It’s All An Act…


“It is better to know some of the questions, than all of the answers.” – James Thurber

In medical school the first thing you want to do is look smart. 

Hell, that all any of us want no matter what our walk in life, right?

How to accomplish this while surrounded by 100-150 other brilliant academic and social high acheivers? This is the delimma. 

My strategy was this:

Only ask second or third order questions and ask them only if you already know the answer. Even more importantly, know when to keep your mouth shut.

Here is the scenario:

You are a third year medical student assisting the most bad-ass vascular surgeon in the hospital during an abdominal aortic dissection repair. This guy is scary. He has kicked other students out of the OR for simply looking at him the wrong way through their face shields. You have to be on the top of your game.

The Prep:

You knew this was coming because you checked the surgery list before you left the night before, read all of the scheduled patients’ charts, and stayed up half the night reading up on everything in text books.

Over coffee on your hour long drive in the next morning before the butt crack of dawn (enough caffeine to stay awake but not so much that your hands shake… it is a fine line) you plan out and memorize your questions.

Act One:

As you are holding retractors, trying to keep the small intestine from sneaking over toward the clamps and bovies, you ask, “So this fellow had a 7.5cm aneurysm. That puts his annual risk of rupture at about 20-40%, right?” You don’t look the surgeon in the eye, though. Never move your eyes from the operating field….

“Yes…” Is his gruff, muffled response. He knows the game you are playing and can appreciate it for what it is.

He then starts to pimp you on the anatomy and you ace it. Thank you, Netter’s Atlas of Human Anatomy…

Act Two:

“Oh, shit!” 

You can see the aorta is dissintegrating in his hands. 

The scrub nurse stands up a bit straighter while the resident surgeon standing next to you kicks your ankle hard, shooting you a warning look as beads of sweat form on his brow. Your own heart is pounding.

Act Three:

The next several hours are tense. You don’t say a word. Your arms are killing you from hold the retractors so hard for so long but you don’t dare let go or even intimate by body language that you are in pain or tired. 

All of those extra questions you carefully planned out? You don’t use them. Instead, you keep your mouth shut because you know that at a time of crisis the last thing anyone needs is a showboating med student trying to make a good impression.

The Grande Finale:

The graft requires two re-sews. You are dangerously close to the renal arteries….

Somehow, though, it holds. No leaks. Everyone stands back and watches for a few minutes just to be sure.

Instruments and sponges are counted.

As a reward, you get to practice sutures. 

“Nice knots,” Dr. Bad-ass says as he looks over your shoulder after scrubbing out. The resident will handle it from here. “I am doing a bypass tomorrow. You are welcome to come hold a retractor.”


Curtain Call:

It is well after 8PM when you finally get to your car only to find that you have a flat tire. You blink the tears from your weary eyes and swallow down the lump in your throat as you get out the car jack and tire iron and set to work. 

The universe has a perverse sense of humor.

As you are screwing on the final lug nut the OR scrub nurse drives past, rolls down his window, and offers to help. You decline, smiling to yourself as he drives off. You now have a witness that you, a girl, sat in the dark parking lot and changed your own flat tire.

Tomorrow you will be legend.

My Request:

Questions. I want to know what you want to hear about from me. What do your inquiring minds want to know?!?!??? Silly questions? Thought provoking ones? I don’t care… Bring them on! 

Just don’t try to ask the anonymous doctor for medical advice. And NO, you cannot send me a picture of that rash you have “down there.”


190 thoughts on “It’s All An Act…

  1. Pingback: Stranger | Behind the White Coat

  2. Okay, I’m packing it in with this, another excellent post–High suspense! Great short story, actually.
    Thanks for an interesting afternoon. Distracted me from these stupid, stupid kidneys. I shall now give the remarkably obnoxious left one a firm punch to show it who’s boss. (I shall fool no one, for it has demonstrated time and again that I am its b#tch.)

    Hah! That’ll learn it! Have a good night, Victo, if you are still awake, and a great day, otherwise.

    Liked by 1 person

  3. Pingback: More Questions! | Behind the White Coat

  4. I don’t know if you’ve addressed this before, but were you ever close to burnout, such that you (for example) considered quitting medicine? What’s your advice to students and junior doctors in terms of not burning out and not becoming disillusioned with their careers?

    Liked by 1 person

  5. Pingback: Empathy in Medicine | Behind the White Coat

  6. Hi there! You have found me (thank you) so now I’ve found you (thank you again). This was the first post of yours I’ve read. Wonderful! I do have a question for you: How do you see your fellow classmates, and the doctors you’re working alongside, generally treat and view their (RN) nurses? My fiancé has a year left of nursing school before she graduates. Of course, she’s heard horror stories.

    Liked by 1 person

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