During my residency training, I had to take time off to undergo an orthopaedic procedure. I learned a great deal from the perspective on the other side of the knife. This Residency Diary entry is the story of that experience.
December 2018
I recently had a discussion with a trauma fellow about the most-important attribute a surgeon must possess during busy night on call. He argued for technical skill. I made the case for character. A skilled technician without a good ethical compass is a danger. A surgeon of strong character can possess insight into his or her own limitations and practice safely.
As someone about to undergo orthopaedic surgery, it was a great relief to me that the surgeon I selected meets both of our top requirements.
As a resident, I was fortunate to be able to choose a surgeon with whom I was familiar. In the pre-op area, my surgeon entered to answer my questions and do his best to put me at ease.
My surgeon described the planned incision. I went deeper and named the approach. He nodded. This was a time in which being an orthopaedic resident was unhelpful. The approach was one of the first surgical techniques I had done independently as a resident, and I saw flashes of tissues and dangers one would expect to encounter throughout the procedure. Even as the patient, my training had been so intense and desensitizing that I could not keep myself from thinking of my own body as mere layers in a surgical anatomy atlas. I focused on the purple ink of the marking pen to pull me back above the layers of the skin.
An anesthesia resident, who was the same year as me, tried to place an IV—it took six tries in my notoriously challenging veins to start a line. But the resident had been kind, honest, and diligent throughout, and when the anesthesia attending came in, I was quick to laud the resident’s effort. As health care trends toward valuing outcomes above all else, we risk losing sight that medicine is fundamentally a human endeavor, and that the bad outcomes—from the extra pokes to the failed surgical procedures—are an expected part of the practice of medicine. It is in these challenging moments when the support we give our colleagues becomes paramount.
As we started the journey through the familiar hallways towards the operating room, the pre-op medications began to take their effect. I remember thinking, somewhat bitterly, that this was a rather extreme way to secure the coveted few hours of uninterrupted sleep that always seemed elusive as a resident.
I was nervous in the weeks leading up to my surgery. I had been an object very much in motion. But in the weeks after the operation, the external forces ordered me to be an object at rest. The only thing I could do to get better faster … was nothing. Being at rest opened a vacuum of time once filled with call schedules and case presentations, allowing empty space in my mind to draw in large volumes of self-doubt. I worried if I would ever overcome this new inertia. Even as a resident—someone with a better-than-average understanding of the process I was undergoing—surgery and its aftermath rattled my concept of self.
Mercifully, time had little regard for my crisis of confidence. I threw myself into my rehabilitation and once again became an object in motion. The weeks passed, but the journey was nonlinear. Surgeons conceive of healing in terms of tissues, motion, and strength; patients know it’s something else altogether. My surgeon had told me that the road back from surgery was seldom like rolling up a ramp, but rather like sailing on the sea with rough waves. I celebrated accomplishments and lamented setbacks in the context of a voyage of emotional zeniths and nadirs. As I put each wave behind me, progress was made. I returned to work, thankful that the experience was behind me, but grateful for all the wisdom gained from going through it.
Like many, I was drawn to orthopaedics because it offers tangible solutions to real problems. It’s clean. It’s measurable. It’s direct. I like to fix things. The tasks and the tools of the surgeon are physical. But illness and injury are not abstractions. They happen to real people, whose lives, sometimes messy and complicated to begin with, only grow more so when their health has been threatened. Taking the time to appreciate how my work impacts my patients as individuals allows me to provide them with better care. A good orthopaedic surgeon is both a skilled technician and can help guide their patient over rough seas when faced with injury or illness. The tasks and the tools of the healer are empathy.
Footnotes
A note from the Editor-in-Chief: I am pleased to present to readers of Clinical Orthopaedics and Related Research® the next installment of “Residency Diary.” Lisa G. M. Friedman MA, MD, is a resident in the Orthopaedic Surgery Residency Program at the University of Minnesota Medical School Minneapolis, MN, USA. In this quarterly column, our readers have the chance to follow Dr. Friedman as she progresses through her residency, chronicling events and interactions that have made an impression on her.
The author certifies that neither she, nor any members of her immediate family, have any commercial associations (such as consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article.
All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research® editors and board members are on file with the publication and can be viewed on request.
The opinions expressed are those of the writers, and do not reflect the opinion or policy of Clinical Orthopaedics and Related Research® or The Association of Bone and Joint Surgeons®.