How I Became a Surgeon

Two years of medical school classes flew by, followed by three brutal weeks of preparation for the USMLE. “Enjoyed” doesn’t adequately describe the excitement, inquisitiveness, and joy I experienced when I finally left the classroom and board exams behind to take care of patients. Every rotation brought new challenges, which I embraced wholeheartedly.

Then, in the middle of third year, I did General Surgery at a busy community hospital. I spent six weeks working my brain and hands to the limit. From the moment my attending pressed my hand onto a bleeder in a patient’s belly – urgently saying “Hold that!” – I knew operating was the most thrilling thing I had ever done.

The faculty answered my numerous questions and generously let me do as much as possible in the OR. I served as first assist on 50+ cases, ranging from colectomy to thyroidectomy to complex oncologic resections. The first-time awe of seeing someone’s deft movements to tie a vessel, explore bowel, or reconstruct a breast still sticks with me.

But I didn’t want to be a surgeon! At the beginning of medical school, I planned on Family, Internal, or Emergency Medicine. I valued the rapport and relationships developed by caring for people throughout their lives or managing their toughest days. I hoped that one of these would prove to be a better fit than surgery.

Internal Medicine fascinated me. Sure, rounding took an eternity, but I liked long discussions and introspection, researching questions from rounds, and having daily lunch conferences. One day, I dragged my entire team down to the lab to look at our multiple myeloma patient’s rouleaux under a microscope. On night float, I enjoyed the strange peace of a hospital without the daytime bustle. I had to admit to myself, though, I still missed the OR.

On OBGYN, delivering babies and performing oncologic surgeries both interested me, but preventative care clinics did not. Although it’s a privilege to assist healthy people with important life decisions, preventative medicine and family planning just didn’t offer me the same satisfaction as surgery.

One night on my SICU sub-internship, the PGY2 and I admitted 19 trauma patients; we placed our 15th central line as the sun rose into view over the city. Later, I talked with the brilliant PGY9 trauma/critical care fellow about my difficulty choosing a specialty. She said something I’ve never forgotten: “Surgery is the coolest club around, but the dues are high and you have to decide if you want to pay them.”

The situation came to a head on my last Emergency Medicine shift at a large urban hospital. I had spent the night placing central lines, suturing lacerations, taking the good-natured ribbing of my brotherly interns and responding in kind. At 7:30 AM, I walked to my car, weary to the core, and realized that what I loved most about EM was procedures and trauma – the aspects that most closely resembled surgery. I burst into tears in my shabby student car, still parked in the garage.

I continued to deliberate, and talk to family and mentors. Finally, my dad told me I should make pro/con lists because my fretting was making no progress. The lists laid out all the issues that floated through my brain (thanks, Dad!).

Pros: the straight up joy of operating, using my hands, fixing things, and making people’s quality of life better. Cons: residency would take five or more years and the demanding schedule could make having a family difficult. To be honest, I’ve forgotten most of the other cons. I’ll spare you the lists for Internal Medicine, Emergency Medicine, Gyn Onc and Psychiatry.

When I did an Otolaryngology elective, I knew by the end of the first week that I had found my specialty: the perfect blend of medicine and surgery, gorgeous anatomy, patient stories and the instant gratification of fixing things. We did complex cases, like image-guided transorbital/transnasal resection of a maxillary sinus cancer, and simple cases, like laryngoscopy and biopsy. The ability to approach a tumor from multiple angles without a single external incision astonished me. Otolaryngology offered a remarkable spectrum of procedures from delicate ear surgery under a microscope to twelve hour oral cancer surgery with mandibular split and free flap reconstruction. I loved it.

My other concerns melted away. I had female and male mentors who were spectacular surgeons, diligent academics, excellent parents, humanitarians, and teachers. I developed a longterm friendship/mentorship with one of my senior residents; we still talk sporadically, and always get together at academic meetings.

Five years ago, my personal statement read: “From the first day in the OR, I felt at home.“  Five years into residency, it surprises me to realize that I still miss other parts of medicine.  When you choose one specialty, you must give up the others. But would I choose differently? Absolutely not.

I connect with patients every day. I’m privileged to use my hands to remove cancer, help patients hear their families, restore faces after trauma, and enable people to breathe comfortably. It doesn’t get any better than this.

Keep up the strong work,

Single with Scalpel

This essay originally appeared as a guest post on #LifeofaMedStudent