lung snob

"I will keep them from harm and injustice. In purity and holiness I will guard my life and my art." - Hippocratic Oath

[lungsnob]

Jadi gini rasanya jaga sebagai residen paling junior 😂😂 (Dec 5th 2017)

[super-doctor]

Teruntuk CPPDS (baca: Calon PPDS) part 2

Sambungan dari yang sebelumnya, moga2 gak bosen:

4.       UJIAN PRODI (PROGRAM STUDI)

Terdiri dari ujian tulis & wawancara. Untuk ujian tulis, beberapa departemen ada jg yg mengikutsertakan journal appraisal, so be prepared. Inget2 lagi ilmu statistika jaman skripsi, ini soalnya essay gitu jadi gak bisa nembak. Persiapan untuk ujian tulis adalah belajar, gak ada lagi yang lain. Ngedukun syirik. Soalnya biasanya berupa pilihan ganda, jd mentok2 bisa nembak (jangan ditiru). Cari info2 ke senior tentang apa aja yg harus dipelajari atau buku apa yg mesti dibaca dll. Kalo ada soal2 latihan lebih baik lagi. Kalo gak ada, jangan sedih, gw juga gak punya. Gw belajar dari slide2 jaman kuliah, artikel dari internet, dan dari buku tentang Patologi Klinik yang gw beli di Sagung Seto. Udah. Jangan belajar melulu jg nanti malah stress apalagi kalo sambil jaga di RS atau klinik. Take sometime off to go somewhere, meet people, get socialized. Kalo punya temen belajar lebih baik. Gw gak punya, sedih. Tapi gak apa2 *menghibur diri sendiri*

Persiapan untuk wawancara ini yg agak heboh, yaitu:

Mental (lagi2), terutama kalo dapet pewawancara Prof2 killer gitu yg suka nyecer. Tenang aja, boleh deg2an tp gak usah panik. Jangan nangis, haram! Biasanya pewawancaranya 2 orang atau lebih supaya gak subjektif hasilnya & biasanya yg killer didampingi yg angel.

Persiapkan jawaban dari pertanyaan2 yg kemungkinan besar selalu PASTI muncul seperti motivasi & sponsorship. Jawaban gak usah bertele2. Diplomatis & to the point. Saran gw, tulis pertanyaan & jawaban yg kira2 akan muncul di secarik kertas supaya bisa kita baca ulang lalu bisa kita tambah/kurangi jawaban kita sebelum wawancara sesungguhnya.

Pakai baju yang sopan & formal (for guys, you may need tie & suit, yes suit!). Tunjukkan seberapa kalian mengharagai profesi ini & seberapa kalian ingin diterima. Kebayang kan kalo bajunya ngasal, pewawancaranya bakal mikir ni orang gak niat abis. Ke kondangan aja niat, masa demi cita2 gak niat?

Jangan telat, dateng 1 jam sebelum waktu yg ditentukan! Show your integrity! Ketok pintu dulu sblm msk ruang wawancara. Masuk begitu dipersilakan, bagitu pun duduk. Jangan ujug2 duduk. Jabat tangan pewawancara atau ucapkan salam. Senyum. Jawab pertanyaan dengan tegas tapi sopan. Duduk yg tegak, jgn nyender. Jgn nopang kaki. Kalo di depan kalian ada meja, taruh tangan kalian di atas meja. Kalo gak ada, taruh tangan di pangkuan, jangan bersedekap. Intinya, manner over knowledge. Mau sepinter apa pun kalo gak sopan, jawaban lo hanya hembusan angin lalu. Terakhir: jawab hanya yg ditanyakan, biar gak jadi boomerang.

5.       SARINGAN UNIVERSITAS

Tergantung kebijakan Universitas sebenernya, kebetulan Universitas tmpt gw daftar kmrn mewajibkan ikut & lulus ujian saring. Selengkapnya bisa baca di: Harus di-SIMAK?!

6.       DOA

Ikhtiar udah, lanjut doa. Ini mah bener, mau seheboh apa pun persiapan kita, tanpa ridha Allah gak bakal ada artinya. Banyak2 berdoa, sedekah, baca Al-Quran. Minta doa sama orang tua karena ridha ortu adalah ridha Allah juga. Jangan mempersulit urusan orang lain alias bantu semampu kita kalo ada yg minta tolong, insha Allah jalan kita pun akan dimudahkan. Terakhir: tawakal. Gak usah sedih kalo dapet kabar burung, belum tentu bener. Tetap berpikir positif sama Allah. Apa pun hasilnya nanti adalah yg terbaik menurut Allah. Allah Maha Mengetahui yg terbaik bagi hambaNya.

Alhamdulillah gw lulus. Semoga jalan gw ke depannya dilancarkan & semoga gw bisa menjalankan amanah ini, menjadi dokter Spesialis Patologi Klinik yang baik & bermanfaat bagi keluarga juga org2 di sekitar gw. Aamiin ya Rabbal’alamin.  God speed.

[lungsnob]

Jadi seperti yang saya sebutkan di repost-an sebelumnya, bahwa timeline bisa berbeda tiap semesternya tergantung kondisi. Waktu saya mendaftar untuk masuk semester ganjil (juli 2017), persiapan pendaftaran (CHS dan online) dilakukan sejak Februari. Saya beli formulir di CHS awal bulan februari 2017 sekaligus tes TOEFL di LIA pramuka, balikin formulir 2 minggu kemudian, daftar online awal maret 2017 (lebih maju dibandingkan tahun-tahun sebelumnya yang biasanya diadakan bulan april/mei), ujian SIMAK di depok awal april 2017, lanjut psikotes dan MMPI di salemba seminggu kemudian, sekitar 2 minggu kemudian saya mendapat surat panggilan dari departemen tujuan saya untuk ujian bagian (tulis dan wawancara, tidak ada tes kesehatan khusus/journal reading). Saya kedapatan ujian bagian awal bulan Mei, selama 2 hari berturut-turut, hari pertama tes tulis pilihan ganda 80 soal, hari kedua wawancara dengan 3 penguji (untuk departemen tujuan saya, ujian wawancaranya one on one tidak keroyokan, 1 kandidat 1 penguji ada total 3 penguji jadi deg-degannya 3x, jangan lupa asah skill conversation pakai bahasa inggris karena akan ada penguji yang dari awal sampai akhir nanyanya pakai bahasa inggris. Nggak usah jiper! PD aja, jangan lupa berdoa).

Pengumuman dikeluarkan setelah semua ujian dilaksanakan (jadi bukan sistem gugur, kita nggak tau nggak lulusnya di ujian mana), waktu saya pengumuman tanggal 21 Juni 2017 via web pk 14.00.

Alhamdulillah, saya lulus dan diterima sebagai peserta PPDS di departemen tujuan saya. Harapan saya, sama seperti super-doctor, semoga jalan saya kedepannya juga dilancarkan dan semoga saya bisa mengemban amanah ini dengan baik, menjadi dokter spesialis yang baik dan bermanfaat dunia akhirat.

Aamiin ya Rabbal’alamin.  

[lungsnob]

Hi. Can I say something?

I am scared shitless.

First of all, I didn’t think it was ridiculously stupid for me to apply for the upcoming residential program admission in the first place. It was purely the jealousy speaking whenever they posted online on Instagram, facebook, etc, the LoA from residential programs they were applying. So I thought maybe I should give it a try.

But as of now I’m beginning to question my motives. Who are you to apply to one of the best medschools in your country? You didn’t even come from a public med school, not the best graduate in your class, have a little to none research or scientific publication, not well connected to those high level demi-god professors, and haven’t done anything to show that you are truly care with your society, heath-wise. You spent the last year and a half working like crazy (in a private hospital, I may add) that you couldn’t even find time to date properly.

So yeah, who are you to apply?

#mentalbreakdown

[lungsnob]

Entrance test D-5. Been preparing for the whole month, but just like the old saying, the more you read, the more you feel you’re lacking. It’s been tough to juggle between my managerial work, my clinical work, and exam preps. I have to exert all my willpower to wake up every morning knowing that I have tons to do. But to remember what my friends and family have done to support me up to this point, I can’t just give it up, can I? Fingers cross and wish me luck. Whether I pass these exams or not, it will definitely be a life-changing experience. I really, really want this.

[kuntawiaji-deactivated20220209]

[lungsnob]

Working in the ER still scares the hell out of me sometimes. I never know who or what will come, burst in from those swinging doors. I remember the first person I stitch up. I remember my first solo premature newborn rescucitation. I remember those I tried to safe but failed nevertheless. It never occurs to me that I will spend most of my working hours under pressure. I panic, I waver, I get nervous, I get yelled at, I've had my periods of mental-breakdowns, I have even thought of giving up. It's never easy. I'll never know enough, never be smart enough, never be skilled enough. Things are scary. Sick people are scary. Dying people are the worst. But tenacity is my forté. So I grit my teeth and grind hard. Praying for strength and may the knowledge He bestowed upon me be useful in helping others. Because deep down, deep deep down, during our first encounters, I know I am their best chance to survive.

[lungsnob]

"People who really want to make a difference in the world usually do it, in one way or another. And I've noticed something about people who make a difference in the world: they hold the unshakeable conviction that individuals are extremely important, that every life matters. They get excited over one smile. They are willing to feed one stomach, educate one mind, and treat one wound. They aren't determined to revolutionize the world all at once; they're satisfied with small changes. Over time, though, the small changes add up. Sometimes they even transform cities and nations, and yes, the world." - Beth Clark . . . In Clination Indonesia, we believe that every single person on this planet has a skill or talent that can provide value to other people. And it is a truth that every person has something to give to the world. A student. A doctor. A backpack traveller. A writer. A photographer. You name it. Life can be much broader once you discover one simple fact: it is about YOU helping yourself by helping others. It's about adding value. If others can do it, why can't you? (In honor of 'Hari Bakti Dokter Indonesia' 20/05/2016) . (Video is excellently done by @waysmissed for @clinationindonesia) . . . #CLINATION #healXplorers #travelwithyourheart #explorewithyoursoul #doctor #doctors #baktisosial #indonesia #travel #traveller #probono #volunteers #indotraveller #wanderlust #liveauthentic #dokterindonesia #indonesiasehat #haribaktidokterindonesia

[lungsnob]

I am sworn to do no harm and will not betray my art as a doctor, so I ain’t gonna kneel and treat you differently just because jeij istri sekda/sodara wakil bupati. I have another patient dying on another bed, so yeah, who you are is never matter to me.

Untuk pejabat-pejabat (dan keluarganya) yang suka ‘abuse’ status kepejabatannya di IGD RS supaya bisa langsung divisit spesialis.

[lungsnob]

Di luar negeri (negara-negara maju), akses kesehatan serba gampang, bebas biaya pula karena asuransi jiwa dan jaminan kesehatan sistemnya udah bagus banget. Ada emergensi, tinggal telpon 911. Alat defib berceceran dimana-mana, dan karena semua citizennya terpelajar, mereka semua tau cara penanganan pertama kegawatdaruratan. Pemerintahnya punya budget lebih buat bikin iklan layanan masyarakat tentang CPR karena nggak perlu pusing mikirin utang negara, korupsi, dan kebakaran hutan. Tenaga kesehatan dan pasien semua sejahtera, angka pendapatan per kapita jauh di atas garis kemiskinan. Secara geografis, luas wilayah negaranya kebanyakan tidak berupa pulau-pulau yang terpisah samudera, jadi memungkinkan referral ke center-center kesehatan yang canggih secepat mungkin jika dibutuhkan. Ketika kasus-kasus paling banyak di sana seputar penyakit degeneratif yang 'fancy' (kalo enggak jantung, DM, stroke, ya kanker atau penyakit genetik lainnya), di negara kami Indonesia tercinta ini bahkan dokternya aja masih ada yang meninggal karena infeksi, in their line of duty. Masih ada orang-orang yang mati karena busung lapar atau karena komplikasi melahirkan. Budget pemerintah buat kesehatan lebih rendah dibandingkan buat pendidikan, gaji tenaga kesehatan lebih rendah dari guru, bahkan lebih rendah dari buruh. Boro-boro mikir mau bikin iklan layanan masyarakat tentang CPR, udah bisa bikin penyuluhan garam beryodium aja udah syukur alhamdulillah. Sungguhlah kondisi di negara kita ini jauh dari ideal, jadi janganlah dibanding-bandingkan dengan di luar sana, di negara-negara maju yang rakyatnya tidak lagi pusing soal besok mau makan apa. Terus kenapa lo diem aja nin? Saya nggak diam saja. Anda pernah dikirim bertugas di daerah terpencil, yang dalam sehari mati lampu bisa 5x, yang saking seringnya mati lampu, kita sudah biasa di tengah-tengah operasi harus menjahit dalam gelap? Anda pernah dikirim bertugas di daerah terpencil, yang selama 2 minggu sama sekali tidak ada air bersih bahkan untuk buang air? Anda pernah dikirim bertugas di daerah terpencil, yang kebanyakan pasiennya baru mau diantar ke rumah sakit kalau udah sekarat napas megap-megap saking nggak punya biaya dan nggak kebagian jamkesmas? Saya pernah. Dibandingkan anda-anda yang cuma liat beritanya di tv dan internet, saya langsung ada di sana, ikut berjuang bersama sejawat-sejawat lainnya. Kami tidak bisa mundur atau menghindar hanya karena kondisinya sulit, kami kan sudah disumpah atas nama Tuhan untuk menolong sesama. Coba, pekerjaan mana lagi yang kontraknya eksklusif langsung sama Bos Besar, sekolahnya paling lama, paling mahal, tanggungannya nyawa, tapi masih aja dicerca sana sini dibilang kurang usaha? Mungkin ada satu-dua oknum yang patologis, tapi janganlah dipukul rata ibarat kami semua sama. Pekerja-pekerja lain yang tidak puas dengan keputusan pemerintah, dengan mudahnya tinggal turun ke jalan, orasi sepatah dua patah kata, mengancam mogok kerja langsung dikabulkan permintaannya. Kalo tenaga kesehatan yang demo, dibilangnya mangkir dari tugas, IGD nggak ada yang jaga, rumah sakit menolak pasien, masuk berita dan ujung-ujungnya diamuk massa. Makanya kami paling jarang protes walaupun tersiksa, da serba salah mau gimana juga. Da aku mah apa. Cik atuh mikir saeutik. Tidak semuanya seberuntung anda-anda. Tidak semuanya anak orang punya dan dari kalangan berada. Indonesia tuh negara dunia ketiga, coy! Kita nggak perang saudara kayak di palestina aja udah bagus... jangan cuma bisanya ngomel aja. jangan cuma hidup dalam 'bubble' sendiri yang nyaman, tapi liat-liat ke bawah juga. Mana tahu besok kita yang di sana.

[lungsnob]

This is very interesting! I really hope I can make some time to attend this MSF event.

[regentijd]

No greater opportunity or obligation can fall the lot of human being than to be a physician . In the care of the suffering he needs technical skills, scientific knowledge, and human understanding, he who uses these with courage, humility, and wisdom will provide a unique service for his fellow man and will build an enduring edifice of character within himself. The physician must should ask of his destiny no more than this, and he should be content with no less.

Tinsley R. Harrison (Does the name ring any bell? Don’t tell me you don’t know who Tinsley R. Harrison is. That will be such a shame. Semua mahasiswa kedokteran di dunia ini harusnya tahu siapa dia. Harrison? Harrison’s Principle of Internal Medicine? Yes, that’s him.)

[lungsnob]

Today, I may have saved a life

Today, I saved a life.

And I wish I could tell you a story about fancy heroics — about an exploratory laparatomy, a chest thoracostomy, or a patient that coded and I was the last person to perform the chest compressions that brought them back to life.  But I can’t.  But I can tell you that I saved a life.

She was 16-years-old, and moved here four years ago from a different country.  This was her follow-up appointment for an otitis media.  It was her second time visiting a doctor in the United States.  She was seen just three weeks ago and was prescribed amoxicillin for her ear.  The doctor her told to follow-up in 2 weeks.  It’s been three weeks, and she is now coming in to the clinic.  She missed her last appointment because her mother couldn’t find the time to bring her to the doctor.

I take a look at her chart before entering the room, and I noticed that she’s in the 3rd percentile for her weight and 50th percentile for her height.  Odd proportions, if you ask me, and I decide that I am going to dig a little deeper than “how’s your ear.”

I open the door to see a bright, cheerful young girl dressed in a paper gown.  She takes one look at me, and immediately blushes and wraps the gown tighter around her frail body.  I immediately try to make her feel comfortable by making a joke or two, but I can’t seem to connect.  She’s avoiding eye contact.  She seems self-conscious, maybe?  I introduce myself to her and her mother.  Her mother speaks only Spanish, and she speaks English.  I ask her mother if it’s acceptable that I interview her in English.  She obliges.

“I understand this is your second time here, so I just want to learn a little more about you, if that’s ok with you …”

I begin to ask questions about her ear, about the antibiotic regimen, her hearing, associated symptoms.  She answers the questions, but she still seems too timid to make eye contact.  I still can’t connect.

She has absolutely no past medical history, no past surgeries, no medications, no allergies — I am flying through this history.  I begin my physical examination, and other than some mild tachycardia, she appears perfectly normal.  Even her tympanic membranes are normal.  Her ear infection has been cured.

And just as I am ready to wrap up the interview, I take one glance and notice four small scars on her wrist under her bracelets.  And in that moment, I remembered that she was in the 3rd percentile for her weight.  I think.  I walk over to the chart, and confirm my thought.

I take a careful diet history, and I find out that she doesn’t eat much.

“I am just never hungry,” she admits.

And I find it odd that a growing 16-year-old-girl isn’t hungry.  I tell her that I want to ask her more personal questions, and I ask if she would rather that I ask her mother to leave the room.  She says that her mother can stay.  And I gauge that she’s comfortable with that because her mother doesn’t understand English.  I look at her mother, and she doesn’t look at me — almost oblivious to the interview, almost negligent of her child’s health.  I mean, what parent doesn’t want to pay attention to what their child has to say, even if its in a different language?

I ask her about her menstrual period, and I find out that she hasn’t had a period in 2 months.

“Is there any chance that you might be pregnant?”

Eye contact.

After a very long five seconds, she answers, “No.”

I knew she wasn’t too sure of her answer, and I decided to take that as an opportunity to dig even deeper.  To investigate.  To get to the bottom of her lack of eye contact, missed periods, and odd scars under her bracelets.

I learn that she recently lost her virginity to her boyfriend, and he broke up with her a short time later.

“What a jerk,” I think.  But I can’t let it show.  I find it devastating how one person’s actions can take such a toll on another person, with the offender being absolutely unmindful of the damaged they have caused.

I learn that she recently started throwing up her food after she eats, mostly because she feels fat.

“I have a big belly,” she says.

I learn that she was hospitalized two months ago because she fainted in a store.

I ask her mother about this in Spanish. “It’s because she didn’t have breakfast,” she says.

I ask about the scars on her wrist, and I lose eye contact.  I walk up to her, place my hand on her hand, look in her eyes, and tell her what I know.

“I know that some people cut themselves whenever they feel angry or sad.  Do you know anyone who does that?”

She nods, hesitantly.

“Do you have any friends that have done that?”

She shakes her head, slowly.

“Have you done that?”

She looks me in the eyes, and doesn’t say one word.  And I know.

I ask her if she’s ever told anyone about any of this before — about the vomiting, the cutting.  She puts her head down, and shakes her head.

I ask her if she has friends, relatives, or a parent that she feels comfortable talking to.  She keeps her head down, and shakes her head, ever so slowly.

I ask her if she has ever thought about killing herself.  She looks me in the eyes, and doesn’t say one word.  And I know.

And just then, it occurs to me that this is a girl crying for help.  A girl who is broken behind that big, beautiful smile.  A girl who needs someone to talk to, someone to confide in, someone to listen.  A girl who might do something destructive to herself if she doesn’t get help soon.  A girl who was waiting for someone to ask the right questions.

I leave the room to consult with my attending, and we decide the best course of action is to call the ambulance to take her to the emergency room for evaluation of her electrolytes, tachycardia, and suicidal ideation.  And she leaves.

And just then, I realize that she came in for an ear infection.

Today, I may have saved a life.

Edwin Acevedo, Jr. is a medical student.

[lungsnob]

I am just a medical student

She’s 58, but appears maybe three days older than 42. Her eyes are sunken, tearful, worried, anxious.  She tells me about her two grandchildren, and how she just visited them in Michigan.  She came to the hospital, straight from the airport.  She’s worried.

She’s worried because her shortness of breath hasn’t gone away for over a month now.  She has had breast cancer, and opted for a more conservative approach: a lumpectomy with axillary node biopsy without radiation.  She’s admitted, and gets a chest x-ray and a CT scan, which show a pleural effusion with what looks like nodules in both lungs.  “Likely represents metastatic disease,” reads the official radiology report. She knows, so I don’t bring it up again.

“I am just a medical student,” I think.

On the second day, she undergoes surgery to evacuate the effusion, and her lung is biopsied.  Now, we wait for the pathology report.  I visit her every day as we wait, sometimes two or three times. I’ve met her husband, and we know each other by first names.  Her daughter and son are also beautiful people, just like her.  They ask me questions, and I keep my answers limited to what I’ve read in the chart. They never ask me about the cancer. They know what the radiology report said, so I don’t bring it up again.

“I am just a medical student,” I think.

She never complains. Not from post-operative pain, not from shortness of breath, not from coughing, not from anything.  I take my time with my physical exam, ensuring that I don’t miss any tenderness.  I don’t want her to suffer unnecessarily.  “Surgery is painful,” I tell her, “make sure you let us know if you are in pain.”  She agrees, but never complains.

The nurse corners me one afternoon, and asks me, “Is there any way to put in an order for morphine PRN for her?”

“I am just a medical student,” I think.

“Why?” I ask.

“Because when her family isn’t here, when she’s alone, she cries.  She’s in pain, she’s scared, but she’s a silent sufferer.”

I am the first person she sees every morning, and I try to make sure she’s comfortable.  I offer extra blankets, water, anything I can do just to make sure she is as happy as she can be.  She appears more and more cheerful, and I spend what seems like hours holding her hand and chatting about life, the weather, her family, my family, my future goals, my girlfriend.  I show her pictures.  We laugh. We smile. But her eyes remain anxious and worried.

She says she likes my bowties, so I make sure to wear one every day for her.  And I tell her, “I thought of you when I put this one on this morning.”  She smiles through those tearful, anxious, worried eyes.  I smile back. And that is enough to make my day.

I walk in with my bowtie and smile around 6:30 p.m. She just got back from the CT scanner, and her family is around her bed, as per usual.  I visited, just to say goodbye for the day.  The sun dips a few degrees further west, just enough to peak through the curtains, and her husband turns to me and says, “Edwin, thanks for bringing the sunshine.”

I stand there, in a loss for words, armed with little more than a bowtie and a smile.

“I am just a medical student,” I think.

Edwin Acevedo, Jr. is a medical student.

[lungsnob]

The decision not to become a surgeon

Every medical student goes though a process of elimination when deciding what kind of doctor they want to become. We hear the old saying, “Internists know everything and do nothing; Surgeons know nothing and do everything; Psychiatrists know nothing and do nothing; Pathologists know everything and do everything but it’s too late.” We hear that pediatricians wear bow ties, are short, and love to laugh and play; that surgeons are decisive but arrogant; that proceduralists are “scoping for dollars”, that orthopedists have long hairy arms that reach to the floor, that family doctors are the best balanced, etc. There may be grains of truth in the medical school palaver, but I think we decide both based on our experiences during medical school and our own personality (plus the need to repay school loans).

The first case I ever scrubbed in on was an open heart procedure back in 1963. The unfortunate patient had severe aortic stenosis (narrowing of the valve) in the days before artificial valves were invented. Having changed into my scrubs, put on my cap, paper booties and scrubbed in, I meekly entered the inner sanctum of the OR. The head nurse spotted me and immediately barked, “Here take this gown, go stand in the corner and don’t do anything until I tell you.”

Other staff came in and one by one put on their gown and gloves. This is a little tricky because you can’t touch anything, otherwise you’re contaminated. As you might suspect, I put my gown on wrong, was barked at again but given a second chance. Finally I was at the side (almost the foot) of the operating table, trying to peek around the two residents assisting the thoracic surgeon. A huge incision was made, a blade much like a small hoe inserted and the handle given to me, “Here, here’s your job. Keep pulling on this so I can see. Harder!”

The left ventricle was punctured bluntly and a curved blade-like instrument inserted up through the aortic valve in attempts to open it up. There were dense calcium deposits so the going was tough. After several tries, the operation was completed, bleeding controlled, and the patient sent back to the surgery floor.

Almost immediately the patient had low blood pressure and a slow heart rate – not good signs. I was asked to sit at the bedside and administered a levophed drip to try to keep him going. He died at about 3am. At the autopsy, it was found that the wall between the left and right ventricle was punctured, not the aortic valve. I don’t know what the surgeon felt. He was the author of the major textbook on thoracic surgery and the author of many papers. This was in the very early days of heart surgery and it had to start somewhere I suppose, but it didn’t make me want to be a pioneer.

The pace of the surgical service was amazing. The chief would arrive at 6am and expect the residents to give him full report on the status of the patients. He would be in the OR from 7 to 9am, then off to a breakfast with the University Regents. There was a pecking order and pyramid system for the surgical residents’ survival. It was very difficult to survive this structure to become a chief resident.

After all this, I chose internal medicine and ultimately more training in infectious diseases, pulmonary and critical care medicine. Strangely, the intensity of the ICU isn’t that different from the operating room. But in the OR, there is only one leader. You don’t break for a conference or try to reach a team consensus. The surgeon is expected to know what to do, to do it well, and to do it fast (better outcomes with less time under anesthesia). As a nurse said, “The surgeon is like a god in the OR.”

But surgery is changing. I walked into the ICU to see a post-op consult in recent years, and asked the “nurse” what the vital signs were and her assessment. She kind of smiled and said, I’m the new urologist and just created an artificial bladder for this patient with bladder cancer. I profusely apologized for my gaff and she let me off gently. In fact at the nurse’s desk later, I asked her to explain the surgery. She replied, “It’s just sewing. You take a piece of colon, make a pattern, stitch it all together, plug in the ureters from each kidney, and voila!”

Well, although you might see why I didn’t become a surgeon, I hope you understand that I have great respect and awe for their arduous training, for their skills, and stamina, and, yes, guts.

Jim deMaine is a pulmonary physician who blogs at End of Life – thoughts from an MD.

[lungsnob]

Why I am a surgeon

An excerpt from Behind the Mask.

Why do you do it?

Do what? Get up in the middle of the night? Rush in to the hospital to patch mangled bodies, sew holes closed, stick my finger in a dike spewing blood and, hopefully, repair what’s broken and allow some unfortunate soul to live and love another day? A good question. I could have been a pediatrician, almost became one as a matter of fact, or a plastic surgeon, but I failed the ego test. No, I had to be a general surgeon. For glory? No.  For personal satisfaction? Maybe. For intellectual stimulation? Perhaps. For the money, definitely not. Then, why?

Why did I go to school for all those years? Elementary school, junior high school, senior high school, four years of college, four years of medical school, five years of residency, working a hundred hours a week. All for what? To be able to wrestle with an intoxicated man at 3am, trying to evaluate the stab wound to his buttock or fathom why a beautiful woman would decide, in a moment of severe, devastating depression, that she didn’t like her breasts and try to cut them off? Or why a distraught father failed to check behind his car as he pulled out of his driveway, just to pick up a container of milk, and inadvertently ran over his two year old daughter?

Why do bowels perforate, aneurysms burst, appendices rupture, arteries clog, gallstones form; why does anything bad have to happen? Why do the nicest people you could ever meet develop inoperable and incurable stomach cancer; why does anyone have to get cancer? Can’t we do something to prevent it?

You ask why I do it. Can anyone answer even one of these questions or a million other, similar ones?

But, every illness, all the injuries, all the misguided thoughts and actions, every trivial, little act that we wish we could take back, every moment that should never have happened, all these things that bring us to a doctor seeking a remedy, are they reason enough? The battle against disease rages onward, fought by doctors, nurses, technicians and therapists at all hours of the day and night; most of the time the battle is won, but the war always goes on, never ending. And if it never ends, if there can be no victory, what’s the point?

Is it enough to replace the look of overwhelming fear and distress, a look I routinely see on patient’s (and their family’s) faces, with a smile? Is the look of relief on the faces of worried family members when they are told that everything went well, that the lump was benign, that the injuries are not severe, that their son will be back on the basketball court in just a few weeks, is this enough reward?

I’ve asked myself these questions over and over again. Sometimes I have the answer; sometimes I just shake my head in bewilderment, but all the time I answer the call, do my best, and hope that those I try to help, the sick and injured, return to a normal life.

So I come to the hospital at 3am and probe and palpate and listen and probe some more. And then, I cut and dissect and clamp and tie and cauterize and sew and resect and reanastamose and bypass and sew some more. All of this so that, in the end, a person, broken by the struggles of life in this fallen world, can have a few more moments as a complete individual.

Why do I do it? Because of what’s waiting for me under those drapes. A patient, with a name and a family, who has entrusted me with their very being. But … do I deserve such trust?

(David Gelber is a general and vascular surgeon who blogs at Heard in the OR and author of Behind the Mask.)

[lungsnob]

I'm speechless, seriously. You make me see something that I have never seen before. I love baking. I will solve this soon and be happy :) thank you so much for your really great advice and for sharing your experience with me. I'm touched, thank you :)

No biggies. I just thought that I've been there before too and I know how confusing it can get. I hope you can find the best solution to your problem because after all others can only talk. You're the one who has to face every obstacle in your life and the decision is all yours to make. It was nothing but I'm glad if I can make you feel a little easier ;)

[lungsnob]

Hi, I'm kind a confuse right now. I'm a medical student and this semester is my last one but I still need to remedial few subjects. So I need 1 or 2 semester to go. But if I want to be a doctor, I need to continue my study 2-3 years in the hospital. But the problem is I want to quit. I don't have any passion left to continue my study and I don't think I want to be a doctor in the future (because doctor is busy and I just want to be a good wife for my husband and a good mother for my children).

Hey I feel you. I have just graduated from medschool earlier this year and now that I have been taken my oath, I'm officially a medical doctor now. Well, truthfully I've just realized recently that my passion is not in medicine and I have always been coming back to what I love the most at the end of the day: writing. I love writing and I always want to be a writer. But somehow my mother suceeded in talking me into medschool, I remembered once she said that I could not be a doctor if I become a writer but I could always be a doctor who writes. I guessed her words made sense and there I was, spending the last 6 years of my life studying my ass over something I did not really enjoy. I used to woke up feeling blue and heavy each time I reminded myself that I had to go to the hospital. Medschool is not an easy stuff at all. We are comitted to a life-long learning and we will be responsible to others life. I even came to the point of my life where I started questioning why would I do something that would only torturing me from the inside? But each time I looked back at how hard my parents tried to take me to the place I'm standing right now, it just got me. I told myself that it's okay, hang in there a little bit even if it's hard, just hang in there because I'm not alone. I have my parents beside me all along. They are expecting the best result from me and since I owe them my whole life, I thought those 6 years are nothing. Life is hard and I know they only want the best for my future. I told myself that I only need to finish what I started then after that I'll try talking to them about what I really want to do. I followed a writing competition in my country and turned out my short story was chosen as the second place and they are going to publish it into a book. I was more than happy when I received the news.I thought I finally have something to show to my parents that I'm actually pretty good at what I love. I know they will understand. It takes time to sort things out, and I'm not even sure of what to do for my future. But one thing I learned from all these years, being a doctor can actually become quite handy sometimes :) Do I regret the 6 years I've wasted? No, not really. I learned a lot and all that experiences molded me into someone I am today, so why regret it? :) I know it's hard for you now, but as I said before, just hang in there a little :) even the darkest storm has it own end and there's always a way out for every problem God gives you :)