Intern Year: Errors

“I did this,” I thought to myself over and over again as I helped to roll my patient down to the ICU. 

“This is my fault.”

My mind was racing with the myriad of things that I could have mistakenly done – or not done – in the week prior to inadvertently cause my patient to suddenly decompensate out of nowhere on a Sunday morning. 

Was it the bed rest? Did I keep him on it too long? Oh God. The senior helping me just told me he should have been on a higher dose of clot prevention medication. Did he throw a clot in his lungs? Oh God. His heart. His kidneys. He just had surgery on his intestines. But what about his wound that’s basically been falling apart? Oh God. It’s a blood clot in his lungs, I just know it.

Oh God.

I don’t know what I don’t know, I don’t know what I don’t know, I don’t know what I don’t know.

It’s an intern mantra we repeat to ourselves, but it only goes so far when serious repercussions can happen as a result of knowledge gaps. And at the end of the day the phrase ends up sounding hollow and empty – laughable even - when those lapses in experience can be equated to us inadvertently rolling the dice with other people’s well being. 

I had been alone during my last week on the Colorectal Surgery service, playing a myriad of roles on a fairly busy service, but with only a portion of the knowledge to carry out even just one of those roles. I had been dreading the week for the entire month, but I somehow managed to make it through the week unscathed. I was grateful that the service had fewer OR cases than normal and I also lucked out with only one new patient consult the entire week. What had at first seemed like a terrifying week ended up being one of valuable use as an intern – one where I was able to step up, do a bunch of cool senior level OR cases (mine, all mine!), and make decisions with my big girl pants fully hiked up.

I went into the weekend with a 24-hour call on Saturday into Sunday, feeling like everything was winding down. I was ready to get it over with and be done with the stress of the week, the promise of starting on my pediatric surgery rotation just a few blessed days away. I made it through rounds and performing most of my tasks on Sunday morning with no issues and was about to leave within an hour or so, my excitement and relief swelling as the time continued to pass and I moved into hour 29 of working.

The irony of my patient crashing within that last hour doesn’t escape me. 

He had been a complex patient, one who had underlying, serious disease in a lot of his organ systems. I had been involved in this patient’s care since the early days of the month, and it had been a struggle from the beginning to gain control of the system-of-the-week that was having issues. By that last Sunday, everything had mostly resolved and he was on the upswing. My attending and I had even talked about discharge plans that morning.

Another irony that doesn’t escape me.

After I rolled my patient down to the ICU, the pressure of the week – and of the day – hit me. I’m grateful for the senior resident that took me aside to offer support, and for my co-intern that gave me a hug once I walked back upstairs. 

I went home soon after, and was somehow able to go to bed and fall asleep despite the knowledge that once I woke up, I’d probably be able to find out what had gone wrong. 

The relieved sigh that escaped my lips upon finding out that it hadn’t been a pulmonary embolus – the thing I thought I had caused – echoed the internal alleviation of tension that also occurred with the discovery, though I still felt awful and was still worried about what would happen to him.

Regardless, I did my best to unwind for the remainder of the evening, knowing that I had to reset and get ready to start a new rotation in a new location (the worst combination) the following day.

I checked my phone right before going to bed to look through the patient list one more time, seeing if there was anything else I could tidy up before the new residents took over the service, and also wanting to chart stalk one last time to see how my patient was doing.

I blinked once. 

My heartbeat picked up. I refreshed the screen. 

I blinked again.

…What? 

Another patient of mine had not only gone to the ICU, but was also in the process of being emergently taken to the OR.

I did nothing but sit on the couch in the silence of my apartment and stare off into space for a few moments, the gears in my brain frozen, unable to think, let alone feel, any emotions, having already devastated the majority of my reservoir earlier in the day (and the week).

Click. Click. Click. The gears began thawing. And it started coming to me in pieces. 

His labs. The nurse off-handedly making the remark that his room smelled a bit worse than usual in the morning. The fact that he had been clinically stagnant the past couple of days – not doing worse but also not really improving either. He had been another medically complex patient, but still…oh God. 

Thankfully, his serious complication had been caught by the senior on call that same day just a few hours after I had left, but it still was a terrible feeling to know that I had missed something on one of my patients….that I was unable to put the pieces of the puzzle together from the trickle of clues that had been left here and there along the course of the morning. What if it hadn’t been caught that day?

Hindsight is 20/20. Hindsight is 20/20. Hindsight is 20/20.

Another phrase we tell ourselves. It’s comforting and painfully true, but it also serves as a reminder of our human limitations.

The next morning, I woke up to start my first day on pediatric surgery filled with uncharacteristic anxiety and aversion to going into work. I remember staring at the computer screen in the OR lounge that morning, unable to focus on looking up numbers and information on the list of new patients. 

Thankfully, expectations were low on the first day and, since I wasn’t assigned to be the intern seeing new consults that day, I spent most of the day doing nothing but operating. While that normally would have excited me to no end – pediatric surgery is what I want to do with my life, after all – instead it felt unsatisfying, filled with brief moments where I just wanted to crawl out of my skin and hide. 

Surgery residency is always go, go, go.

And I just needed it to stop, stop, stop.

Which, of course, it never really does.

I deliberately reached out to one of my closest friends that day, telling her that I needed to talk to someone (an action I rarely do), and I was thankfully able to talk with her a couple of days later.  It helped, as did seeing that my two patients that went to the ICU gradually started to improve over the following days. I still felt slightly off though, and I spent my first couple of weeks in mostly solitude, not really wanting to socialize or talk to many people outside of work. 

I knew that what I was feeling was partly heightened by the fatigue that had gradually built up during the months. There was also the reality that I was also still a fairly new intern that had just recently moved to a new area with no partner and no family. And no matter how blessed I feel by my new resident family, at that time they were equally – if not more – busy and stressed as I was. 

The rational, logical part of me knew that it was all a perfect recipe for the way that I was feeling and possessing that knowledge helped me move through the days. If the concept of resilience was a moving object, I was trudging just behind it. 

Thankfully, the familiarity and enjoyment at being back in the pediatric world started to bring me back to my baseline. I started to feel a sense of contentment that increased day by day. It wasn’t until my string of four nights straight that I felt back to normal, resilience once again back on my side. 

Working nights can inevitably be chaotic, but I’ve also found that I enjoy them immensely. The solitude and limited interactions of the night were often a stark difference from the whirlwind rat race of days, and they provided a recharge to my introvert batteries that I needed. When combined with the fact that it was pediatrics, it was potent enough to snap me out of my funk.

As the weeks passed, both of my patients that went to the ICU were transferred to the floor and eventually discharged. I still intermittently check to see if they were re-admitted, something I don’t really do with other patients. 

Looking back now, I sometimes feel juvenile for feeling the way that I did – for having such a lingering reaction.  They hadn’t died.  In fact, one could reasonably make the case that complications were to be expected given their medical histories and statistical chance.

However, it doesn’t change the fact that on that day and the week prior, I had been the resident responsible for their care, seeing them far more frequently than the attending or anyone else except for the nurses.

The experience was yet another new one in residency – learning how to grapple with the reality and concept that not only do patients not do well sometimes, but they also end up not doing well because of the things we as doctors inadvertently do or not do, despite our best intentions and the amount of hours we put into taking care of them. 

We’re human, too, after all.

I know that this will happen again. And not only that, I know that there are worse things that will happen - worse events missed, worse errors, worse outcomes. I also know that in the future I will most likely look back on this entry and shake my head at my naivety. Even now, I look back at some of my entries from medical school with a wistful smile.

Regardless, getting used to the reality of complications, errors, and bad events happening to patients is yet another hurdle that we face as new doctors that unfortunately needs to be experienced. It’s not something that we can escape, no matter how hard we try. And with that comes the inevitability of learning how to cope and move on.

We owe figuring out that process not just for ourselves but also for all of the patients that will follow.

Intern Year: That Time I Cried in a Stairwell

Over the past four years of medical school, I’ve learned to strongly believe in the power of vulnerability. It’s a concept that I’ve embraced – though not without difficulty – and I try my best to not only incorporate it into my personal life but also my professional life.

(Though something I’ve discovered is that those two lives bleed into each more often than most of us have the courage to admit). 

With that being said, and rather ironically, I’ve always had a terribly hard time crying in front of others in the context of one of my weaknesses or insecurities being put in the spotlight, especially when done in a sudden and unceremonious fashion. Crying as a result of anger and frustration never - for whatever reason - leaves me feeling as bothered.

Perhaps it’s because I subconsciously feel that crying from the latter emotions is a sign of passion or strong opinion whereas crying from the former is a sign of personal failing. 

So when I found myself in tears in a hallway on the Friday morning on my first week of residency, literally unable to hold them back after barely succeeding in doing so for the prior hour, the first thing I felt was shame and embarrassment. 

I have a bad habit of bottling my negative emotions and stress. Usually, I can keep the bottle plugged and hidden until I’m able to sneak away and empty it out when no one is watching. There’s only a small handful of people that I would every willingly engage in a conversation where I know it will make me cry.

But sometimes the bottle gets filled too much, with so much pressure that just builds and builds and builds until it shatters. 

The first week of residency, being on call twice in one week, and having a relatively high amount of complicated patients (for my level, at least) was the perfect recipe for it to happen. I was disorganized and flustered on rounds on Friday in a way that I have never been before (literally), and the results of that were not pretty. 

My chief resident caught me as I was trying to hold a conversation with him a bit later, the dam holding everything at bay starting to crack more and more with each passing sentence. 

“Are you crying?” he asked me. 

Busted.

“Yeah,” I answered. 

He stood up. “All right, come on,” he replied, guiding me in my dazed trance into a nearby stairwell. 

“It’s okay that you’re crying…it’s normal,” he stated calmly, “But one of the rules of residency is that if you’re going to cry…always have your moment in a stairwell.” 

I laughed at that, immediately grateful for the genuinely empathetic way in which he handled the situation.

Noted, I thought.

“I just have too much botox around my eyes to cry anymore,” he also added. 

Pro life tips of an awesome senior resident. 

I felt better the next morning, but the main thing that lingered after was the embarrassment I felt in losing my composure in front of a person I barely knew. I felt exposed, transparent in a way that made me squirm. I still wince thinking about it. And that in and of itself made everything even worse.

Why is that?

Probably pride. Maybe a little bit of ego. Two concepts that have been stripped down, torn apart, and reset already in the few months that I’ve been a general surgery resident. 

I consider it to be a good thing. 

I’ve always thought that pride and ego is a double-edged sword for a surgeon – we need to have a certain amount to be able to do what we do (can I even include myself in ‘we’ at this point?), but on the other hand it can quickly become our biggest downfall. It’s a balancing act. For me, vulnerability has always been a way to maintain that balance. And perhaps embracing my weaknesses in a new way was one of the first necessary growing pains in figuring out residency.

“Be gentle with yourself” are words I often say to other people.

Perhaps I need to start listening to my own advice more.

That first rotation already seems a long time ago – even though it was really only two months ago. 

I started on a GI surgical oncology service where there was no shortage of patients with complicated medical, surgical, and personal histories. It was humbling to start my journey of being a doctor on a service where patients are often grappling with some of life’s hardest questions and curveballs regarding terminal illnesses, dire situations, and end-of-life care. And many of them did so with a light and hope and warmth that was incredibly authentic inspiring.

That rotation was followed by a month of nights – a crash course in surprises and everything under the sun. It felt like the wild west of surgical care. Overnight, another intern, a third year, and myself covered five services, about 60-70 patients, and new acute care consults (gallbladders galore!). It was, oddly enough, a very enjoyable month. Amidst the chaos that can occur at night, there was a certain peace to walking the empty halls of the hospital at night. 

Getting adjusted to the rigor and intensity of residency has also been an adjustment in and of itself, filled with moments where I was tired, up for more than 28 hours, and my brain function felt nonexistent in situations where it was desperately needed. 

Thankfully my capacity to think while being exhausted has continued to improve. And now when it feels like I’m learning about 50 new things in the span of five minutes, approximately 27 of them stick in my brain as opposed to the measly 10 at the beginning of July. 

Progress, people.

During night float, I started to see how easy it could be to become callous and robotic – how empathy and patience can be some of the first emotions to be put toward the wayside. In moments where I’m trying to do an admission, am getting new consults, still have 5 postop checks to do (yay Vascular!), have a patient unexpectedly start to decompensate, and am getting hammer paged seven times within five minutes, it would be so so easy to just snap at somebody. Especially since I’m still trying to figure out how to respond to, do, and handle all of those things (yet another growing pain) without asking someone or without being slow.

At least I know where the food, coffee, and bathrooms are. 

During the past few months, I’ve learned how to make empathy more of an active process rather than to just let it be a subconscious, passive driver like I have in the past.  The simple, cliché statement of “putting yourself in other people’s shoes” really does hold true. 

If I’m being paged, it’s because someone is concerned, they’re trying to help their patient, or they’re trying to make their own lives easier (all things that I can empathize with, even the last one). If someone is snapping at me or being hard on me, perhaps they’re having a bad day, someone had just got done yelling at them, or that’s how they were, unfortunately, trained. Or perhaps that’s what they strongly feel will make me learn the best.

It’s all an interwoven, never-ending cycle. And I’d like to think that most people are trying to do their best in a complicated, difficult system that never sleeps and rarely lets up. 

I’ve also learned that stopping – both physically and mentally - in the midst of the chaos and just taking a deep breath can help immensely. I can’t control the things going on around me about 90% of the time but I sure as hell can control my own actions and thoughts. 

Be present.

My patients help with that. When I walk into a room, I do my best to ignore the list of things that still need to be done so that I can just simply focus and be in that moment. 

Most of the time I succeed in that endeavor. Other times I unfortunately don’t. I have a feeling that will continue to be a perpetual struggle for the rest of my time as a healthcare provider.

The residents, midlevel providers, and nurses that I work with also tremendously help. They’re a wonderful group of people and I feel very blessed to be in the residency that I am in. It’s a comforting feeling to know that you feel safe to ask questions, be vulnerable, and learn in front of a group of people. And to have fun, enjoyable times along the way as you do so. 

As I near the end of my third rotation (Colorectal Surgery!), I look back and am in awe at how quickly the past few months have flown by and how much I’ve grown in just the few short months I’ve been an intern. I can only imagine what the next three months will hold and where I will be then. 

I haven’t had any other moments of crying in a stairwell since that day (okay okay okay, I did cry one more time post overnight call in my car a couple of weeks after), but there most certainly may be more.  

And that’s okay.

But for now…one day  - and experience - at a time.  

Medical School: Four Years, Four Parts

Year One. 

A year of self-discovery and uncertainty. 

Who I was as a person intrinsically changed, shifting my perspective in a way that was both exciting and terrifying. I’ll admit that the terror and anxiety outweighed the excitement a significant portion of the time, and unfortunately a lot of my decisions on whether to engage or not engage with the people in my life, both old and new, were based off of that fear.

Along with those changes came the overwhelming feelings that inevitably go hand in hand with starting the daunting path of pursuing medicine, meeting new people, and being in unexplored places.

Most people probably don’t know that I questioned my decision of becoming a doctor nearly every day that year. 

If beginning the journey of medical school was a white line, I stood with my feet firmly planted on both sides – one in my old life and the roots that had taken hold, and the other in a staggeringly overwhelming new life, resistant and hesitant of everything it entailed.

As the year progressed, however, a chasm started to split along that white line, slowly widening more and more day by day until balancing both my old and new life became increasingly difficult. I stubbornly persisted in trying to maintain that balance despite subconsciously knowing how much I was failing at it. 

However, it was also a year of laughs and of joy. Of refreshing moments and allowing myself to open up to people who were, at that point, strangers. 

I learned – and for the first time truly believed - that vulnerability is strength.

I learned of deficient areas in my life and made goals on how to improve them, most of which included opening myself up more to people about my thoughts, my feelings, and myself. Professional and personal development all in one – two birds with one stone. Easy, right?

If only I had known that my first year of medical school was the slow ascent to the pinnacle of what would become a downward slope.

Year Two.

A year of pain.

Suffocating and heartbreaking pain. 

It was rare that I went a day without crying, and it’s possible that I was clinically depressed, something I had not experienced before and, despite my adamant belief in mental health care, never admitted to myself when it was happening. 

I used to think that being able to maintain a normal, even positive, external façade in tough circumstances was a strength of mine, but I’ve learned since that it can also most certainly be a weakness.

One of the worst feelings I think I have ever experienced is feeling alone in a crowded room filled with people close to you, and my second year of medical school consisted of far too many of those moments.

The overwhelming newness of the prior year’s changes had settled into multiple harsh realities, none of which I was equipped to deal with, especially when dangerously combined with everything occurring during one of the hardest years of medical school. 

The chasm had widened to a point where now I had no choice but to fully embrace this new life of mine, both feet on one side, and I often felt a shadow of my former self. Looking in the mirror was difficult and some days I almost expected it to crack, a true reflection of what I felt was happening inside myself.

I marvel at the friends and people in my life that kept me afloat (and still do) on the daily, often without even realizing the depth of their impact.

There was a notable transformative, bright spot that year – a classmate who came into my life and helped me laugh through it all…somebody who found sinking pieces of myself and dug them out until I started to recognize them again, though they were certainly still cracked and caked with grime. There’s something to be said for letting a person figuratively pick you up.

By the end of my second year of medical school, and before moving to Pennsylvania, a few situations had thankfully resolved, and my world started to spin in a direction closer and closer to a purposeful, positive axis. It wasn’t the same one as before (nor did I want it to be), but was instead something different, an intriguing and curious new start. 

One that, thankfully, would only become stronger, better, and more meaningful with time. 

Year Three.

A year of growth. 

The pieces of myself that had been chipped away at in the prior years started to repair themselves. I started to polish the dirt off slowly but surely.

What I found underneath was surprising – on the surface there were parts that had always been there – certain character traits, strengths, and weaknesses. But there was something else…a shimmer that hadn’t been there before. A newfound strength and comfort that I didn’t know what to do with at first.

My academic drive and motivation returned, something I hadn’t truly fathomed that I lost until beginning my third year. But along with that, there was a humility and empathy that hadn’t been present prior. 

I used to joke to people that met me during my medical school years that if they had met me beforehand, there’s a good chance we might not have been friends. I was judgmental, cocky about it, and also lacked any sort of understanding for those different than me. I needed humility and a wake-up call. 

All of the pain I experienced was completely and absolutely worth it to rip that horrible, inexcusable part of me away. Some of the things I have said and done to people in the past, all in the name of religion, are some of my biggest regrets. Maybe one day I’ll find the strength to send apologies to people in my past I no longer talk to and treated poorly.

In a year defined by caring for patients for the first time in a clinical setting, I feel like I truly started to grasp whatever it is that connects each of us through our human fragility. We are all capable of having moments of both utter joy and overwhelming suffering, no matter our life circumstance. 

For every time a patient looked at me and said “thank you” I wanted to say “No, thank you” right back. I strongly feel that being open to learning from each other will always be the true foundation of humanity.

During this year, I also became wonderfully aware and open to the value and concept of community – of truly creating a family with people unrelated to you – as this was my first time living outside of Florida. As the growth continued, and for the first time since the beginning of medical school, I was able to put my guard down and allow myself to connect with those around me. 

And what a blessing it was. 

Because for all of the dirt that I wasn’t able to polish off or the cracks I wasn’t able to repair, my patients, my program’s faculty, my classmates, and other friends…they did it for me, finishing and touching up the repairs in my life with a care and compassion and acceptance that I don’t think they realized they exuded.

Thank you.

Year Four.

A year of self-acceptance and learning to love myself.

If the first three years involved discovering more of who I am and the person I want to be in the context of other people’s support and drawing on their strength, this past year involved this same discovery, but instead drawn from my own fortitude, self-love, and resilience.

It was the year that I truly felt healed.

For years, I had forgotten what it was like to feel at peace. It didn’t occur to me until the end of third year going into this past year, that an inner contentment had returned. It had occurred so gradually that I almost didn’t realize it until one random day I thought to myself “Wow, I’m truly happy”, paused to reflect on the notion, and then had no subsequent feelings of anxiety or despair creep back in.

The nature of fourth year contributed to that.

Whereas third year involved the stresses and challenges of clinical rotations in a setting where I could fall back on my classmates and familiar faculty, some of fourth year involved doing clinical rotations alone in a foreign environment. It was one of the most intimidating things I have done in my professional career so far and I was blessed to meet new people and sharpen not just my clinical skills, but also my character. 

After, I spent months traveling around the country for interviews, which was equally as isolating and intimidating. I was left with just myself in unfamiliar places. Hours and hours spent wandering new streets. Eating alone in restaurants. Filling the time in my day however I wanted to, often only speaking to strangers. Or not really speaking much at all. 

The parts of me that had been cleaned off and repaired to reflect the positive growth in the prior year were now becoming more refined…more confident and more content. 

I’m stronger now. 

I don’t recognize the person I am now when compared to the person I was starting my first year of medical school. However, I have a feeling that I’m not alone in that sentiment. My journey is just one amongst my classmates – each having their own stories that defines them. 

Even as graduation nears, I’m still learning. I’m still conquering fears and insecurities. And truthfully, I hope that part never becomes stagnant. I hope that as I begin residency in a few short months that the layers never stop being peeled away, testing me to continue to push to be the best version of myself that I possibly can be. 

For now, I’m simply content with being able to say that I’m proud of the person that I am. 

-

Here’s to the next journey.

On Suturing

1.

“Looks like it’s your job to fix this – don’t screw it up.”

I was watching the finish of a pediatric surgery case with an upper level resident – I can’t remember whether it was a port placement or a port removal, but either way it signified an unfortunate and difficult path that no child should ever have to undergo.

The resident was placing deep dermal sutures, which are sutures that are usually placed as the second to last step before the skin closure. It’s a layer of suture that can make or break the appearance of a closure – it can either bring the skin edges together flawlessly for an easy skin closure or it can make the skin edges lopsided and bunched, a poor reflection of what a closure should be.

She placed one. It was fine. She placed another. It, too, was fine. And then she placed the third. It resulted in an uneven approximation, bunching the child’s skin, leaving it noticeably distorted and uneven. She stared at it a moment, shrugged, and then asked the nurse to hand me the suture to close the skin on top of her sloppy, lazy, poor job.

“Looks like it’s your job to fix this – don’t screw it up,” she said to me.

I was furious.

One of the many reasons I want to be a pediatric surgeon is the tedious perfection and care that is needed in every aspect of care with a child, and that includes skin closures in surgeries. Where adult skin is more forgiving, tough, and already marked with life’s scars, the skin of children is not. It’s delicate, easily scarred, and any poorly thrown stitch is noticeably visible.

Learning to suture children closed was an entirely different ballgame from adults…absolute perfection was the demand. And it was all under the umbrella of an intensely protective culture of the miniature patient on the table. It is that part of the pediatric surgery culture, amongst many many other things that has made it such a draw to me.

In examples of the one above, I’ve seen pediatric surgeons take out inadequate deep dermal sutures to redo them over and over and over until they’re perfect. It’s simply the norm.

I remember holding the needle driver in one hand, unsure of what to do or say. The shock and anger had rendered me relatively speechless. Regardless, she didn’t care either way and walked away, leaving me alone to try to close the skin and make it look as flawless as possible despite her poor job. I wished that the attending had been in the room.

What made it worse is that she had just made the decision to pursue pediatric surgery, and I was also incensed at that. If she was going to be lazy about this, what other, more serious things, would she be lazy about?

All of this was passing through my mind as I started to close the rest of the skin. Thankfully my skills were advanced enough at that point that I was able to work around and minimize her mess. It was still visibly distorted from what it could be though.

(Side note: I usually try to maintain some semblance of anonymity in my writings, but I will outright say that this was not a resident at my home institution…and that she was awful to work with throughout the entire rotation).

The entire scenario with her blasé attitude, despite the anger it caused, brought up other thoughts and sentiments. Was this just her personality? Did she start residency like this? Or was she a product of the long hours, jaded attitude, and burnout that goes hand in hand with a surgical residency?

Also going through my mind was the power differential that inevitably exists within medicine between students, residents, and attendings…how it prevents people from speaking up and expressing concerns. One of the things I am looking forward to most is to creating an atmosphere where the situation in which that resident put me in never exists.

Throughout medical school, we each come across role models that inspire us to be just like them. However, I’ve also found immense value in the unfortunate role models that inspire me to never be like them.

So what can I strive for?

Right now – to be the type of resident and attending that always cuts out and redoes even the simplest of sutures for the sake of the patient, while simultaneously never putting anyone around me in a position where their morals become compromised.

2.

Well over a year ago in October 2016 I texted one of my best friends a picture of a suture board with a loaded needle driver. I had been extremely uneasy in the OR that day, so nervous that my hands had shaken uncontrollably under the watchful eye of my attending and resident as I sutured a patient close. It was not one of my finer moments as a medical student.

I had been so embarrassed that I took a suture board home with me that day to practice, stubbornly determined for the episode not to be repeated.

“Practicing suturing as if I had any idea of what I was doing,” I texted jokingly and simply, not relaying the true nervousness and insecurity that had plagued me through the first half of my surgery rotation.

“You can do it,” she responded. “Looks like cool practice. I know you have shaky hands though. Mind over matter.”

I remember thinking something along the lines of “Busted!” at her very casual yet very correct comment. Her adeptness at reading and stating the unsaid has always been an intriguing, yet comforting and much appreciated, skill of hers.

I’ve never been good at expressing how I truly feel, something I have been incessantly trying to work on throughout medical school. This is one of the friendships that has brought out the vulnerability in me, and the underlying strength that ultimately lies within that concept. I owe a lot of my inner growth over the past few years to her and our friendship.

“Thanks,” I replied. “I’ll have to remember that. I get nervous when people watch and when it’s on a live body.”

“You’re supposed to be nervous. You’re a person,” she stated. “We all get nervous…Maybe when you’re doing it you can think of me and how I get really nervous every time for karaoke even though I do it all the time. But once you’re doing it and you see it’s going fine it’s easier to relax. Everyone watching you has their own nervousness too. It’s ok.”

As I remember this in depth now and reflect on it, good conversations and the blessed irony of an unlikely friendship fills my head. But aren’t those supposed to be the best connections? Her words struck me as profound (they usually are though, more than she probably realizes) and the insight stuck out to me in a way that obviously has remained (always with a smile, too, when I think of the karaoke inclusion).

“You’re right,” I responded. “It’ll probably be better anyways if I just relax. I think these weeks of surgery are good for me…I just gotta embrace it more and get over the hump.”

I am a combination of the people in my life…the deep friendships that push me to want to be my best even in the moments where I want to stop and give upright before the proverbial hump. They always carry me over.

This was one of those moments. A permanent handprint on my life that lingered and will no doubt continue to linger.

Over a year later and my hands don’t shake nearly as much anymore. I embraced and conquered the hump and it ultimately led to my decision to pursue surgery. The stark contrast between this conversation and my thoughts at the time compared to now don’t escape me. Life is funny sometimes….okay….maybe a lot of the time.

I’m grinning as I type this despite the fact that I’m also tearing up…sentimentalism at its finest.

There are moments where I definitely still get nervous while suturing – situations where an attending, chief resident, and nurses are all silently looking at me and critiquing me in a quiet room save for the steady beep, beep, beep of the patient’s heart rate on the monitor.

I still think of this conversation in those moments. And also in moments that have nothing to do with suturing.

I simply pause, take a deep breath - Everyone watching you has their own nervousness too. It’s ok.  – and continue. It always helps.

You’re never alone.

Mind over matter.

3.

As a third and fourth year medical student, suturing skin closed seems to be the one thing that we can reliably be able to do. I’ve always thought it to be a bit ironic considering that it’s the one thing that patients look down and see, and yet it’s often one of the first surgical techniques we learn how to do.

“You better do this well because it’s the one thing they’ll be able to visually judge you for” is the general statement that I’ve heard repeated to me ad nauseum by a multitude of attendings and residents at a few different institutions.

The first few times I did it was rough. Shaky hands, not knowing how to maneuver the needle driver and my forceps let alone knowing that there’s so many other details that go into it – how to grip the skin edge, what angle to place the needle, how far on the needle to clamp, and a multitude of other minute particulars that all lead to an efficient, beautiful skin closure.

“Dermabond fixes everything” is another phrase that a medical student often hears from residents and attendings.

Dermabond is basically surgical superglue. It’s usually smeared on an incision site after being closed with sutures to protect the incision and further pull skin edges together in a desired fashion. It’s the fix-all to any less-than-perfect incision closure and it truly does work (if only it could be used on children per the first story).

However, I cringe every time a resident says that phrase to me.

Because when a resident says that about my incision, it implies that it wasn’t done as perfectly as it should have been the first time. Each time I want to ask if I can redo it….if I can work on learning the technique so perfectly that I just use the Dermabond as an extra layer of protection rather than a corrective measure. Realistically though, Dermabond could probably make my incision look better regardless of how perfect my skin closure is.

I remember reflecting on this a few weeks ago as I was hanging up clothes in my closet. In the moment, I was slightly perturbed by the fact that the hangars weren’t the same and that some of my clothes weren’t facing in the same direction. At one point I stopped and shook my head at how ridiculous I was being, and I wondered in the same moment if lamenting over Dermabond should evoke the same response of silliness.

My obsessive-compulsive traits have been a strength. It’s never reached a pathologic level, but instead has fostered a perfectionism in me that has helped me be successful in both my professional and academic life. I double and triple check everything I submit with my name on it. Organization and completing tasks in an orderly fashion genuinely makes me feel satisfied. It’s what will make me – hopefully – an excellent surgeon.

But these same traits can also be a weakness.

I hate it when objects are partially hanging off the edge of a counter. I check to make sure both my alarms are on in a ritualistic fashion at least three times each night. I used to often go back after heading outside to make sure my oven was off and my door was locked, but I’ve thankfully made myself let that slide over time to a less neurotic level. And those are just the ones on the top of my head as I type this.

I’ve learned over the past few years that there’s something to be said for easily being able to let go of a situation or certain things. It’s also healthy.

And it’s a balance I’m always struggling to maintain.

Surgery residency is going to be a struggle of discovering how to work efficiently while not sacrificing that perfection where it matters, and I wonder if I’ll be able to conquer that struggle. Will my need to dot every ‘I’ and cross every ‘T’ eventually overwhelm me? Will I even still be able to do that? Should I?

I feel that finding that balance is just one of the many keys that goes into unlocking how to navigate through residency successfully…how to be both effective and efficient without being overwhelmed.

Right now, I have my jeans hanging up in my closet with different hangers. It makes me internally twitch a bit sometimes whenever I go to that section of my closet, but I’ve learned to shrug and let it go.

I haven’t had to force adaptations such as that in my professional life yet – I’ve always had the time to devote in order to maintain my strict work tendencies. However, I know that’s about to change in a few short months, where my equilibrium will have to be shifted to maintain my sanity, and ultimately, maintain good patient care.

And perhaps learning when and where to let the proverbial superglue in life take over is simply the first step to ultimately conquering that hurdle.