Hurricane Jill

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Someone at UW Medicine has a sense of humor. Or maybe at CMS . . .

. . . nah. It’s gotta be the UW people.

Also I changed my page settings so that the blog will load faster. It was starting to irritate me, so I can only imagine how much it irritated my three readers.

So I’m on the second month of plastics now. And while there’s absolutely no danger of my deciding on plastics as a career, it has been nice to be able to follow the results of my suturing work over time. I’ve been keeping a very careful record of exactly which layers and areas of skin I close. Not only because I want to be able to remember it when I see them in clinic, but because there’s a tendency in surgery to blame the most junior person for anything that turns out crappy-looking. And I only want to be blamed for my own crappy work.

In fact, the other day in clinic, one of our recent bilateral reconstruction patients came in complaining about her scars, and the fact that obviously the attending had done one side, and the trainees the other. Sure enough, one side had a nice, thin, straight closure, and the other was lumpy and bumpy and very aesthetically unpleasing. There were two other incisions from the same surgery that also looked thin, straight and flat. She demanded to know which part I had done. So I consulted my little surgical record book, and pointed to one of the thin and straight closures. Then she demanded to know who had done the lumpy-bumpy one and I told her (truthfully) that I only kept a record of my own work and couldn’t say for sure who had done what elsewhere.

On the interview trail last year, an interviewer told me that one of my recommenders said I had “good hands.” He then asked me on what basis the recommender had made such a comment. I said that I had no idea how any of my letter writers would know that about me, and that my goal was simply to be as good as I could become with whatever natural skill I possess.

Which is true–I didn’t want to say it in exactly these words, but I was expecting to struggle just to be average. So I’m glad not to make a liar out of my recommender.

Is the plastics intern really necessary?

So. There are two PGY2 neurosurgery openings for 2008. One of them is an expansion, and the other appears to be an early dropout (someone matched there for 2008, and the program isn’t adding a new position).

And the earliest I can get in to see my program director to discuss my plans for next year is the end of October. It’s very frustrating, because I don’t want to apply without her support.

Neither of these programs is a place I applied to last year. And since I scoured every source of information I could find about every program in the U.S. before deciding where to apply, that actually means something. In both cases, it wasn’t so much that I’d heard anything negative, just that they were missing something I really wanted in a program, and I wasn’t aware of any compensatory strength in some other area of importance to me.

Of course, it could very well have one, and there’s just not enough information out there for me to have heard about it.

Really I’d prefer to stay here, but I don’t see any of these guys leaving, either voluntarily or involuntarily. And I’m not reapplying through the match because a) I can’t afford it, b) my vacation month isn’t until the spring and c) I can’t afford it. Also I have my Harborview neurosurgery month during the most active 4 weeks of interview season. And of course, right now I’m lolling around on plastics for two solid months, which is a nice break but of limited usefulness to me in finding a spot for next year.

All in all, very frustrating.

Also I feel like I’m not getting much out of this rotation. The division just hired a PA, and so most teaching efforts are being directed toward teaching her, and there aren’t enough cases for both of us to be scrubbed in and helping. Or actually, there are plenty of cases, just not enough OR time for the division to be running them simultaneously so we can both be involved. So she gets priority, because she’ll be a permanent part of the service, and theoretically will be teaching subsequent interns. There’s often not even room for us all to be scrubbed. This is billed as one of the “operative” rotations for interns, but frankly I operated more when I was on trauma.

And there’s clinic three days a week, so whenever there are cases and clinic going on at the same time, my job is to be in clinic. But even in clinic, it seems like I’m there mostly to help carry the dictation load. In every other respect, the service is micromanaged by the senior. Which may simply be his style. However, I don’t like having to redo my work over matters of personal preference. So now I just wait for him to tell me exactly what he wants, because if I try to anticipate what he wants, whatever I did, he’ll want something different. That’s the problem with micromanagement: it discourages initiative.

So my scutwork is being micromanaged, and my reward for doing the scut well and efficiently on this service is being done to a large extent by a PA, who currently can’t function in any non-operative capacity without asking a ton of questions of whoever happens to be nearby (usually me). And who arrives after me every day and goes home before me. I’ve been nice about it so far, but the bottom line is that the service doesn’t need an intern, and it doesn’t seem like the intern is going to get much out of it either.

On the gap between perception and reality

Last weekend I was on call for general surgery at the U, and I ran into one of the medicine consultants for a patient I was covering. After discussing the patient on whom he was consulting (and whose issue, coincidentally, was one of the medicine cases I got for my CCS–of all the luck!), the conversation turned chatty, and he asked me where I had gone to school. I told him. He asked me why I had chosen surgery, and made some remark along the lines of it being difficult to know whether you like medicine when you haven’t had a high quality clerkship experience.

(*sigh* people are such suckers for propaganda)

I replied that I had actually quite an excellent medicine clerkship, and that while I have immense respect for people who choose to go into internal medicine, it was not for me. I told him that I like surgery because I like fixing the problem. When I’m operating, I forget how long I’ve been standing, and whether my feet hurt or not. There was never really even a question of whether I would go into medicine or not, although I did my best to keep an open mind until my neurosurgery clerkship. After that it was pretty much over.