Has the excitement of performing surgery declined as you've entered residency and practice?
Here's my perspective as a mid-level resident (just finished pgy-3 year and started in the lab). The initial thrill that you feel as a student seeing stuff for the first time like an open abdomen does change. I remember getting excited as a student when the resident let me throw a few subcu skin stitches for the first time. Obviously, doing it for the n-th time isn't thrilling anymore, but I do still do enjoy doing it and making it look nice. Great analogy by pilot doc, btw -- the infatuation phase passes. But surgery is no less fascinating for me. I find I still enjoy the technical aspects of operating, learning how to improve my technical skills, economy of motion, setting up the approach etc. But then again, I have always tended to enjoy anything technical -- central lines, even nurses asking you to put in a difficult IV, etc.
Even more fascinating for me are the intricacies of clinical decision-making -- workup, diagnosis, operative and non-operative management, critical care, etc. Honestly, I wouldn't mind spending my lab years at a coffee shop, just curled up with a few surgery texts because the sheer volume of knowledge required to make you a good surgeon is just enormous. Another thing that hasn't changed for me, is the occasional feeling that you really made an impact on someone's life. Not just talking about good outcomes, but also being able to comfort patients/family when there are bad outcomes or grave prognoses. I know it sounds cliche and melodramatic, but I do think surgeons have a special opportunity to connect with another human being on a deeper level at their time of crisis. To be truthful and more accurate though, most days aren't like this at all and surgical residency is not a glamourous job, not like what you see on tv. Most days are just long and hard -- you feel like you spend most of your efforts navigating administrative barriers or pushing paperwork, especially as a junior resident.
How have your perspectives about career choice, ideal work environment, time with family, etc... changed as the years progress? Open to residents and attendings with thoughtful responses.
Yes. Personally, I find that as I transition from junior to senior resident, my priorities are evolving. As an intern I had the attitude that I would work until I physically drop and put my very last ounce of effort into this career, so that I could become the very best that I could be. However, you'll find that you can always put in more time and effort into this field and not feel that you are doing enough. You can always know your patient better, you can always know the literature better. It is endless, and at some point you have to draw a line, whether it is for your family or your personal sanity. We all tend to be compulsive perfectionists, but you end up settling for less-than-perfect compromises because there is a limit to your time and energy. As an intern I would try to stay up and read even when tired until I fell asleep with the book. Now older, I find I would rather get a good night's rest so that I can function more effectively the next day. Maybe I am getting soft. My priorities as an intern were 1), 2), 3) surgery, surgery, surgery... but they've shifted a little more in favor of sleep, family, having a balanced life. It is daunting because when I look at my attendings, many of them work harder than we do as residents. Some are in academics, some in private practice. There is no easy road it seems. But perhaps, this not representative of the range of lifestyles possible as an attending because I'm at an academic center.
