Observership Woes

By Ajay Shah

This summer, I spent more than 400 hours in Toronto hospitals. No, not as a patient, but as an unpaid, underappreciated “Medical Observer”. The official role of an observer is limited to simply observing their preceptor, but my responsibilities were vastly different. I would wake up at 5:30 AM and commute an hour to the hospital. If I arrived early enough, I would do morning rounds on my preceptor’s overnight patients. Then, I would rush to the Ortho wing for 6:45 AM morning handover, as the sleep-deprived residents scrolled through X-rays and MRIs, describing unfamiliar and new procedures and fractures. We’d march single file down to the Teaching Room, for 7:00 AM teaching rounds. There, a senior surgeon would speak for an hour about an incredibly specific orthopaedic condition; avascular necrosis of the talar head, anyone? In a valiant effort to stave off sleep, I’d infrequently jot down notes in my notebook, trying to appear engaged. Lest anyone arrive late to these sessions; senior surgeons are ruthless and unforgiving in their admonishments.

Once the morning festivities subsided, the residents rushed off to their respective stations. Pagers were handed over, ER consults were delegated, and patient rounds were polished off. It amazed me how freely people would disrespect colleagues and superiors behind their back; medicine is truly as cutthroat and drama-filled as Grey’s Anatomy would have you believe.

It amazed me how freely people would disrespect colleagues and superiors behind their back

Around 8:00 AM I’d follow my resident into the Surgery wing or Orthopaedic clinic. In surgery, we’d greet the preoperative patients, shave and mark them for surgery, then prepare the operating room. Doctors are so specific about each table, tool and tube; even a slight anomaly can induce profanity-laced tirades. Clean room, patient in, drape & sterilise patient, scrub in, operate, suture, scrub out, undrape, splint, patient out, fill orders, post-op report, clean room, rinse, repeat. Around 3 PM the surgeon would look at the clock, shocked at the slow pace of the day, and blame nurses, porters, residents and students for the slow pace. Finally, around 4:30 PM, the final patient would be bandaged up, sent to post-op wards, and the surgeon would go home. The residents and students were none too lucky. We would be operating in the Trauma or On Call rooms until at least 8:00 PM, seeing post-op patients in between each operation. After a long day operating, we would change out of our scrubs, drive home, and spend the night reading published articles or Orthopaedic textbooks.

Clinic was a different story, although no less stressful. Around 8:00, the triple-booked patients would begin their impatient waits. While we quickly scrolled through X-rays and reports, we could feel the anxiety and resentment from the waiting patients continue to build. Each patient was consulted, examined, and, for the vast majority, told to go home. It is very frustrating to tell a patient, on their third round of referral, that we cannot do anything to help their pain. Even worse is telling a patient that they are not a surgical candidate; their chronic daily pain isn’t severe enough to warrant an operation. Every patient somehow feels marginalised by the system, feels that the doctor is giving them the short end of the stick. Thick accents, learning disabilities, degenerative disorders, and general hatred make some patients difficult to deal with, evoking little of the compassion or empathy we are taught to show in medical school.

So why, one might ask, would anyone want to be a surgical resident. 100+ hour weeks, 48 hour shifts, relentless work, a steady stream of thankless ungrateful patients. Perhaps the emotionally numbing experience is a rite of passage for becoming a senior consultant. Perhaps the long hours build character and motivation, both of which are needed to the utmost when performing operations.

Perhaps the emotionally numbing experience is a rite of passage for becoming a senior consultant

Or perhaps the long hours we spend on rotations, internships and residencies serve to grind us down, to make us bitter and angry. Perhaps experiencing such hard work gives senior surgeons a sense of entitlement, and a licence to treat their junior colleagues poorly. Perhaps this poor treatment propagates a vicious cycle of unfriendliness, burnout, and resentment. Maybe the general malice is a quality necessary in brilliant surgeons; their meticulousness and attention to detail may irk some people, but it certainly gives good outcomes.

I learned a lot this summer about medicine. But I learned more about people. I saw amazing residents, and I saw incompetent residents. I saw funny, friendly surgeons, and I observed arrogant, crusty old surgeons. These articles usually end with a parting piece of advice, so mine will be this:

Don’t be afraid to kiss ass, laugh at unfunny jokes, or go the extra mile. Show up early, don’t make mistakes, and be the last to leave. Those who work the hardest now will reap the most reward when the time comes. Take time to educate and mentor those younger than you, and be friendly to everyone you meet. Wisdom is hidden behind clichés.

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