“Grief is like the ocean; it comes on waves… Sometimes the water is calm, and sometimes it is overwhelming.  All we can do is learn to swim.”

Vicki Harrison

   I walked in to look at the patient with the laceration.  He was extremely thin, with long, stringy hair.  Half his teeth were missing, the other half in various stages of decay.  He was fairly intoxicated, and someone had hit him over the head with a broken bottle.  After about three minutes, I clearly understood why someone would want to hit him over the head with a bottle.  He was rude and obnoxious, insulting everyone who walked into the room, demanding a plastic surgeon because he was worried about the scar.  His problem seemed so minor compared to what I just saw, I felt like saying “Listen, you jackass, someone just died.  Someone just got their organs smashed, their chest crushed, then lingered for about an hour until they bled to death.  You are obviously a completely worthless scum bag, and your biggest worry is a tiny little scar!?  You think you have a problem, why don’t you go talk to the little kid whose Dad just died?”  But that really does not constitute an acceptable bedside manner. 

     I walked into the back staff bathroom feeling physically and emotionally beaten, ready to crawl into a corner, curl up in a fetal position and cry.  But as I learned over and over again, a busy surgery intern doesn’t get the luxury of grieving for a patient, doesn’t get to process and analyze and understand those feelings.  I stood in the cold, bright bathroom for a moment, then shoved all those feelings into a corner of my brain as my beeper went off yet again.  I took a deep breath, went back to the ER and gathered my medical students to take care of the patients who were waiting for me.

     It was the middle of the summer, in 1994, and I was just starting my intern year in general surgery training.  Even now, 30 years later, that particular night remains vivid in my memory.  This was the night that I truly understood that other people’s lives would depend on my ability to make the right decisions, and to make those decisions quickly and with certainty.  Their lives would depend on my technical skills, my knowledge, and my judgement. The importance of devoting myself to learning everything I could about surgery was evident, because at any moment I might be called upon to manage some life-threatening situation.  I had to be prepared.   As a medical student, I had a rather glamorous idea of what it meant to be a doctor, and this didn’t include failure.  I didn’t know that being a doctor meant I would watch someone bleed to death in the ER despite my best efforts to save them.  There will always be injuries too great to fix, illnesses to overwhelming to cure.  But our duty to our other patients will remain. 

     As I reflect back, it is clear that my intern year, that transition from a student of medicine to a physician with real responsibility, was probably the year of my most profound evolution and growth.  My experiences during this year solidified in my mind that I had made the right choice, that I indeed belonged in the field of surgery.  About half way through, I realized what a wealth of experience I was building up, and what unique people I had the opportunity to interact with.  I started to write these experiences down, on loose sheets of paper which I stuck in a folder, on napkins shoved in a pocket, on floppy disks, in files on hard drives of various computers that I copied and kept.  I finished my six year residency program in 2000, and spent the next four years in the United States Navy, as a lieutenant commander in the Medical Corps.  I deployed on an aircraft carrier as the Ship’s Surgeon, spent time stationed at a Navy Hospital, and deployed in support of Operation Iraqi Freedom to set up and staff an evacuation hospital for the casualties of the Iraq war in 2003. 

     After my honorable discharge from the Navy, I spent several years in private practice, and became involved with teaching surgical residents.  Residency is a whole different ballgame now, with limits on the number of hours per week a resident can work, limits on how long they can be on call, mandatory protections on their time so they can read and rest and go to educational conferences.  I realize I am among the last of the surgeons trained the “old-fashioned” way, when you stayed at the hospital until all the work was done on all the patients, and no one really was very concerned about how well-rested and comfortable you were.  I thought it was time to put together all those recorded bits and pieces and tell the story of my year as a general surgery intern.