Retrospective entry: 7 things I miss about Surgery
I've been in my second department of housemanship (internal medicine) for a week now, and I am frequently asked this question by my colleagues and friends is: Do you miss surgery? Well, I do.
If you ever forget to write something important/ time-sensitive in the bedhead ticket (BHT; the folder in which we write case notes regarding about patients), the medicolegal department asks that we make what is called a 'retrospective entry'. So in the spirit of better late than never, here is a post I wrote 2 weeks ago.
I'm a week into my second posting in Internal Medicine, and after six days of tagging, I made the brilliant move of getting my booster shot a day before my day off. Naturally, I am spending my weekend sick, nursing a swollen armpit, and ruminating just how much I miss the simplicity of surgery.
- I miss doing morning reviews. The male ward here slightly resembles those gory scenes from Holocaust films where hundreds of wounded soldiers are lined up like sardines while being nursed to some acceptable form of health by a healthcare worker that looked like they could use about fifteen showers. Unless you're willing to show up to work at 5am, which you won't because nobody gets paid overtime here, you never get the chance to finish your morning reviews. In fact, even if you show up 30 minutes earlier than your clock in time at 7am, you've just about finished tracing all your blood investigations, culture results, and laid out the respective BHTs in front of each patient before your medical officer shows up at 8am asking you the only thing that they expect you to do, "Have you traced all the bloods?".
- I miss examining my patients. As you can imagine, if you don't have the time to review your patients, then you don't have the time to even so much as touch them, rendering the feel of an enlarged spleen, ballotable kidney, and tinge of conjunctival pallor an ever arousing enigma. You just stand there squinting at your medical officer when they auscultate (listen to sounds with a stethoscope) the patients lungs trying to imagine the breath sounds a patient with this diagnosis would have, and then scribbling at warp speed the findings they then divulge with little to no empathy at your sadness at having missed out on what could have been the heart murmur or bilateral basal crepitation of a lifetime. On rare days when time permits, I will sneak a listen or feel because positive clinical findings are the absolute wet dreams of all junior doctors.
- I miss speed rounds with the specialists. It felt a bit like a game show really, walking briskly around the square room, spitting out diagnoses like we were all afflicted with some medical Tourette's, and answering questions our specialists had like it was the lightning round of our life. It felt strange to boil down an entire human to a two to three-worded diagnosis, and I don't mean this in a dehumanising way. In medical school, we were always taught to be thorough, and that case presentations were meant to be this arduous process. The reality is, we are facing the unfortunate combination of being understaffed and over capacity, and all of us, even our specialists, are racing against time to be efficient with what information needs their qualified opinion, because it saves time, which is such a commodity for us overworked whitecoat slaves. Time we could use to snooze just a little longer if it meant a smidge of rest for the billions of neurons that are constantly expected to buzz. Time that is threatened because who knows when the next polytrauma or perforated viscus will be wheeled into the red zone?
- I miss the high turnover of patients. In the surgical department, patients come and go like new COVID-19 variants. The process from admission to pre-op care to being operated on to post-op care to being discharged is shockingly short, unlike in the internal medicine department where the thickness of their BHTs rivals that of those medical textbooks you used to use as a laptop stand. With every extra day the patient is in the ward, their story develops, and with that the length of their morning reviews, and boy do I miss the straightforwardness of a surgical diagnosis compared to a medical one.
- I miss the healthy veins. Those big, juicy, bouncy, visible-from-a-mile-away veins of the predominantly young and healthy-if-not-for-an-inflamed-appendix patients. Trying to cannulate patients with end stage renal failure will be the bane of all house officers existence in the medical department. Many will argue that we should appreciate the opportunity to practice on difficult veins because we are doing our future medical officer selves a favour, but nonetheless, I still have the right to whine about it so long as I am adjusting to the transition from perky to poorly palpable peripheral veins.
- I miss hanging out with other house officers. In surgery, there would always be a few house officers assigned to each cube, and at any given time, there would be a handful of them loitering in the nurse station. However, in medical, we are so short of house officers that you will end up spending most of your time with the medical officer in charge of your cube, with the occasional glimpse of other medical house officers panting past you in a hurry as they attempt not to drop any of the many forms and specimen bottles they've likely stolen from the surgical ward because we're short of everything else too, not just house officers.
- I miss grand rounds. Every Tuesday and Thursday, we did grand rounds with the Head of Department (HOD). On Tuesday, the medical officers present the case, and on Thursday, the house officers take their turn. These were the two most exhilarating days of the week where everyone came to work ungodly early to ensure that every patient is reviewed, and to literally rehearse. Our HOD has quite the affinity for teaching, and during these rounds, almost everyone would join. It was spectacular, because their passion for medicine and passing along their decades of experience radiated through every syllable uttered in the hopes that we would one day know better. Of course, it would suck to botch your spoken word case presentation performance, and the rounds lasted what felt like a century, but their commitment to education, and deliberate emphasis on the importance of compassion made me feel very lucky to have been in their presence, even if just for a while.