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I sat down again to study what I thought would be dry material, but as I began mastering some key concepts—almost sensing my father there in the room with me—I had a glimmer of enlightenment, and I understood perhaps even the essential purpose behind these vertiginous rounds.
The next day we started with Bed 32, where there was a young woman with advanced amyotrophic lateral sclerosis, ALS, the dreaded Lou Gehrig’s disease. She had already undergone a tracheostomy, a surgically created passage in her windpipe to which a tube from a ventilator was connected. Her breathing was very labored. Her disease had progressed quickly and she was in the throes of its final stages.
She was not much older than me, and I pondered the horrors of how this poor woman was dealing with the reality of her impending demise. Was she ready? What loved ones was she leaving behind? How many dreams were going unfulfilled?
My empathetic response gland was suddenly kicking in. “Patience” care was starting to make sense.
12. Let the Bacteria Kill Them All
I had heard the war stories, that surgeons were a human resources nightmare, a culture of sanctioned bullying and humiliation. Tough shit. As disappointing as my third year was shaping up to be, I wanted to be a surgeon; enduring the third year of med school, I now had skin in the game. No one would stop me.
I reported to City on my first day of surgery rotation, stopping by the clerkship office.
The director’s assistant flipped quickly through a file and assigned me to Team C.
I glanced at the form. Dr. Roberto Asco would be my chief resident.
I was unfamiliar with him, so I hunted down a desk clerk. “Excuse me, I am looking for Dr. Asco...”
The clerk rolled her eyes; she had better things to do than talk to a stupid student. “Over there.” She pointed a bedazzled acrylic fingernail.
I was directed through an imposing set of double doors intoacute care, where a mini-squadronof doctors stood gathered around a patient’s bed. I made my way over and hovered a few feet outside the circle. I tried to find the perfect moment to jump in. No such moment came. Finally, I simply broke the ice.“Excuse me; I am looking for Dr. Asco?”
“Yes. I’m Roberto Asco. Who is asking?”
He had turned around sharply, looking miffed at having been interrupted on rounds. He was medium height, slightly rotund, with salt-and-pepper hair and deep, frightening cystic acne scars.
I heard myself stammer,“Um, hello, Doctor, I’m Rory. I will be your medical student on rotation for the month.”
He barely acknowledged me. I stood there for at least half an hour. My humiliation was mounting. Finally, when he was good and ready, Dr. Asco turned around again and faced me with his fiendish face for an instant.“Be here atsix thirty tomorrowmorning. Good day.”He walked away down the corridor.
What the hell was this mind game? I was expecting to get right to work. I was supposed to...what, read a book?Go home? Go to the mall? Get my nails done? So, I left for the day.
Overly anxious to get to work the next day, I arrivedat 5:30 a.m., all dressed up, already feeling desperate, standing like a beggar at the nurses’station, hoping to collect a fewpatients for early rounds. It didn’t help that I looked like I was ready to go shopping for accessoriesat Nordstrom.
I asked for patient charts from the nurses, but they categorically ignored me. I was completely invisible, a student totally flattened under the medical pyramid. It quickly became clear that sighting a snow leopard on a Himalayan peak was more likely than finding a paper chart amidst the chaos of the nurses’station.
During rounds, I began presenting a postoperative patient whose intestines had become obstructed. After every sentence, Dr. Roberto corrected me in a rising crescendo of anger. I felt myself starting to tear up, and silently repeated my mantra, the one I’dadopted fromMadonna’sfilm about an all-girl baseball team: There’s no crying in surgery.
The next day, strictly out of obligation, Roberto brought me to the operating room. It would be my first day EVER scrubbing into surgery. For two years I had anticipated this day, the entree into my dream career, the valiant start of a hero’s journey.
Entering the sterile OR core section was like boardinga spaceship bound for an alien planet. The all-white hallway was filled with machines, monitors, IV poles, scrub tanks, robotic devices, and laparoscopic camera towers. Supply rooms on each side along the corridor were packed with infinite materials. How would I ever memorize the specific uses of all of these parts, pieces, and supplies?
As I would learn too late, all physicians, nurses, technicians, equipment representatives, and maintenance staff were expected to be dressed in standard uniform: scrubs, scrub hat or bouffant cap, shoe covers, and masks. No one, not even the US president, was allowed entry into the operating room without Proper OR Attire.
I entered with Roberto, my head naked. I hadn’t forgotten a scrub hat; it wasjust that no one had ever trained me to wear one.A nurse grabbed my arm forcefully and pulled me out of the sterile core.“Get your hat on! You can’t come in here without a hat, don’t you know any better?”
My tears begged for release. No crying allowed.
I took a deep breath. After solving the hat crisis, I affixed my surgical mask and shield to my face.
Two doors led into each operating room: one small door adjacent to the scrub tank and another larger door directly accessing the hallway.
A dry, wrinkly hand grabbed me by the back of the scrub top, as if about to maul me or toss me clean out of the room. Brow furrowed, Roberto growled in fury.“MEDical student!”he roared, accent thicker than usual.“You cannot go in that door. Don’tyou know how theaircirculates around? You are trampling in all of your bacteria through that door. Didn’t you ever practice this shit on little bunny rabbits?”
With that, I ripped off my mask.“No, Doctor. Here in America they don’t let uspractice on Thumper!”
Next, I observed a man with white hair, the attending, walk in through the same double doors without a hat, mask, or shield. This was my first glimpse of thesclerotic surgicalhierarchy.
