Stanley - The Making of a Surgeon

The Making of a Surgeon

Stanley Ashley, MD with John Hanc

Copyright

The Making of a Surgeon

Copyright 2012 by Harvard University

Cover art to the electronic edition copyright 2012 by RosettaBooks, LLC.

All rights reserved. No part of this book may be used or reproduced in any form or by any electronic or mechanical means, including information storage and retrieval systems, without permission in writing from the publisher, except by a reviewer who may quote brief passages in a review.

Authors note:

The interviews in this book were conducted with permission. The names and details of the patients in this book have been changed to protect their privacy.

This publication is not intended as a substitute for the advice of health care professionals.

Electronic edition published 2012 by RosettaBooks, LLC, New York.

Cover jacket design by Carly Schnur

ISBN ePub edition: 9780795332913

Table of Contents

5:45 a.m.: A clutch of white-coated figuresfive women, two mengather around a dimly lit nurses station. The soft hum of air conditioning, the muted beeps and chirps of monitoring devices are the only sounds in the wee hours of this July morning.

That and the rustle of paper as white sheets with long lists of names and numbers are distributed among the group. One of the seven is checking her phone. Jennifer, says a tall, dark-haired white-coat in what can best be described as a firm whisper. Drop that, were starting.

She pockets the phone, picks up the paper. Another 12-hour day is about to begin.

While these young men and women are beginning their long day at the hospital, many of their friends are rolling over in bed, squeezing in a few more hours of shut eye after a night out socializing before heading out to jobs in finance, law or high-tech; their college and graduate school years clearly in the rear view mirror as they push full speed ahead into their futures with the energy and optimism of youth.

These seven are, in effect, still in school. But, as we shall see, while they do attend lectures and classes and have homework and research papers to write, its a different kind of education.

Okay, lets start, says Dr. Lawrence Lee, the tall, dark-haired white coat. Peters.

The young woman with the cell phone responds crisply and on cue. Hes doing fine. No vomiting, no nausea, urinary output good.

Good, lets give him some crackers today. Kennedy.

A young man with a cherubic face and an Arabic surname responds, haltingly and in heavily accented English. Complaining of indigestion. Says he feels some numbness around the incision.

Okay, check it and talk to his nurse. Fernandez.

A prim, pretty young woman, who sounds so well-rehearsed you expect her to whip out a Power Point presentation, answers. She was having issues at midnight, but her third set of cardiac markers came back, and there was nothing impressive.

Read by you?

Yes.

Okay, good. Give me the numbers.

5.5, 39.7, 29.2

(Thats a CBCcomplete blood count, and in this case it means the patients white blood cell count is 5.5, his hematocrit is 39.7, his platelets 29.2).

Inside darkened rooms, the outlines of feet under blankets protrude from half-closed doors. These are the sum total of the numbers, the embodiment of the staccato summaries of bodily functions. For some of them, the morning will soon begin on a good notefor others, there will be more anxiety, another disorienting day in a strange environment.

Jansen?

BP, 90 over 50, was asymptomatic. No other problems.

Good, shell go home today.

Rogers.

There is some stumbling here in the response. The tall, dark-haired white coat looks up, his usually friendly demeanor now replaced by an icy, no-nonsense glare. Theres been a screw up. Someone was sloppy with the listas these detailed, precise summations of patient data are called. The information was improperly recorded, and the erroneous information was passed along to others, in this case the radiology department who was supposed to do an MRI on this particular patient. A chain reaction will now occur, and it will be the responsibility of this team, led by the dark-haired chief resident, to sort it out.

Once you give it to radiology, theyre locked, he says angrily. We cant correct it at that point. In the future, we need to make sure the list is right. We cant have this kind of crap happening again. Understood?

A downcast, ponytailed head nods.

All right, everybody, ready? Lets go.

In a flash, the group of seven moves with startling speed, down the dark corridor. Clearly, theres a reason that theyre all wearing running shoes.

Outside, the sun is rising over the city of Boston. Its the beginning of another day at Brigham and Womens Hospital. For these seven, and 68 other interns and residents in what is one of the most competitive medical training programs in the country, this ritual of morning rounds is one more step in a marathon endurance test. If they reach the finish line, they will join the elite of their profession; a profession whose actions have a more dramatic and immediate impact on the lives of their patients than any other branch of medicine.

This is the story of how surgeons are trained at Harvard Universitys premier teaching hospital.

The education of surgeons has long been a subject of lurid fascination to both artists and the general public. One of Rembrandts most famous paintings, the Anatomy Lesson of Professor Nicolaes Tulp, shows the good doctor revealing the forearm of a corpse to a group of astounded looking men (art historians tell us that the corpse was a dead criminal, and that Dr. Tulps audience are not really medical students at all, but burghers who paid young Rembrandt to be in the painting). The great American artist Thomas Eakins produced not one, but two famous paintings on this topic. One of them shows a bewhiskered late 19th century doctor in the midst of what appears to be surgery-in-the-round. A group of hirsute, nattily attired young men sit watching in an amphitheater around him, as the eminent physician flourishes a scalpel and appears to pontificate on the intricacies of the human body.

Even the name of this set-up, a surgical theater, suggests performance. In more recent years, television has struck gold with shows involving surgeons. From Ben Casey to M*A*S*H to ER to Boston (and now New York) Med, the airwaves have transmitted a steady stream of dashing, brilliant, kindly, sometimes witty, and occasionally flawed, scalpel-wielding heroes.

As with any profession, the reality of both the training and the job is a little different than the Hollywood portrayal. They dont operate on deceased miscreants, for one; nor do they perform surgery in front of large audiences like some musical theater troupe. And while surgeons can laugh in an operating room, if only to break up the tension and long hours, the non-stop riposte of Hawkeye, B.J. Honeycutt and Colonel Potter is rarely found.

If surgeons were really that funny, they would do stand-up.

The purpose of this book is to show you how its really done; how young surgeons today are taught, at one of the countrys oldest and most prestigious teaching hospitals. The reality, as you will see, is sometimes as or even more dramatic and demanding than the way its treated in popular media; oftentimes, less so. Either way, its undeniably important. According to the Centers for Disease Control and Prevention, there are 48 million inpatient procedures performed annually in the United States. These range from knee replacements to the insertion of coronary arteries; from hysterectomies to C-sections. And there are millions more that require longer stays.