It’s All An Act

colorful canal in Burano, Italy

“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 dilemma. 

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.”

Yes!

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. Ask me a question. What do your inquiring minds want to know?!?!??? Silly questions? Thought provoking ones? I don’t care… Bring them on! 

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

*If you have been with me for a while, you may have recognized this post from last year. I thought I would recycle it, hoping to get some blog posting ideas from your creative minds!

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127 thoughts on “It’s All An Act

  1. I scrubbed in for that same surgery several years ago. The surgeon was much like the one you described. He was in the process of replacing the artery and got them mixed up right to left. Patient was all sewed up but there was no pulse from the femoral artery. So he spend another 4 hours redoing the operation. He was a little testy about the situation.
    Leslie

    Liked by 1 person

  2. I’ve always wondered why the medical world expects you all to function on so little sleep both in training and after. Isn’t that extremely dangerous for the patients? It’s so weird when it’s all about health.

    Liked by 2 people

  3. Questions? Heck, I come here for ideas. I love your posts, the fiction is wonderful, it’s a perfect blog. I’ll try one. Can you recommend a site or document that will give me the scary stuff about performance enhancing drugs? Not just in sports, but the military too. I’m writing a book of short stories where PEDs will play a role. It’s mild science fiction this time, so I may invent my own drugs, but it’s nice to base them on reality. Maybe you can milk a post from that question.

    Liked by 1 person

  4. Here are some questions, most of which, over your long and illustrious blogging career, you’ve already answered, but…:

    1. If you were to give one piece of advice to the average reader about the thing they could most do to protect/improve their health, what would it be?

    2. Do you know when a patient is lying to you? How?

    3. In what ways does being a doctor help you in being a mother? Vice versa?

    4. What’s a pseudoscience/pseduohealth product that you wish people knew the truth about?

    5. What do you think is the greatest health crisis of our time?

    6. How do you feel about modern day feminism?

    7. Why does it still suck to have to buy a swimsuit?

    8. Studies show that transgendered patients often avoid going to the doctor when they should. Is there a way you would reach out to/encourage that demographic?

    9. If there were one topic you WISH you could write about, but you don’t feel like you could do it justice, what would it be?

    10. What do you most want to change about the world we live in for your children?

    Sorry; I tend to go big or go home, as they say. Feel free to ignore all of these. I’m a big fan of your blog regardless, and can’t wait to see how others’ questions translate into posts!

    Liked by 4 people

  5. Okay, okay, I have questions!

    Your prose and photography are both magnificent, but I’m wondering if you have connections in mind. I suppose with all art, the interpretation is best left to the viewer, but I thought perhaps you might be willing to shed a little light on your own process for pairing art with story.

    Finally, have you considered adding captions so that your devoted and adoring readers will know precisely what they’re looking at?

    Liked by 1 person

    • I tried captions. That was a drag. Disrupted the flow of the post, really. I would love to do a post on photography and what I look for! And if you ever want to know where a photo was taken, let me know. 🙂

      Liked by 1 person

  6. Parenting, doctoring, partnering, blogging… My question is how? And I don’t mean in smile modestly, Superwoman kind of way. But more in a what do you get back that makes it worth it to do all those things?

    We are the lucky ones—your readers/patients/admirers. But what do you get out of all of it?

    Liked by 1 person

  7. Do you have a solution for remaking the way medicine is practiced in the United States? I know our politicians don’t consult either doctors or patients when they write their laws. But let’s pretend they will listen and do the right thing…what would you suggest? (K)

    Liked by 3 people

  8. Great post again…. Here’s a doz questions or topics….
    1. If you only had one major do-over allowed, what would you do and why?
    2. If someone gave you 1 million dollars, tax free, what would you do with it? Would you still work?
    3. Name the three best days of your life, not counting having your kids. This might be fun to share with all of us chiming in listing ours.
    4. What do you hate the most about the medical field, what to you love the most. One thing each.
    5. I think you might have done this one: what is the grossest thing you ever had to do as a MD?
    6. Write one of your stories but have your readers write five or six sentences to end it.
    7 Write about “the one love who got away”, if there was one.
    8. What will you tell your daughter when she comes to you in 10 -13 years and says she wants to have sex with someone.
    9. What will you say to your son for the same question above?
    10. What is the best miracle you have witness as a MD?
    11. What was the biggest hurdle you had to get over to become an MD?
    12.What will make you quit your job, if anything?

    Anytime you write is a pleasure. I absolutely love the story of your shart…. I sitlll laugh at it…. but then I am wild about anything about farts…. I love your humor

    Liked by 2 people

  9. I love your blog – particularly the real-life stories. But I’ve always wondered where the name comes from. I tried googling “Victo dolore meaning” and found, first, your novel, and then something about it being some historic surgically oriented person’s motto. I haven’t studied Latin in YEARS – so what does it mean? Victory over sorrow? Sorrow wins? Winning money? WHAT???

    Liked by 1 person

  10. I cannot even fathom the kind of dedication and discipline you have illustrated with this post. I now wonder if a lot of people ask you about their rashes down there — Is that a common inquiry of non-patients? Goodness.
    If you hadn’t become a doctor, what other field of study would you have pursued?

    Liked by 1 person

  11. Good post. When I was in nursing school I had a classmate named Ginger that could never keep her mouth shut. If we were lucky we could observe a couple of surgeries. Ginger told a surgeon that she thought the laparoscopy incision he was making was too long. We also happened to eat lunch in the hospital cafeteria and one of the hospital’s nurse recruiters joined us. Ginger started rambling on about how she thought most of the nurses she’d met at this hospital were unprofessional. I was so mortified.
    As far as sending in a picture of the rash down there, I’d say feet can sometimes rival a rash down there for the potential surprise ick factor.
    I have never changed a flat tire. I recently was travelling and one of my tires was losing air. I was petrified and just decided to get a brand new tire installed rather than deal with the potential of a flat.
    As far as questions, mine would be about the struggles you(or others) face combining medicine and motherhood.

    Liked by 1 person

    • I don’t think people realize how annoying they can be, how the things that come out of their mouths sound. I count myself guilty of that a time or two, too! Great question!!!! 🙂

      Like

  12. I would like to see the,

    ” Best Victo patient one liners”

    The post could be divided between,

    In the office and in the OR..

    I bet you could write a classic, best of, on this 😄
    And maybe be as much fun for you to write as for us to read 👍

    Liked by 2 people

  13. You might have written about it before, maybe I have even read it and commented but I was wondering how often you were close to quitting? It seems so darn hard to get through and I bet everyone gets to the point where they consider dropping out. Some do. You didn’t. What made you continue?

    Liked by 2 people

  14. Dang my mind is a blank. I’m so tired but if I don’t comment tonight I won’t get it done later. Great post for ideas but I love how you handled the God surgeon from hell. Four stars for that.

    I have no questions but maybe what was the most embarrassing moment of your career either with a patient or another medical professional. That’s all I can come up with but, someone else might already have asked. 🙂

    Liked by 1 person

  15. I wanted to ask this on your last post but thought it was too personal. Is your husband a doctor? now or was he? Do you think doctors have a leaning to use alcohol more? Do you have to abstain from drinking if you have a surgery the next day? Just wondering…

    Liked by 1 person

    • I have never been married to a doctor. 😉 Doctors don’t abuse alcohol more than the general population, but the repercussions are worse in some ways because of the job. I never drank on call. Most of my surgeon friends would not drink if they had a big surgery early in the AM. Drinking, especially as you get older, does nasty things to your head and equilibrium. 🙂

      Like

  16. Excellent description of a very intense learning experience Victo – from a student’s perspective. From a patient’s perspective, it leaves me with some questions. For instance – as other commentators have mentioned – I question the effectiveness of training when the student is tired beyond all reasonableness. I know that studies of children have shown unequivocally that learning is much more effective when the child has had sufficient sleep. Also medical professionals preach getting good sleep as improving health and learning on all levels. I was involved when the trucking hours of service rules were updated for Canada and the US. The doctors and scientists that we relied on for information regarding the latest sleep studies were all adamant that it was dangerous to have commercial drivers able to switch from dayshift to nightshift without days off in between. I talk to nurses at the hospital regularly and they are required to switch shifts exactly that way.

    Another concern is who checks the doctors? For instance if a doctor makes a mistake, is there any process by which his/her work is ever assessed -other than the obvious patient mortality? Not daily, of course, but in any meaningful regular assessment. I’ve had doctors make major mistakes on me and my only recourse was to change doctors (which I do). At no point has any doctor ever apologized to me (one put me in hospital for 10 days because of a blatant mistake and another caused a serious side effect that should not have happened except the doc was in a rush. That one followed me for almost a year and will be there off/on for the rest of my life). In one case it was obvious to all it was an error and the other case,I thought the problem was me until a nurse I trust took me aside and pointed out the mistake – I looked it up and sure enough there I was in the literature.).

    I have been in the position of assessing training programs and, with no exception, programs that are aggressive rank last in information and attitude gained by the student. No exceptions. Mind you assertiveness is critical but aggressiveness is destructive.

    I could go one but those are my biggest questions.

    Great post Victo. 🙂

    Liked by 1 person

    • Gibber asked a similar question about fatigue and learning and I intend to do a blog post specifically about it. In training, everyone is watching you. When you are out of training, less so. I was on the hospital committee that reviewed adverse patient outcomes and concerns for a few years. In that instance it worked. Physicians policed and disciplined themselves. That being said, there was a recent case of a neurosurgeon in Texas who paralyzed or killed multiple patients. Multiple complaints were made to the hospital’s he operated in and to the state medical board. For years. Finally, after a long string of horrific errors, his license was revoked. Apologizing to patients for your errors is hard. I have had to swallow my pride and do it a couple of times myself. Fortunately it wasn’t a situation where anyone was hurt but I think patients have a right to know if they were given. The wrong medication by staff or a result was misread. You have more experience with healthcare than anyone else I know and it is a shame you have had such awful experiences.

      Liked by 1 person

      • Don’t get me wrong Victo, I have received what I would judge to be the very best of care. People make mistakes and when they”don’t” make mistakes they are either not learning or they are lying. In transport we used to review driver errors that were brought to our attention to see if there was something in there that could prevent further occurrences of the same issue or to identify a problem. We used a pyramid paradigm where by the base of the pyramid was a collection of small, sometimes no impact errors, the center would represent larger incidents , but fewer and the top represented cataclysmic events involving death or major environmental contamination, etc. The theory was that errors promulgated from the bottom to the top, so catching and correcting small errors was critical to stopping big ones. In B-school we studied various paradigms for identifying and correcting errors and classifying errors. There is a whole area of professional study around that very topic.

        But first the errors have to be recognized and admitted. For instance (speaking from experience) when doing colonoscopies on patients with colostomies, always do the rectal stub first as it has no harmful bacteria. Fistulas are not uncommon for patients that have had radiation treatment and scoping the stoma first and then the rectal stub will introduce harmful bacteria to the stub where there may be an unidentified fistula. And the doctor who did that told me i was being childish when I complained about bladder pressure while he was inspecting the stub using compressed air. If he had stopped to listen and had made even a cursory check he would have discovered that and saved me 10 days in the hospital on IV broad spectrum antibiotics. I even complained to his nurse and she shrugged. I changed doctors but he never had to admit his mistake and I am sure others have made the same mistake. It bothers me when there is no recognition of errors or communication of them. I’m not in the least interested in punishment – in fact I once put a policy in place whereby my employees were given gift certificates for reporting their own errors – up to a certain amount and type of damage. In the end I am convinced it literally saved lives. And it resulted in a fast reduction in error numbers and costs and an increase in efficiency. Go figure.

        Liked by 2 people

  17. I changed my tire once in college. It felt like it took an hour. How long did it take you? Would you have accepted help if you weren’t almost done changing the tire? Did your arms feel like rubber? How did you hold those retractors in the same place for so long? I just can’t imagine, but maybe I could have when I was younger.

    Liked by 1 person

  18. I love your blog, you always tell such great stories (real as well as fiction) with empathy and compassion, you write wonderful poems too (I am not jealous…much)! All this on top of being a busy doctor, wife and mother!
    What I wanted to ask was, if you didn’t have to work, what would you do? 🙂

    Liked by 1 person

  19. Holy Exhaustion, I couldn’t have done med school. But if you only ask questions you know the answers to, how do you find out the answers to things you don’t know? Now I’m worried about what question my doctor never got the answer to…

    Liked by 1 person

  20. Wonderful post. Enjoyed it just as much this time. I had worked with my doctor when she was a partner in another practice. When she opened her own, I got my mother the first appointment when she opened her own practice. Do you remember the first patient in your practice?

    Liked by 1 person

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  22. Dear Dr. Dolore,
    I’m a high school student who wants to go into primary care one day. I’ve been reading this blog since Christmas, and I read the entire blog (I think) over Christmas break, but never have commented before. I greatly admire both your writing and your willingness to share your experiences. I have many questions for you, but the main ones are…
    How did you choose your specialty?
    If you had the chance to change anything about your career, what would you change?
    Is it medicine worth the many years of education/sacrifice of your 20’s?
    Do you have any advice for aspiring physicians?
    Thank you so much!
    Taylor

    Liked by 1 person

  23. This is one of your best posts in my opinion. Very interesting.

    Do some long-time patients ever become familiar with you, as in addressing you as other than “doctor”, and if so, does this have any effect on your treatment of such patients? Whatever your answer to this, what is typical in the field?

    Liked by 1 person

  24. I admire your calm in the face of life or death situations (flat tire included!).

    Just wondering what you would change about the way physicians are trained (if anything). It all seems rather oppressive, but there may be good reason for the “hard-ass” approach.

    Liked by 1 person

  25. A marathon session of Q.I., yes that panel show with Stephen Fry also helps.

    Why? Banter is sometimes better than flawless knowledge when during tense moments you need a joke or something silly to at least smile. The British are amazing at banter…

    Liked by 1 person

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