He died for want of a plastic tube in his nose, which, in general surgery, is akin to a mortal sin. I was paged about his nausea while rushing to the operating room (OR) with a little girl who was carried into the emergency department with a mile of free air under her diaphragm. He was a cirrhosis patient on his ninth life who had happily been eating Jello that morning. The pediatric patient took precedence in my mind.
The floor nurse called again as my hands traced a familiar path from the ligament of Treitz towards the cecum. The OR nurse repeated the message out loud—my patient was coding.
The crowd parted for me as I arrived at a scene from a horror show—a pool of vomit, no pulse, no airway, pitiful access, yet a hundred hands—a gruesome scene I had helped to create. I bent my head and got to work, but the patient succumbed to darkness, to the black and bilious secretions thick in his lungs.
I think of him now, months later. There is no going back, no undoing the mistakes of the past. I work every day toward a future where I balance the demands of taking care of the sickest patients in the hospital with equal care and foresight. Every order signed, incision made, and suture tied is a promise to be better. Yet I realize, with a face more stoic than my heart, that I have caused tears and pain and will do so again and again.
My classmates in other specialties are more than halfway through their residencies. They’re looking at job offers; they’re stretching their wings, looking forward to taking less call, and being big, bad chiefs.
I have many years of darkness ahead: of predawn rounds and frantic midnight calls, of fledgling judgment, and of errors by my hands, with each year’s increasing responsibility promising even more devastating complications. Why do 20 percent of residents quit general surgery training? If you have to ask, you have your eyes closed and your hands clapped over your ears. A better question: Why do we stay?
At the end of the day, the toll of death and destruction is not the only tally worth counting. I remember the first time I disagreed with a radiologist—and was proven right in the OR. Or when I gave someone bad news, and he thanked me. Mustering the daily courage to soothe a difficult family and finding you’ve become the one they trust, or climbing the podium at a morbidity and mortality conference to take responsibility and grow from this experience are worth counting. Realizing I could finish rounds on 20 patients before a medicine resident’s alarm clock sounded. I came to know the feeling when 100 pleading eyes settle on you—and somehow, you know exactly where to begin.
So, I will work until the job is done, tally the marks, good and bad, and reset my alarm to do it again tomorrow. I owe this to myself. I owe it to the patients I left behind and to the many patients yet to come.
