surgery / pain

Coming back from break this past week, I started on my three month surgery rotation in the hospital. The first month is actually two weeks of anesthesia and two weeks of emergency medicine, before the actual surgery part begins. But anesthesia requires being in the operating room (OR), as they prep all the patients for their surgeries. And because most of the action happens in the beginning and ending of the procedures, I spend most of the day standing and watching the anesthesiologist monitor the monitors in said OR. In the simplest of terms an anesthesiologist keeps patients pain-free and alive during surgery. Which is a very worthy occupation. We spent much of the past six months thinking about people's pain; a lot of what influenced my experience and what I want my future experience to be, was about that.

This time around, literally taking away the capability for pain has me thinking about our own pain as medical students. This is not to compare at all to our patients, but maintaining relativity doesn't have to take away from personal subjective experience. Keep in mind that anesthesia is perceived as the easiest part of the surgery rotation, in terms of hours and exhaustion, and it has been. But it gives a glimpse of what's to come, and during the hours of standing, I can't help but consider the suffering we go through for this profession.

We wake up when it's still black outside, and at the height of freezing. I normally like short walks in the cold; your face warms up after a few minutes and the sharpness makes me glad for senses. But that early in the morning, destination matters and I don't look forward to going to the hospital, where the ORs feel as cold as outside. I hate wearing scrubs and how I have to layer up underneath. I hate the face masks and the fuzzy blue shower caps they call hats. An hour into surgery my shoulders ache, my lower back aches, my feet hurt. On surgery proper on most days the days are twelve hours long and you go home when it's as black as when you woke up. On surgery proper surgeries can be up to seven hours long, and there are no breaks for food or bathroom. Your sole purpose might be to hold an instrument in the same position throughout the surgery so that the surgeon can do his thing, and to answer questions I'm pretty sure I don't know. I feel inadequate in all ways, which is immeasurably worse than feeling inadequate in only a majority of ways. I can't pay attention for that long, I process things slowly, my fingers aren't nimble, I liked anatomy but am bad at it because I'm bad at spatial visualization, and I'm not good at learning motion from watching others. In surgery one of the few things we might be allowed to do is tie knots, and it took me about ten times as long as my classmates to learn this. Once I try on my own terms, it's fine, but as a med student your presence seeps away from you with each step to the OR. The one thing I felt decent at was talking to my patients, and I've spent a total of ten minutes doing that all week. I spend some time each day imagining how I'm going to do this.

And more so, why. Why do we do this? Besides from the learning, which I know there will be. But while this is a wide open avenue for education, to be melodramatic it is also elements of torture--slow, long, physical and emotional at once. Over break I read Murakami's memoirs as seen through his marathon running, and he talks about the pain of running too, and how the most important things are learned through physical pain. Sometimes I think of the process of becoming a doctor as a marathon. People talk about the uselessness of some of the long years of medical training--the requirements, the studying, the politics, the busywork, all the things that necessitate a type A personality and that physically exhaust us. No one thinks of a marathon that way, but really when you think about it, the purpose of both is to accomplish something, and it's really crazy when you consider what you're doing in the meantime. You just keep going for the sake of it. Sometimes people patronize that. But it's not mindless. For me it's a conscious decision each day.

But I haven't decided whether the will and strength that you develop makes the level of bullshit valid. Having hours at the hospital for mind wanderings is not that good for me. There are so many things I'd rather be doing--writing, talking to patients and friends, sleeping. I don't even spend this idle time the way I'd like to spend nothing time, time that I often pine for. I think about stupid things. Like how I would like really long hair again so that I could chop it off. And how awkward it is to be in an elevator with a group of pretty swimsuit clad girls and a college guy ogling them. I think about self-detrimental things. Like how I keep having vivid dreams with cameos from people I don't want to think about anymore. I think about things I want to do that I couldn't do even if I weren't in the OR, like travel and spend time with my family. And I think too much about how much I don't like this.

It all gets so mixed up that it's impossible for me to write coherently about it. I resisted using this reason not to write, because this is how it is.

I met with my surgery advisor today, who gave me the good advice to always look and see. And there is a lot valuable to be seen. I think one of the hardest things for patients is not understanding what's going on inside their bodies--how something so intimately close feels impalpable. I know that developing a view of this, and being able to describe it for someone, is valuable. The problem is that I don't see the nuanced differences between the tangled monitors tracking their blood pressure and temperature, or the differences in the tones of the multiple steady beeps in the background (or foreground) telling us how they're breathing. A sweet 87 year old undergoing a heart bypass said that at his age everything scares him. As I stood in the back of the OR, I thought about how at age twenty five, I sometimes feel the same way. As med students, we see a lot in the OR. We see a system of tools that are purely functional. We see the wall between us and the people whose bodies we see more closely than they ever can. What I see is foreign, and we're supposed to familiarize such that that goes away, but honestly, I'd rather not. I'll work for skills and knowledge, but not to wear away the foreign, because how then would we really know pain, ours or theirs.