This one time, during brain surgery...

Today I had the opportunity to watch a neurosurgeon remove (debulk would be a more appropriate term) a really nasty & invasive brain tumor.  The following conversation occurred during the surgery:

Neurosurgeon (NS): What year are you?
Me: I'm a 4th year, sir.
NS: First, don't call me sir.  Second, what are you going into?
Me: Obstetrics
NS: Really, ob/gyn?  That's too bad.  When I first met you I had thought you very intelligent. 
silence

Then, post surgery:
Me: Thank you for letting me scrub in.
NS: Of course.  It was great having you in the case, and nice meeting you.  I still think you're making a stupid specialty choice though!

And so begins the ob/gyn bashing that I have heard so much about.

On another note - two interesting new stories today about reproductive health.  First a story on the Turn Away Study and the second was ACOG bringing attention to HR 1797, the District of Columbia Pain-Capable Unborn Child Protection Act, which is progressing in the house.  This bill would ban abortions after 20 weeks, leading to more "turn aways" and issues with access.  While it is specific to DC, it could set an ugly precedent. So glad that this is how congress is spending their time, and our tax payer money, instead of doing things like dealing with the ongoing sequestration.  Ugh!

The end of surgery

This week marks the end of surgery.  Well, at least the end of in-patient surgery.  I still have 2 weeks of out-patient surgery, gyn surgery, and possible surgery electives in my future.  This is good seeing as I actually really like being in the OR and think I'll miss it.  Regardless, I have an oral exam and a national shelf exam to take this week.  These exams will be the determining factor between honors, high pass, and pass, as I already know that my evaluations are solid.

I feel completely and totally unprepared for these 2 exams.  I'm pretty sure that I've never felt this unprepared for any exam in all of medical school.  Over the last 8 weeks I have learned how to stitch like a pro, how to spend long hours on my feet in the OR, and how to not mess with the pancrease.  Today I proved that I can use a bovie like a rock star and drive a camera with precision.  I'm pretty sure that I can even do a lap choly completely unassisted, assuming there was no gross anatomical variant or unexpected complication (ha!), and assuming someone would be stupid enough to let me try. 

However, over the last 8 weeks I have not learned how to verbalize surgical procedures, explain anatomy, articulate complications, or manage medically complex co-morbidities.  The medical team hospitialists do that for us.  I have done my best to stay on top of the reading and go through practice questions but I often find myself so exhausted at the end of the long day that I don't manage to retain what I'm studying.  Basically, surgery has prepared me to be a hamster on a wheel but not to take these exams.  How do other med students do it?  I'm feeling screwed.  And sleepy.

Impostor syndrome

impostor

noun fraud, cheat, fake, impersonator, rogue, deceiver, sham, pretender, hypocrite, charlatan, quack, trickster, knave (archaic), phoney or phony (informal) He was an imposter who masqueraded as a doctor.

Collins Thesaurus of the English Language – Complete and Unabridged 2nd Edition. 2002 © HarperCollins Publishers 1995, 2002

Imposter syndrome is a common phenomenon among medical students.   A malignant idea that you aren't actually smart enough to be a medical student, don't have what it takes to be a doctor, and were just accepted to medical school because someone accidentally confused your file with someone else.  

I struggled a lot with impostor syndrome when I was struggling through gross anatomy my first year, and again when I was retaking step 1.  It currently seems that surgery is bringing on another flair up.  Left unchecked, it can be a crippling condition and self fulfilling prophecy.

The acute onset began during an M&M presentation I had to do on friday.  I stumbled over my words.  Unable to present an orderly case and lacking the clinical terminology I have been taught to use.  It was a fine presentation but very elementary in nature.  Sure, I'm a medical student, of course my presentations wont be as crafted as my superiors.  However, I was sub-par to my contempariers in presentation style.  This event coming on the heals of receiving my mediocre pediatric shelf exam score, and immediately prior to not knowing the answer to the ONLY question I was asked by my attending that day just left me feeling defeated. Acute events of impostor syndrome lead me into a tail spin of desperation: just skidding by on my rotations, not matching for residency, culminating in unemployment and failure. Destructive thinking.

Hopefully this week I'll prove my knowledge and abilities, both to my attendings and to myself.  I sure as hell could use a confidence boost right about now. 

"Grey's Anatomy" didn't lie

Surgery is chock full of drama.  Unfortunately, it isn't the fun sexy drama, but rather the drama that comes with clashing strong personalities.  My day is filled with strong egos and quirky neurocies attempting to co-exist in a high tension environment. 

I love the procedures.  I find the breadth of pathology that we treat on general surgery to be fascinating. I'm even okay with the slow pace and meticulous nature of the day to day.  However, the surgeon's personality?  After only 9 days, I'm already ready to shove a scalpel into my own eye.  The god complex is painful on a whole other level.  Plus, I'm finding that the answer to everything is always "cut it out" which doesn't fit neatly into my idea of being a comprehensive [primary care minded/preventive medicine based] medical provider. 

44 more days to go...

Surgery call math?

Tonight is my first night of call.  Well, first night of call as a doctor-type since I did it all the time as an EMT, but I digress... It is home call so it only half counts anyway. 

Call + surgery clerkship + Halloween night + stupid people = exciting learning?

Time will tell how this equation ends.