Seasons of Surgery

Three months of my Surgery rotation are almost entirely behind me. Today I was on the ward jubilantly dancing to my own personal rendition of “Two and a Half Days Left” – if you haven’t heard it yet, don’t worry. It’s on my mixtape. Have a listen.

While a nurse wondered aloud whether I needed loading with Dilantin for my seizure-like activity, I blithely one-man-partied on.

This afternoon I had an epiphany: medicine is all about people.

But what about those five years of complicated biochemistry and endlessly detailed anatomy? Those reminders about evidence-based management and peer-reviewed research? All still relevant. But at the end of the day, what the delivery of health care is about is people.

Effective health care delivery means knowing what what people want.

We have to know what the patient expects from us. “to get better” is not a specific enough answer. It can mean keeping a limb or losing one. It can mean an IV line that never stops dripping, never mind that it’s only infusing normal saline. We have to know our patients.

Radiographers and radiologists are overworked. They know how we warp medical histories in our desperate attempt to get our patients’ done first, they know that sometimes we flat out lie. Yes, sometimes they send back really bad xrays and don’t bother to do the ultrasound for days because the porter only just now got sent for the patient, but getting angry has never solved any problems. They know we need their help, and we have to know when to pull back from all the pushing.

We have to know people.

Pharmacists are understaffed. They wield a lot of power behind their glass windows – second to laughter, medicines are the best medicine. They don’t have a lot of stock to work with either. Half the time, we’re out of this antibiotic or that painkiller. Now we have proton pump inhibitors, now we don’t. It’s like playing peek-a-boo only instead of a friendly face, what pops up is a stomach ulcer.

When we’re frustrated because the patient with a blood clot up the entire length of his leg hasn’t gotten his heparin because it wasn’t sent to the ward, it doesn’t do to yell. Yelling only makes pharmacists crawl behind their glass windows and give us a glass stare. I’m learning to bite back retorts and swallow anger because all it does is take me two steps back. Hopefully PPIs will be in stock by the time I get my stomach ulcer (which should be any day now).

We have to know people like porters. Have to know how to get them to work for you, instead of making them put you to work. Today, I got a patient down to the radiology department without having to accompany them personally for the first time. It was a red letter day, lemme tell you. It took me a dozen phone calls, endless cajoling and three months of saying hi and being friendly for it to happen. (In return, of course, I got a metric tonne of attitude, one “you owe me lunch, doc” and, AND, the results of my patient’s xray and ultrasound thankyouverymuch).

Working in a public hospital is about knowing how to tread around toes and egos, knowing how and who to bribe (always have candy) and knowing how to keep your head down and work hard. There’s a lot of humility and swallowing of pride and a little bit of knowing your limits. (there needs to be more knowing of limits).

It’s great to have someone you can learn from, even if that someone is sometimes yourself and your own mistakes because internship is one hell of a learning experience.