass…don’t know something, well that’s ok, you are “just” a med student. Not on this team. Every time I didn’t know something, I looked it up, wrote it down in my handy mini moleskin notebook and burned it into my brain. The embarrassment alone was enough not to let me forget it. Nothing was ever overtly said, but not knowing the answer to something is unacceptable to me (I put a lot of pressure on myself to be the best I can). I feel so lucky to have my resident on our team. She pushed me out of my comfort zone–in the process, I face-planted. Only to get up feeling like I actually can be a resident next year. Every day, I am starting to feel more comfortable about the non-theoretical medicine stuff. Like what meds we actually use to replete mag, how much do you give? When is it time to take out a blake? What CVP are you comfortable with? What are extubation criteria? How to remove a chest tube without giving your patient a pneumothorax. Nitty gritty medicine, you don’t want to waste time intern year having to look-up. After a 6-7 hour open operation our patients are fragile; their kidneys do funny things, their hearts get funny rhythms and there are a million reasons why we manage them in the ICU. With each passing day I’ve grown less terrified about how it all works.
As in most surgical specialties the days can be long. Really, really long. My record was starting the day at 4:30 am and not getting home until midnight after two long open heart surgeries. At the end of that day my feet felt like I just climbed Kilimanjaro. (Hint: I ordered compression stockings for rush delivery that night). I am in awe of our CT surgeon who is a mythical creature. He works like a machine. Never needing to use the bathroom. Barely eating and always up for adding on an additional heart case no matter how late in the afternoon the consult is. Heart surgery requires such a person. I have convinced myself that for 4 weeks I can assume the role of a machine, but not a day longer than that.
The surgeries themselves are amazing. Who doesn’t want to spend the day staring at a human heart. Stopping it. Then bringing it back to life again. Heart surgery is surprisingly formulaic and now having done 7 or so surgeries I can start to anticipate the next move. I know where to suction, how close to cut the suture, when to retract, when it’s my turn to step in and help with opening the thoracic cavity or what closure suture to use. Now that I know what I am doing, I enjoy the OR very much.
I didn’t know what to expect starting this rotation. I have been pleasantly surprised at how much it has challenged me. My resident is an amazing mentor. She’s found the exact style of learning that will take me to the next level of my training. A combination of uncomfortable pressure with the generous reward and satisfaction of knowing something I failed at before. If I can make it through this, who knows what else I’ll be able to accomplish.
Sometimes you have have to fail at something to learn.