Why I Walked Away From Surgery: Part 1
Due to the length and importance of this topic, it will be presented in shorter pieces over the next few weeks. So stay tuned and thanks for following along! -Mr. MedSchool Money
It is one of the biggest decisions you'll make in medical school. It doesn't just shape your next 5-7 years... It shapes the rest of your life. The decision to pursue medicine or surgery is undoubtedly one of the biggest decisions of your life. Like many other forks on the road to being a physician, the decision is made with very little information. Weeks after finishing USMLE Step 1, newly minted 3rd year medical students are thrust into the fast-paced, often ill-organized machine of clinical learning, AKA "the wards."
From start to finish, students have 15.5 months to experience as many medical and surgical specialties as possible. As with any job, it takes a few weeks to get comfortable working in a new environment. Don't worry, as soon as you get your bearings, you're off to the next rotation. After finding the one field that tickles your fancy, you have your remaining months before the Electronic Residency Application Service opens to arrange away rotations, write your personal statement, beg for letters of recommendation, and don't forget about studying! The SHELF exams that go along with many of the 3rd year rotations can be daunting. Additionally, many students take Step 2 Clinical Knowledge (similar to Step 1) and Step 2 Clinical Skills (in-person exam with standardized patients) during this time period.
3rd year is... busy. Amidst this craziness, 3rd year students must ask themselves some very deep questions with the biggest question being "Do I want to spend the rest of my life in the OR?"
I am currently in month 13 of the 15.5-month quest mentioned above. In 2.5 months, I submit my application for residency. Since I am applying for a training program that is focused on what happens after intern year, I will have to apply to categorical, transitional, and preliminary year programs as well.
Like many young bucks, I came into medical school KNOWING I was going to be a surgeon, a cardiothoracic surgeon in fact. I knew it. My family knew it. My friends knew it and often joked about me cutting them open someday. Since being a premed, pursuing medicine has meant pursuing surgery. I even have 4 published abstracts in cardiothoracic surgery from my preclinical years.
The first few weeks of my general surgery rotation at a very busy, prestigious, university surgical department were wonderful. The days were long, the cases were exciting, and the coffee was flowing. I can remember my first emergent case- it was a man who was post-op from a robotic colostomy takedown with end to end anastomosis, a Hartmann's reversal. His bowels hadn't quite woken up, so we were treating him for ileus and very cautiously advancing his diet. His abdomen was quite distended, and it only worsened. After a few days of rounding on him, I was used to the protruberant abdomen that greeted me each morning, but on this Saturday, it was beyond that. The patient was in significant pain.
After ordering a STAT abdominal X-ray, we found out that our working diagnosis was not quite correct. With his small bowel dilated to >10 cm and free air under the diaphragm, we weren't sure what the problem was, but we knew that we had to cut him open. We were in the OR for a few hours before we spotted it. After digging through the bowel and lysing adhesions for way too long, a tiny spec of color flashed across my field of vision... and then it was gone.
"There it is," I said. And, although my chief resident and attending surgeon weren't keen on taking orders from the med student, they asked what I had seen. Flipping back a few folds, I spotted it again and showed them the 1 mm hole in the bowel, which turned out to be the site of anastomosis. It had scarred down so severely that a portion of the wall broke down, allowing small amounts of feces to leak into the abdomen. Additionally, the break in mesentary below the site of anastomosis had become a hole through which the rest of the small intestine had herniated, leading to a small bowel obstruction. This was the source of our problem. The surgeon and chief resident profusely thanked me for speaking up, stating it could have taken them hours to find that small hole if I hadn't spotted it...
Click here to read part 2!