Shadowing updates and thoughts

No new travel updates. Over the past two weeks (literally, I got back on the 8th), I’ve completed 19 secondaries. Only 3 more to go! In between, I’ve been shadowing a neurosurgeon (and Duke alum, which was how I found him) in the clinic and in the OR. So far, it’s been a great experience. Dr. Garcia is very kind, and he has not only allowed me to shadow, but he’s been very involved in educating me by explaining surgeries pre and post-op, what he sees in the X-rays and MRIs, how the medical/insurance system works, and politics. Obviously, HIPPA’s privacy rule protects patient’s health information, so I’ll comment here only on general thoughts I’ve had.

In the clinic, when Dr. Garcia sees a new patient/consult, he takes time to explain what he sees in the patient’s MRIs. He is also very good with analogies, which he uses to explain the disease or the surgery required. He isn’t very liberal in offering surgery as a first resort. For many patients, he often discusses patches, physical therapy, a spinal stimulator, etc. before talking about possible surgical interventions. In his view, surgery is in the category of “be careful for what you wish for,” which he does occasionally tell patients.

I remember one patient who came into the clinic. Dr. Garcia had to take a phone call and stepped out of the room, which was when we started chatting. The patient told me, “I prayed to God to find a good doctor. I was picking between another doctor and Dr. Garcia. But praise the Lord that I picked him. You know, some of the younger doctors, they’re fresh. They’re HUNGRY. They want to jump straight into surgery and this and that. They’re just hungry. But him, he’s humble and I know he’ll do what’s right for me.” This message hit home. I guess a lot of the younger surgeons are subconsciously looking for experience, which may be why they’re more inclined to offer surgery as a solution. The seasoned surgeons have seen so much more and probably have grown more conservative over time. I think the most important point is retaining and practicing with humility and compassion.

Dr. Garcia showed me a prototype for a device that would allow him to perform minimally invasive lumbar fusion with lateral access to the spine while the patient lies on their tummy (as opposed to on their side). It’s a really neat device (GLIF) that shifts the surgeon’s perspective rather than shifting the patient’s physical position.

I had a little, erm, frustrating moment in the OR the other day. The anesthesiologist and I were talking. He was very helpful, explaining parts of the surgery and answering the questions with which I kept bombarding him. At one point, he stopped and told me, “This career path is harder for women. You have to decide when you want to start a family, because you don’t want to wake up when you’re 35 and realize that this isn’t actually what you want to do¹.” I know that he meant well with his advice. He was just trying to impart wisdom he’s gained over his lifetime. But this attitude that (1) all women want children and (2) the pinnacle of womanhood is motherhood, one that majority of society holds, is one of the underlying reasons why a glass ceiling still DOES exist. Even if (wo)men ARE consciously trying to be equal, people still hold these inbred ideas that subconsciously affect their opinion. Say, for example, a management or surgery or what-have-you team is looking to hire or promote someone. Subconsciously (or consciously), the hiring people will consider a woman’s age. Is there the same age consideration when hiring/promoting men? Although I have no scientific evidence, I think not. The societal beliefs that we hold, one of them being that women want children, affect how we treat people and how we make decisions. (I don’t think the well-intentioned anesthesiologist would have made the same comment about deciding if this career path is right for me if I were male…) Maybe this is why I love shadowing Dr. Garcia. He truly takes time (of which he certainly is not in excess of) to explain things that we see, as if I were already a serious medical student. For example, one time, Dr. Garcia performed a cubital tunnel release. As he was cutting into the elbow to get at the ligament entrapping the ulnar nerve, he pointed different parts out as he cut through them. He pointed out the ulnar nerve before sewing the patient’s elbow back up. He answers my questions genuinely, and I really appreciate that.

The OR is kind of like a time warp and it has its own special kind of silence (well, at least once the surgeon starts his work), penetrated only by the steady beep of the heart rate monitor². I find the steady, repetitive sound (well, hopefully steady and repetitive) soothing. Yesterday, we were hit with a pretty intense thunderstorm. I had no idea because I arrived at the OR at 0700 and didn’t see the outdoors (no windows) until 1600. It was only when I left that I saw the downpour, flooded roads, traffic lights out, and horrific traffic. I have never encountered a silence that I didn’t like (on the mountain by yourself silence, being surrounded by people but in total silence like on trains in Switzerland, savasana silence, ear plug silence, the list goes on and on). The ‘OR silence’ has entered my list of favorite silences, behind the silence I experienced while standing out on the quad in front of Duke chapel late one brisk, fall evening as clouds raced through the sky and the relative silence of diving.

Side note: Whenever Dr. Garcia introduces me, whether that’s to another physician, a patient, a nurse, etc., he always introduces me with my first AND last name. I remember reading an article some time ago about doing this makes it easier for people to remember your name. I resolved to try it, but found the practice too formal–too foreign on my tongue. But after hearing it several times by Dr. Garcia, I’ve found myself introducing both my first and last names when meeting new people. Funny how that works.

¹I think it’s a lot easier to wake up when you’re 35 and realize you want to start a family (there’s always adoption) than it is to wake up when you’re 35 and realize you don’t like mothering and being at home and want to go into a career in surgery.

²I originally wanted to name this blog beatsperminute, because that was during my attempt to ‘figure out life’ and I thought a description of the heart combined with a blog about ‘finding a passion’ would make a nice metaphorical image. However, the domain name was already taken, hence I picked breathsperminute


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