The Grumpy Surgeon

“God dammit just follow the F**KING directions!”  This was said to me the other day in the middle of a surgery.  The person who said it is actually someone I typically enjoy working with.  We were doing a pretty routine case that I had done dozens of times with other staff at different hospitals.  One of the positives of surgical training (although often frustrating) is that many staff do the same procedure in different ways.  It is a benefit in that you see many ways to get to the same end result.  But it is extremely frustrating as you gain seniority and attempt to take the reigns on a case only to get shot down because you aren’t throwing a stitch the way this particular staff wants you to throw it.   Anyway, we were getting through the procedure and I started to load an instrument in the only way I have seen done.  My staff was frustrated (as he often seems in the OR) and told me to load it in a very uncomfortable and in my opinion [weird] way.  Of course I fumbled and then he raised his voice and yelled at me.  This is in front of 2 junior residents, the anesthesia team, the circulating nurse and the scrub tech.

I would be lying if I told you that this didn’t ruin the rest of my day.  It was embarrassing and unnecessary.  But this is the culture of surgery.  Albeit, it is changing and I’d like to credit the current rising generation of surgeons for not tolerating this type of behavior anymore.  I wasn’t sure what to do about this.  If I told my program director about this and this staff got in trouble, he would know it was because I said something.  I decided to keep it to myself, try to process it and not let it affect me.

I want to describe the chain of reaction though that this interaction had.  After the case I was upset.  My new intern asked me a question about how to put an order in and I snapped at him.  I got a consult from the medicine team who was concerned about a patient but hadn’t called the appropriate people before just reacting and consulting surgery…stat.  It took a lot of deep breathing for me to not be incredibly rude over the phone.  I’m sure I came off though as that “grumpy surgeon.”  It is a domino effect of rudeness!

I think that this type of demeaning culture that the older generation of surgeons trained under needs to cease to exist.  This type of language used in what is supposed to be a professional environment is no longer acceptable.  I’m sure that patient would have been horrified if he heard what was happening around him as he had this procedure.  I also believe that this type of language used and environment created by staff contributes to resident burnout.

So what should I do?  Should I tell my program director?  Should I tell the CEO of the hospital?  Why doesn’t any of the OR staff  or Anesthesia staff say something?  Did they think it was okay?  Why is it acceptable to watch a colleague get spoken to in this way? Surgery, it’s time for a change.

Photo by Pixabay on Pexels.com

 

 

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Finding a way out of burnout in medicine

Well it has been almost a month since my last post and I am in a much better place.  Although I still have moments at work when I want to just drop everything and leave, I have found a way to deal with my frustrations and find some daily happiness. I wanted to share some things that have worked with me this past month.

1. Leave work at work: Anyone in medicine can attest to this.  Some patients and their stories just stick with you.  They can even haunt you for a while if you let them.  But for this past month, when I left the hospital, I left it all behind.  I made sure that I exercised and read things that didn’t have to do with work.  During my burnout phase, I would literally come home, open my laptop and go through patient charts from that day.  It had to stop.  Now when I leave work, I don’t go through any charts until the next morning when I am preparing for that day’s rounds and cases.  I am still working on trying to compartmentalize the things I see on a daily basis, especially in the trauma bay.
2. Pick back up old hobbies: The day I realized I was burned out, I was having coffee with a friend.  We were talking about our frustrations with residency and he asked me, “So do you have any hobbies?”  My initial reaction was, “Psh! Yea I have hobbies!”  And then a moment of pause.  I couldn’t even remember what I liked to do before residency.  I rarely went on runs anymore.  I barely danced.  I never pleasure read anymore.  Some nights it takes all my energy just to make myself dinner.  So I joined a dance studio and started taking classes.  I told myself I would do this at least once a week and it has been awesome!  Setting a small, reachable goal such as taking a class once per week that has nothing to do with medicine and is good for my soul has really made a difference.
3. Don’t sweat the small stuff at work:  Seriously, in medicine, there is a lot of “small stuff,” especially when you work in a county hospital.  County hospitals can be difficult to navigate.  It is difficult to get patient’s what they need sometimes and it can just eat away at you if you let it.  A few weeks ago it took me about an hour and 10 phone calls to get a patient a special walking boot that she needed.  It shouldn’t be that hard.  I can tell you first hand that at other hospitals, it ISN’T that hard.   I can’t say that I have found a perfect way in dealing with this.  I am still a work in progress in this regard but for now I am trying to take a breath when I feel myself getting frustrated.
4. Figure out what makes you happy in your work:  During my period of burnout, I felt trapped in my work.  I felt like I had no way out.  That was a miserable feeling.  I had to take a step back and try to remember what it was about medicine that made me happy.  I lost sight of it all.  But it truly is the patient interactions.  It’s being able to understand someone’s disease process and knowing what to do to fix it and heal them.  Moreso, it’s being able to sit down with a patient and hold their hand and explain all this to them.  It’s being the one to step out into the waiting room after a case and tell the family that their loved one is doing well and everything went okay.  I think I know what area of surgery I’d like to focus on now and the idea of doing this for the rest of my life excites me and gives me a feeling of relief.

Burnout sucks.  It is so common in medicine and especially in residency and it is something that we need to talk about more.  I believe that people can find a way out of burnout but the first step is recognizing that you have it.  Special shout out to my friend who made me realize that I had no hobbies anymore outside of medicine.  For that was my moment of realization.

 

So, this is Burnout.

I am a woman.  I am a surgeon.  I am a resident.  I am burned out.  Last week I got home from a 24 hour call shift, sat on my couch, opened my computer and googled “how to get out of medicine.”  I spent the next 48 hours of my free time looking at different sites about options for people who completed medical school but don’t want to be clinical.  I also found online forums with threads of people who have switched out of surgery, most of whom seem to never look back at their decision to get out.  There are some articles and podcasts I found about burnout but not a lot about burnout from residents.  I found a few podcasts about surgeons who were mid-career that suffered burnout and while I found them interesting to listen to, I am shocked that there aren’t more people talking about burnout in residency.

 

I am currently getting over the hump of my surgical training and entering into my final years.  I would like to keep myself, my program and city anonymous.  I don’t want this to come off as me putting down my program because I don’t think they are necessarily “malignant.”  I do want to talk about burnout during residency though, specifically surgery and specifically as a woman.

 

At this very moment, I can’t tell you why I went into medicine and I certainly don’t remember why I picked surgery.  Maybe it’s the tough personalities, the frequent 24 hour calls, or the stress of working at a county hospital with limited resources that has got me down.  Or maybe it’s that I can’t remember the last time I had a meaningful interaction with a patient.  I think in most conversations I have with people at work whether it be staff, nurses, co-workers or unfortunately patients, my mind is 50% there.  The other 50% of my focus is about the orders I still need to put in for the ICU patient that is hypotensive and crumping, or the 15 clinic notes I still need to write, or the CT scans I need to follow up on for the last trauma, or the 3 consults I still need to check out to my staff.  That is just a normal call shift around here and an easy one at that.  Frequently, as I am trying to bring my attention to this interaction with a patient, 1 of my 2 pagers may go off with a text page from a nurse asking for a restraint renewal for a patient at 2am.  Those in medicine can probably relate to how painful it is to put in such banal orders.  Shouldn’t there be a system in place so that these basic orders don’t take up more of my time? But I digress.

 

I really can’t put my finger on what has changed.  I was so excited about medicine when I was in medical school.  I loved medical school.  I truly believe those were some of the best years of my life.  Even at the early stages of residency I was excited about what I was doing.  Excited to spend time with patients and families and help them understand their disease processes and the reasons behind our treatment plans.  I got gratification out of these interactions at one point.  Now, I would prefer to be alone in my call room or at a computer with headphones in listening to music while I try to catch up on HOURS of charting that I still need to get done before I can put my head down to rest.

 

I drop patients off in PACU sometimes with 7 pages to answer, 4 consults to see and floor work that still needs to be done and the last thing I want to do is walk to the family waiting room to talk with the family about how their loved one did in surgery.  I know this is bad.  I realize that this apathy should be a red flag.  This is burnout…at least I think it is.

 

What I grapple with now is, did I pick the right specialty?  Is surgery for me?  Is medicine for me?  Did I put myself through all of this as one big challenge for myself or is this actually something I am passionate about?  I don’t have the answers to these questions right now.  But I want to try to remember.  I don’t want to quit.

 

I am going to write this blog in hopes that I can document my journey trying to fight burnout.  I need to find myself again.  I don’t want to become that grumpy surgeon that everyone is afraid to call.  Right now, I think I come off that way but it is not me.  That is not who I am.  Each week I am going to set a goal for myself in hopes that habits will become routine.  This week I am going to challenge myself to be mindful and present in my interactions with people as well as take a moment each day for myself.  We will see how this goes.

-WSR