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Memoirs of an Abused General Surgery Medical Student, Part I

August 31, 2006

edit – 6:14 pm, Thursday: Check out this event on late Saturday night if you’re going to be at ISNA… you know, instead of those usual late night sessions…

kr’s note: Those of you who have been following this xanga for a while, you might recall the “Memoirs of an American Haji” series that I did after this past hajj. What follow is perhaps an antithesis of that, namely my narration of various incidents that took place during my ungodly surgery rotation during the past two months. Some of these stories are funny, others are inspiring… others are downright weird. My penance spent in this purgatory for some sin that I didn’t even know I committed had its ups and downs–mainly downs–and looking back, finally done with it, I can honestly say that I’m just relieved to be done with surgery. I’d never go into general surgery, not even if someone paid me seven figures to do it. It’s such a downright nasty, malignantly hierarchical field filled with miserable people who only look to take it out on the person below them to make themselves feel better.

As a third year medical student, you’re on the lowest rung of the ladder… actually, you’re probably underground with interns, nurses, physician assistants, residents, attendings, and chiefs all ahead of you. It’s funny, because you walk in, having just taken your step 1 exams and you think you’re part of a fraternity, diagnosing and taking care of patients like a peer of the attendings. And then when you walk in, you get hit like a Johnny Cage shadow-kick (remember Mortal Kombat?), knocking you off your assumed cloud nine and back to your place amongst the peons of the medical team. And that’s what you are, basically, like the peon/peasant from Warcraft II (you can tell by all these video game analogies what I’ve been doing during my two weeks off), you only can mouth, “yes, milord”, “command me”, “ready to work”, “daboo, zug zug”, “work complete”, “thank you sir, may I have another.”

That serves as a perfect prelude for Warcraft II character sounds, courtesy of a website I found, to better explain what I’m referring to:
1. Ready to Serve
2. Yes, me lord
3. Your command, master
4. Ready to work
5. Daboo
6. Zug Zug
7. More work?
8. Work complete

HumanPeasantW2

Ah Warcraft II, a finer game was never made… except maybe Starcraft. But I digress, as I have a tendency to do…

The point of all that isn’t simply to complain about med school, no matter how whiny I sounded… hehe. Rather, I think it’s important for people to realize what the field of medicine is all about, not just the studying and memorizing that goes into the first two years, but also the mindless drudgery, insane hours, hospital politics, subjective grading (they can basically fail you if they dont like your haircut), and other things that make the third and fourth years so “grand”. Oftentimes, many people think being a doctor is glamorous and well-paying and hence every desi parent is convinced (mine included) that unless your child is a doctor, they’re a failure… but the reality is that you work hard, you’re never appreciated, patients look to blame you for problems, and the hierarchy that you face is often enough to unnerve even the toughest of people. Believe me, its not a cakewalk, and it’s nothing like the shows you see on TV… later on when one becomes an attending, it’s some of that glamor, but until then, its unending hard work with little appreciation from anyone. Just be sure you fully realize and see that, instead of focusing on the house with the three-car garage and swimming pool… the irony is that many doctors who make that kind of money are so busy working that they never really enjoy any of that. If you want to be rich, there’s dozens of other professions that you’ll make more money, work less, and perhaps be happier than being a doctor. In short, make sure you’re absolutely sure this is what you want to do.

But let’s not all that detract us from why we go into it in the first place: “to help people”, right, though the guy who serves fries at McDonalds and car mechanics also “help people”. But seriously, its about the patients, and of course you feel a sense of fulfillment and gratification by being able to take part in the healing process for another human being. It’s quite… spiritual and profound, and that alone–not the money or the glamor–makes all that drudgery and getting abused worth it.

What follows are several anecdotes during my two months doing general surgery at Christ Hospital (Oak Lawn, IL) that I think serves as education and entertainment for interested readers, regardless of whether they’re in medicine or not.

1. So you want to be a surgeon, eh? This first anecdote really isn’t a story at all, but rather a glimpse into the life of a surgical intern/resident, quite possibly some of the most miserable people on the face of the planet. Especially the first-year interns, a month ago, they had just graduated from medical school, proudly receiving their diplomas and officially receiving their “MD” titles… and now, they’re in the world of general surgery, one wherein they come in at 4:30 am every morning. And what do they do? They’re not busy saving lives, oh no sir. All that studying and training during medical school prepares them for coming in at this hour to look up patient information (temperature, blood pressure, pulse rate, urine output) from a computer and mindlessly copy that down on a sheet of paper that has all the patients on it, affectionately referred to as “the list” (you’ll see in a minute why I hate that term and will quite possibly strangle anyone around me who uses that term). We as medical students, lowest on the totem pole remember, wake up around 3:45 am (one of the most depressing things about this rotation was I’d wake up around this time and ask myself, “Subhanallah, how many times did I wake up for tahajjud like this?”) to also come in at the same time and use our amazing penmanship skills to copy information down as well, and then use the copier (ooooooh) to make copies for everyone. Usually by this time, I would have had several cups of coffee just to wake up and would have to sneak off to find a place to pray Fajr before the 6 am rounds began.

Around 6 am, the senior residents would walk in, and we’d be off to go “round” on all the patients that were in the hospital overnight. It was such a monotonous process of asking them how they felt, how was their pain (on the 1-10 scale), any nausea/vomitting/fever/chills/shortness of breath/headache/chest pain, had they walked around, how they tolerated their diet, etc… and of course, my personal favorite thing to do at 6 am, ask patients, “sir, did you have any bowel movements yesterday?” and “ma’am, did you pass any gas from below since yesterday?”. We’d then have to go and write notes on the patients we saw (the “SOAP”note), making sure we paid attention to note whether or not “BM+/- and flatus+/-” since surgeons are obsessed with that–and deservedly so, since those two things indicate whether a person’s intestines are working, how far along they are in the recovery process, and whether or not their diet could be advanced (from nothing to liquids to general). The “A/P” part stood for “assessment and plan”, and each patient required to have an “A/P” for the day. Here’s a cheat “A/P” for med students and something that I began to dread writing each and every single time: 1. pain mgmt 2. increase ambulation 3. incentive spirometry 4.consider clear liquid diet/advance to general diet and my favorite, 5. discuss with surgical staff.

At 7:15, we’d meet to “run the list”… something which we’d do 5-7 times a day, which basically involves going through each patient on the list, finding out what issues they have, and making sure they’re alive. We’d present the patients we saw to the chief resident, and then scurry off to the operating room (where we’d have our brief contact with the attendings) to begin the day’s surgeries at 7:30. The rest of the day was a factory-like procession of patients coming in and out, usually for the SAME freakin surgeries: gallbladder removal, appendix removal, hernia repair, and mastectomies. You get pretty bored after seeing 8 laparoscopic cholecystectomies (gallbladder removal) in a row. Oh yeah, there’s no lunch… surgeons pride themselves on not taking breaks and eating… I’d have to sneak out to find time to pray Zuhr (thank God Zuhr went until 6 pm each day, I shudder to think what woulda happened had I done surgery during the winter), and when we’d have a few minutes in between cases, we’d “run the list”.

As students, our job in the OR was to hold retractors, drive cameras, and basically try not to look like an idiot in front of the attending. Some of the attendings were amazing, some were… not. The biggest thrill of the day would be at the end of the case, when if you were good, like a mother giving her child a piece of cake for dessert if he ate his lima beans, the attending would let you stitch up one of the small incisions. This would go on until about 5 or 6 pm… I’m skipping all the times you’d get yelled at for things you didn’t do… and just when all the cases are finished and you can finally go home and just sit down… its time to… you guessed it, “run the list” for another 30 minutes. By the time you get home, its around 7-7:30 pm, you shower, have your first meal since 4 am, and immediately sleep after Maghrib. And then you get to do that all over again tomorrow. And every 4th night, you get to stay overnight for call. Yay.

So you still want to be a surgeon?

2. My first Code Blue. I’ll end the first part with a positive note, an incident that was by far my favorite one during those two months and one that I’ll probably never forget for the rest of my life. It was an idle Saturday afternoon, I had just finished morning rounds, eaten lunch and was headed to do Zuhr as nothing much was going on when I heard on the intercom, ‘Code Blue, SINI (room number)’. A code blue is a medical emergency, the ones that you see on ER when the patient is crashing and needs to be resuscitated immediately or else they’ll probably die. When a code blue is called, all doctors that are in the area, even if it’s not your patient, are supposed to rush to that room and help out. Thus, when code blues are called, you’ll see a throng of interns/residents running to get some action for the day… it sure beats running the list, right. Usually, as a student, you’re busy with some mind-numbing task so you can’t go running for those codes, but today, I was free and the code was in a nearby room. I thought what the heck, let’s go see if they’ll let me help, so I rushed in. The patient was a middle aged African-American woman who had fallen off the porch of a third story building while she was high after smoking heroin… she had fallen and was paralyzed in all four extremities and suffered massive internal organ damage and bleeding. I was surprised because only one resident was in the room along with a bunch of nurses, and seeing as there wasnt anyone else there, the resident told me to start giving chest compressions (wherein I basically stand on the side of the patient and push down on the chest with both hands, trying to aim for 100 compressions a minute). It’s funny, I had thought about a situation like this before, and I thought that I’d freeze up and feel too scared to do anything. But I guess watching all those episodes of House helped, because it felt more like a TV show than anything else, so I calmly went over and started administering chest compressions while a growing team of doctors worked on other parts of the patient’s body. It was amazing because as I was giving the compressions, the patient flatlined–her heart rate went to zero, she was clinically dead. I don’t know how to explain it, but I could feel the life flow out of her, like a cold breeze that sent a chill down my spine and caused my hair to stand up, I felt death enter her as life left her. It was quite profound, there’s no other way to explain as to how I knew this, but I just felt it. As we continued with our efforts, me pushing down, one doctor bagging her (mechanically ventilating her), another one pushing various drugs into her, and others preparing the machine that’s become popular in TV shows wherein you go “clear”… I was awed by being there as death entered into this woman’s body with my hands over her heart. After a few moments that seemed like an eternity, the heart monitor began to show a pulse and started to beep once more. At that exact moment, in the similar manner that I felt death in this woman, I felt death flow out of her, and life flow into her once more, like a warm breeze on a spring afternoon. Again, I can’t explain how I knew, but I could just feel it. As her vital signs began to normalize to somewhat stable levels, I was told to stop my chest compressions. She had been dead clinically for about a minute, and was now alive… unconscious and paralyzed, but alive once more. As I put on my white coat and headed out of the room, I felt humbled that I was able to be a part of that, to feel life and death enter and leave this woman’s body. And perhaps, if it isn’t presumptuous of myself to think this, I felt grateful that I had perhaps been a medium that Allah used to flow life back into her.

I made wudu and then prayed one of the best Zuhr prayers I have ever prayed in my life. It was worth waking up at 3:30 am for this.

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23 Comments
  1. The first part of your post made me go cross-eyed. It brought back all the reasons I didn’t want to do medicine (yeah, I guess many Asian parents have the same dream for their children, not just Desis, hehe). Thank God I escaped; my poor tummy can’t take the lack of food for long hours (strangely enough it doesn’t mind fasting TOO much, but anyway). But the part where the lady came back to the land of living was just spooky man. Hmm I don’t think I can handle that sort of thing either. The world ought to be thankful that I am no doc: I think I’d make a poor one.

  2. Anonymous permalink

    is funny cause every time i try and read your longggggggggggggggggg xangas posts….
    i feel abused as well…
    nigger-ul-haq

  3. ^boohoo, your xanga posts lately have been long as well. the pictures and sound files add to the length… never mind, why am i justifying it with you? like ive said before, people who want to read will read it. and maybe if you actually read it, youll realize why it was so “long” and required more than 2 minutes to read.

  4. im actually giving you eprops. i didnt think this day would come, but good stuff. it’s prolly cuz it’s not an islamic topic.

  5. Hahaha, Warcraft II sounds!
    That story about the code blue… wow, great stuff.

  6. Subhan’Allah.. i’m still reeling from your code blue story.. that was amazing..
    as for the first part… it just made me love my dad times two gazillion because he never forced us to be doctors even though he was one haha..

  7. That must’ve been some feeling…subhanAllah.

  8. this was awesome

  9. I should give you 1 eprop for not buying me dessert, Jerkan Riaz =)

  10. Heh heh…as much as I hated general surgery, it was a special experience. Makes me happier that I’m doing psychiatry and my patients are just creepy rapists…at least I get to go home at 5 at the end of the day…and q6 call during internship!

  11. loved the code blue story….
    lt786> why you gotta hate bro?….also….i think you mistakenly put too many ‘g”s….no one pronounces the word ‘long’ that way…. it’s loooooooooooooong 🙂

  12. Anonymous permalink

    haha damn nazim bhai…why you gotta stick up for kamran?  this is coming from the nigga who gave me a fatwah to slap kr a la AIM…or did you forget about that?

    and kamran you told me this story in PERSON…why should I read about it AGAIN on your xanga?  *shrugs* you are a friggin mystery my friend…
    nigger-ul-haq

  13. Will there be lots of parts?

  14. Anonymous permalink

    Man you seriously talk too much.

  15. ^and yet hundreds of people still read… hmmm

  16. Thanks for your comment on our site. Please note that we do periodically delete all comments to avoid ongoing discussion and potentially controversial debates. This is meant to protect all visitors, and avoid offending anyone. We do hope you will visit again

  17. 1)I can not say I ‘love’ UIC, but I have started appreciating it. It is like a second wife. One sort of marries her out of pity, but never really likes her. Meh.
    2)Mortal Kombat is the bestest game forever. No game before or after can come close. Period.
    3)Umm, are you saying you want to quit medicine, or that the incident made you appreciate your field? *scratches head*
    4)Lima beans are awesome…now excess ketchup is disgusting.
    5)And… heart monitor proudly provided by us respectable bioengineers, who relate to the field of medicine but do not compromise sleep. 
    6)The ‘incident’ does sound like an episode of House from a while back…
    And that ends my list of random comments.

  18. I love how you present medicine through the lens of pop culture, with references to Mortal Kombat, Warcraft, and House. BTW, I’ve tried to watch House a couple of times, but the show just doesn’t do it for me. They spend the whole show working on just one unusual case. Hugh Laurie is good, but the rest of the cast is pretty weak. That’s my take on it.

  19. Whenever I drop by, I think wow this is the best post ever. It can’t be topped, and then I revsisit to find myself saying the same exact thing. No .. but seriously, this one is really it.I’m proud of all the kids for making it this far, it’s first and foremost the Mercy of Allah and then your dedication and commitment to the field. Pharmacy is not even comparable to the work you’ve described.. but I’m glad the salaries are, kind of. lolI can’t imagine how you felt pushing down, knowing that her life was in your hands, literally. And the part about you feeling the life come out of her, that left me speechless.Cheers to yet another great entry.

  20. i missed ur ISNA appearance as a speaker. it’s all Devon street’s fault.  salamua alaikum.

  21. ^haha, dont worry, you didn’t miss much =)

  22. and thats why I am choosing to become a psychiatrist….just stopping by. Random propz
    Roxana

  23. i really enjoyed the hajj memoirs and these look like they will be as good, so i’m looking forward to reading the rest of them =)
    and mortal kombat is the best game everrr

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