Anyone else had these same doubts about surgery?

[Micro115]

---

Members do not see this ad.

Was wondering if any resident or attending surgeons could answer these questions:

1) Taking on the responsibility in the OR - Did anyone go into residency loving surgery but still had that fear of making mistakes intraoperatively (e.g., cutting a nerve)? If so, has that fear dispelled now with all of your training?

2) Acuity/Need to make quick decisions - Especially on a trauma rotation, was it nerve-wracking for you to make split-second life-death decisions for the patient? Did you build confidence along the way, or had you enjoyed or were confident in making these types of decisions from the beginning?

3) Anatomy - Did most/all of you surgeons absolutely love anatomy from the start?

4) Lifestyle, family, kids - Particularly for the female surgeons, how do you plan on balancing family and career, if you have an interest in having a family? Before committing yourself to this field, did you make sure you were comfortable NOT having a family if that become the case in your life?

5) Novelty wearing off - Even after doing a surgery multiple times and mastering the necessary technical skills, is doing the surgery still fascinating to you?

6) Attitude change - For those who were always nice/respectful/compassionate to nurses, patients, attendings, etc. prior to residency, does anyone feel that their attitude changed greatly during/after residency such that they act more impatient/rude or less respectful to other healthcare professionals or patients?

 

[Winged Scapula]

Was wondering if any resident or attending surgeons could answer these questions:

1) Taking on the responsibility in the OR - Did anyone go into residency loving surgery but still had that fear of making mistakes intraoperatively (e.g., cutting a nerve)?

Of course. The fear of hurting someone is very common. Even my User Name is in reference to it (albeit something I've never knowingly caused).

If so, has that fear dispelled now with all of your training?

No, not really. Its lessened with the easier, more common, less risky surgeries but when working in a dangerous place, I still worry about hurting someone.

2) Acuity/Need to make quick decisions - Especially on a trauma rotation, was it nerve-wracking for you to make split-second life-death decisions for the patient?

Few things, especially trauma, are "split second life or death decisions". Trauma is algorithmic, so decisions are relatively easy to make. That didn't mean that I wasn't nervous with very ill patients but I worried more about the ICU patients rather than guys in the trauma bay.

Did you build confidence along the way, or had you enjoyed or were confident in making these types of decisions from the beginning?

Absolutely. Confidence was certainly not one of my strong suits, but you build it along the way with little successes here and there. Surgery residency sometimes seem designed to try and break that down but you build it back up by doing a good job, making a diagnosis that others have missed, passing your boards or getting a nice compliment from a patient or colleague.

3) Anatomy - Did most/all of you surgeons absolutely love anatomy from the start?

Eh, not really. I had an affinity for it because memorization was a stronger suit for me and that lent itself to doing well on gross anatomy. But frankly, surgical anatomy is so different than gross anatomy that you sometimes wonder if they are even remotely related. I found physiology more interesting than anatomy but harder to conceptualize.

4) Lifestyle, family, kids - Particularly for the female surgeons, how do you plan on balancing family and career, if you have an interest in having a family? Before committing yourself to this field, did you make sure you were comfortable NOT having a family if that become the case in your life?

I am missing the "desire to have children" gene. Never wanted them although I am told that I am "great with kids" and don't necessarily dislike them. So I never really thought about balancing family and career, but rather figured if I did something that I thought was challenging and interesting, that it would make me a better partner. Fortunately for me, there are lots of men out there (despite what you read on SDN) who feel the same way and aren't looking for a SAHM.

5) Novelty wearing off - Even after doing a surgery multiple times and mastering the necessary technical skills, is doing the surgery still fascinating to you?

Fascinating would probably be overstating the case. Interesting, yes. Every case is a little different as is every patient. While others may think my career choice is extremely limited, as a specialist I see the odd stuff, the things that don't go to general surgeons: widespread recurrences, chest wall reconstructions, angiosarcs, fungating tumors, etc.

6) Attitude change - For those who were always nice/respectful/compassionate to nurses, patients, attendings, etc. prior to residency, does anyone feel that their attitude changed greatly during/after residency such that they act more impatient/rude or less respectful to other healthcare professionals or patients?

Not necessarily. I have probably always been nice and respectful but with little tolerance for BS that I see as a waste of my time. I am however, passive aggressive about it most of the time rather than rude. If I'm tired or extremely stressed, I have been "short" with people (as my mother would call it) and usually regret it later. So training didn't change that so much as rather make me tired or more stressed so more likely to be short if faced with institutional or personal ridiculousness.

Fortunately, there are enough asses in surgery that you don't have to be Mary Sunshine to be thought of as the greatest person in the OR.

 

[LovelyRita]

Was wondering if any resident or attending surgeons could answer these questions:

1) Taking on the responsibility in the OR - Did anyone go into residency loving surgery but still had that fear of making mistakes intraoperatively (e.g., cutting a nerve)? If so, has that fear dispelled now with all of your training?

2) Acuity/Need to make quick decisions - Especially on a trauma rotation, was it nerve-wracking for you to make split-second life-death decisions for the patient? Did you build confidence along the way, or had you enjoyed or were confident in making these types of decisions from the beginning?

3) Anatomy - Did most/all of you surgeons absolutely love anatomy from the start?

4) Lifestyle, family, kids - Particularly for the female surgeons, how do you plan on balancing family and career, if you have an interest in having a family? Before committing yourself to this field, did you make sure you were comfortable NOT having a family if that become the case in your life?

5) Novelty wearing off - Even after doing a surgery multiple times and mastering the necessary technical skills, is doing the surgery still fascinating to you?

6) Attitude change - For those who were always nice/respectful/compassionate to nurses, patients, attendings, etc. prior to residency, does anyone feel that their attitude changed greatly during/after residency such that they act more impatient/rude or less respectful to other healthcare professionals or patients?

1. One of my attendings at an outside rotation was making fun of me saying I have "FOFU" (fear of f'ing up). I told him yes, I have a severe case of this and laughed. But stuff I'm familiar with, well, you always have to be aware of how you could hurt the patient, but your skills become more tuned once you do know what you're doing.

2. I agree with WS's statement. Trauma is kind of intimidating at first but in the trauma bay it's stepwise. It's the PTD 1 stuff that happens that makes you nervous.

3. I didn't love anatomy, nor did I hate it. Did just as well in it as my other coursework. Did good in the lab, and lab partners joked back then that I would be a surgeon. Another kudos to WS--surgical anatomy/gross anatomy = not the same!!! Start looking more at surgical atlases and less at Netter's. You'll see.

4. Sigh. I do not have kids or a spouse for that matter at this point. Why that is remains available for speculation. The fact that most of my time is spent within a hospital likely has something to do with it. Anyway, when I decided to pursue surgery, my mentality was, well, if I meet someone and it produces kids, then excellent. Kind of leaving it to fate.
Honestly, I don't know how people with kids and a husband do it. I get up around 4:15 every day. Am at the hospital by six. Sometimes for 2 or 3 weeks in a row. I'm on call a couple of times a week which means I get to work at 6 and do not come back home till sometime the next day mid morning. This "post call" day is variable. Sometimes I sleep most of the day, wake up, eat dinner, read a little or prepare a presentation then go back to bed. Other days I make plans for general life maintenance—grocery store, work out, meet friends, etc. But you can't really plan, you know? I would not be a good mom if I had a kid, and probably would have to be a resident who is not a strong link on the team because of family obligations. I believe it would be stressful and barely possible unless you had a stay at home spouse who took care of everything for you. Read everything I just wrote 2 or 3 times. It is the truth, and don't let anyone convince you otherwise. If family is important to you in the imminent future, do yourself a favor and choose a residency that might be more lifestyle friendly. Family is important and you only get one shot at this life. Do what's right.

5. Surgery is still fascinating and I love the OR! It is the antidote to scutwork for me.

6. Agree with WS.

Good luck. I look forward to being done. No one has a crystal ball, but facts are facts. Be aware of them. I just remember one recent call night where I had already been AWAKE for 24 hours, I was standing by an elevator, doing stupid nighttime scutwork and thinking about my ER comrades who most definitely get sleep every day within a 24 hour period. What a sham, I thought. I signed up for this?? I'll make it through, but you have to ask yourself if this is the way you want to spend your life. And of course once you're done with the 5 years and become an attending, things are most likely different (they are, aren't they, WS??) But remember, it's a half a decade of your life following the schedule I highlighted above.

 

[geekgirl]

first, i commend you for asking these questions of yourself at all. particularly BEFORE committing to a surgical residency. the only people i have seen leave the field are people who in my opinion had not fully considered these issues, particularly what effect this will have on other parts of you and your life....

1) Taking on the responsibility in the OR - Did anyone go into residency loving surgery but still had that fear of making mistakes intraoperatively (e.g., cutting a nerve)? If so, has that fear dispelled now with all of your training?

i asked myself this seriously before starting. and i agree with the above posts re: FOFU. i may not be the fastest resident to operate with (albeit not the slowest) but my feeling is that doing the RIGHT operation not the fastest operation is important. if i take a little time to make sure i'm identifying the right things, so be it. speed will come with experience. but you can't uncut. that's my feeling.

but to be a good surgeon, you need to be the kind of person who can take responsibility and be able to live through a moment where you realize that something you did had an untoward effect on another human being. becuase it will happen to everyone, regardless of how good you are. so for me being fastidious about what i do and why i'm doing it makes living with the decisions so much easier. because i am trying my best to do the right thing, even if it is not the right thing that is done.

2) Acuity/Need to make quick decisions - Especially on a trauma rotation, was it nerve-wracking for you to make split-second life-death decisions for the patient? Did you build confidence along the way, or had you enjoyed or were confident in making these types of decisions from the beginning?

i do think that despite the above mention of algorithms, there is the need in a good surgeon to be able to make decisions in stressful situations. my theory is that decisions made in acute settings may not always be correct, but they can be modified on a moment to moment basis. i have seen problems arise from inability to make decisions, and problems arise from rash decisions. our job is to calmly guide decisions. and agreed, there are always a few moments to spare to STOP AND THINK. even in a trauma or ICU code.

3) Anatomy - Did most/all of you surgeons absolutely love anatomy from the start?

for me, as the child of an artist and a surgeon, i was born with a visual mind. i actually did love anatomy, but for the same reason i love surgery. if i can see a picture of it, i can understand it. i like words too, granted, but only as a means of conveying the picture i see in my minds eye. but agree with the others, surgical anatomy is a far greater beast than anatomy texts or class. i have found during residency that once i have operated in a given region, i have an almost gut understanding of the region that i could NEVER have gotten from a book. i can barely describe how awesome it was doing thoracoabdominal aortas or lung resections and finally understanding that damn anatomy.

4) Lifestyle, family, kids - Particularly for the female surgeons, how do you plan on balancing family and career, if you have an interest in having a family? Before committing yourself to this field, did you make sure you were comfortable NOT having a family if that become the case in your life?

this is a huge one to consider. i did not intend to be a surgeon, but once i realized i couldn't get rid of the bug and only wanted to be on surgical rotations, i sat down and had a mental intervention, asking similar questions to those you have asked. could i do this? was it worth it? was i willing to give up what i might potentially need to give up in order to do this? my answer was yes. that doesn't mean i don't want to get married, have kids, etc but i was willing to risk that option to pursue this pathway. my theory is that as a single person, it was a crapshoot whether i would find the right person/circumstances, so better to pursue the pathway that i found more fulfilling rather than wait for some faceless person to come along. so far so good.

5) Novelty wearing off - Even after doing a surgery multiple times and mastering the necessary technical skills, is doing the surgery still fascinating to you?

this i never worried about. i stop clockwatching in the OR. it is just fascinating. particularly when you get to do it!

6) Attitude change - For those who were always nice/respectful/compassionate to nurses, patients, attendings, etc. prior to residency, does anyone feel that their attitude changed greatly during/after residency such that they act more impatient/rude or less respectful to other healthcare professionals or patients?

i worried alot about this last one. i recruited all my friends and family and told then to kick me in the shins if i started being a megab*tch. because that is just not me. and again i have found that i am still me. still nice. still seen by others as pleasant and easy to work with. but i did take this "soul factor" very seriously when choosing a residency. i went with my gut and am very happy with my choice. but i did rotations at several programs where it would have been far harder to maintain my soul and personality. so be careful where you train. the attitudes of those around you will effect you. i love my peers and my attendings, so i feel reasonably supported in being me as i train. and no one has kicked me in the shins yet, so again so far so good....

gg

 

[Winged Scapula]

i do think that despite the above mention of algorithms, there is the need in a good surgeon to be able to make decisions in stressful situations. my theory is that decisions made in acute settings may not always be correct, but they can be modified on a moment to moment basis. i have seen problems arise from inability to make decisions, and problems arise from rash decisions. our job is to calmly guide decisions. and agreed, there are always a few moments to spare to STOP AND THINK. even in a trauma or ICU code.

This is an excellent point that I did not address and I think it nearly defines a surgeon.

As a surgeon, you will have to make countless decisions every day. Most of them will not be life or death or have devastating consequences if you are wrong.

However, the willingness to make a decision, quickly, perhaps without all the information and to accept the consequences is a requirement, IMHO. As gg notes, sometimes your decisions will be wrong but you live with that and learn from it. Whether this is a trait inherent in those attracted to surgery or the field demands it (or both), I don't know, but it is something I don't see as commonly in other fields (where you *may* have the luxury of time to make decisions).

The decision making can be exhausting hence my lack of interest in making them when I get home.

 

[Micro115]

This is an excellent point that I did not address and I think it nearly defines a surgeon.

As a surgeon, you will have to make countless decisions every day. Most of them will not be life or death or have devastating consequences if you are wrong.

However, the willingness to make a decision, quickly, perhaps without all the information and to accept the consequences is a requirement, IMHO. As gg notes, sometimes your decisions will be wrong but you live with that and learn from it. Whether this is a trait inherent in those attracted to surgery or the field demands it (or both), I don't know, but it is something I don't see as commonly in other fields (where you *may* have the luxury of time to make decisions).

The decision making can be exhausting hence my lack of interest in making them when I get home.

Thank you to you all who have been responding. I really appreciate your feedback, and it is incredibly helpful to view the surgical field through your perspective.

With regards to the decision-making, how do you know as a med student that it is something you're good at? If a patient codes, if I'm working in the trauma bay, or if another acute situation arises, there are obviously other residents making those important medical decisions, and even after reflecting on my life and medical experiences, it's hard for me to gauge how I would react and reach a decision in those situations. I've definitely been in stressful and life-death situations before but only where I was the one at risk, not where I was the sole person caring for a patient (I think the two types of situations are still different since you must remain calm and assess the situation from a medical standpoint in the latter).

Any thoughts on how any of you can assess your quick medical decision-making skills prior to residency (not including those that you had to make during a timed test)?

 

[geekgirl]

how do you feel in those situations? if the answer is ok, clear, not freaking out or hyperventilating then the chances are good you'll manage.

being a responsible party occurs in a graded fashion over time. there are always people around to help (for the most part). but just assess how those situations make you feel. i was always clearheaded in those times, looking for jobs to assist the chaos rather than reacting to the stress of the situation. if this is you, you'll do fine.

and long story short, there is much unknown in this process of training.

will you be good? will you be a strong resident? will you be successful? in life, there is always the risk of failure - sometimes you just have to try. but if you try it cause you love it, chances are you'll do well.

 

[DoctorMunchkin]

I agree with the almost all of the above. The responsibility and decision making come over time. You grow and learn. There are always people giving you graduated responsibility. You learn to do a basic skin closure, then you get to try to actually make the incision. Somewhere along the way you learn to tie by ligating peripheral bleeders. At some point you are allowed to ligate the tenuous branch of some deep pelvic bleeder (which if your tie falls off you are screwed!!!)

Its like learning to ride a bike. No one is just thrown on the bike and waved along their merry way. Your parents helped you and protected you and slowly let you take farther steps from them. Much of training is like that. You take baby steps and eventually learn to do it all on your own.

the trauma bay is a big scary frightening place. You eventially become comfortable with making decisions based on half the information. The algorithms help but so does time and experience. It all comes together eventually. If it excites you as a a med-student (and doesn't scare you to death) surgery might be the place for you.

The only thing I have to disagree on is the children issue. I have to admit that I never pictured myself as the mothering type growing up. I was more likely to cut my sister's dolls hair than to play with them. But now I have two kids and wouldn't trade them for the world. One of them was actually born during residency. I still work very hard at work, I am usually right at 80 hours a week. I then try to read every night, often staying at the hospital to do it. I occassionally have to do some work at home, but not too often. I am blessed to have a husband who is willing and able to shoulder much of the daily feeding/bathing/clothing issues. It is a juggling act some of the time, but worth it. I think the difference is that I simply prioritize things differently than a single person or married without children would. I did consider not going into surgery, but knew I wouldn't be happy in any other field. I figured I was a much better example for my children as a happy, but busy surgeon than as a not busy, but VERY unhappy psychologist. Perhaps its wrong thinking, but it has held true so far for me. Its do-able, just have to learn to juggle.

Surgery is still the best job in the world. If that's what you want to do, you should do it. If husbands, kids, pets or sick parents or what ever comes along in the future, things can be worked out. Life happens despite being a surgeon and going through residency training. Having a family is a consideration but it should not have to be an either/or situation.

Just my $.02 worth.

 

[fourthyear]

Very good questions to think about. I'm currently in my 3rd month post-residency job in a private practice general surgery group, straight out of 5 year general surgery residency program.

1. I don't have fear while in the OR, but I will say I am very careful and cautious, moreso now that I don't have an attending watching me like in residency...you are very supervised in residency, so I'm feeling it more after residency - wow, now it's all MY responsibility if somethign goes wrong, and I do worry alot about potential complications, which isn't necessarily bad and hopefully will stress me out less as I get more experience.

2. You do have to make quick, decisive decisions at times, but this ability can be developed - I have seen it in many fellow residents who developed it over the years of training and experience. Trauma is actually pretty routine most of the time and my mid-3rd year resdiency I was very confident at the routine.

3. yes, i always liked anatomy - I'm a hands-on kind of learner.

4. I was married long before residency (and am a woman), and delayed having kids during residency b/c I was worried it would be hard to be a good mom with essentially Q3 call, being away from home 10 nights a month...I honestly sometimes was frustrated with having to delay kids, and this is somethign I probably did not think hard enough about before I decided to do surgery...but I plan to have them now and my hours in practice aren't actually that bad, home every night, although occasionally home late, so its much more conducive to kids than residency was. choose your post-residency job wisely and you should be able to make the time for family life, you can always do a fellowship in a more lifestyle friendly subspecialty if you want to.

5. Novelty hasn't worn off yet. They will always develop new techniques, devices, procedures to keep us learnign through our careers, and sometimes even the "routine" cases aren't as routine as they seem once you get in there.

6. Nope, people still tell me all the time I'm too nice to be a surgeon. I had my moments in the middle of the night cranky in the ER in residency, but for the most part I kept my cooperative, friendly attitide.