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May. 06, 2010

Dana Is A Surgical Clerk!

by Linda Brodsky

Right after her vacation (which deservedly came right after taking part 1 of the boards), Dana made a trip to Mexico City, to visit her cousin who is on fellowship there for one year. Then she came back to start her clinical clerkships. What’s a clerkship? It’s the first educational experience when a student doctor spends her days (and nights) involved entirely in patient care. Each clerkship is based on a major area of medicine—pediatrics, general surgery, surgical specialties, obstetrics/gynecology, internal medicine, psychiatry, and in some schools neurology and family practice medicine.

At Dana’s medical school, the University of California, San Francisco(UCSF) the students get a 2 week transitional period to ease them into clinical medicine. I am told that they learn about hospital culture, basics in chart notes, how to keep from being a pest, and how to get the nurses on your good side (so at least if they don’t help you, they are not likely to bite off your head!) These are things I think my generation of doctors just picked up as we went along, for better or for worse, for both the patient and for us.

A lottery system assigns who gets which “rotation” (another name for a clerkship) and when. You put in your request, and the computer spits out a schedule. Dana wanted to start with surgery and she lucked into a very busy hospital, one with a lot of trauma, one where medical students are likely to be needed. A lot.

She also got lucky in that her first night was a call night. She was there working for 24 hours straight. She watched a tube being put into a chest to drain an infection, and she stayed up all night except for a few hours of sleep in the wee hours of the morning before she had to get up at 4 a.m. to pre-round with the interns (real doctors in their first year of training after medical school) which happen before the usual work rounds with the residents (the more senior doctors in training) which occur before the operating room schedule starts, and most certainly before the attendings (the real doctors) come on the scene to make sure everything is being done exactly right. So as you can see, Dana is really the low woman on the team, but it’s a start!

We didn’t hear much the first few days. Only that she hadn’t been in the operating room yet. I had to wait until Sunday afternoon when she finally called and told me all about her first week.

She told us that she has great senior residents, and a great team. I knew this was very important, because if your team players (and surgery training is most certainly a team sport) are not willing to teach, you will be miserable. Inwardly I heaved a sigh of relief. Hurdle #1 overcome.

“Mom, I scrubbed on a hernia. My resident, a really nice guy from Stanford med, sat down and prepared me for all the questions I would be asked about the anatomy. When the attending asked me a question, I didn’t get the first one because I wasn’t quite sure what she was asking me. But after that I knew all the answers.” There was more than pride in my baby’s voice. A pride I couldn’t help but feel as well. Hurdle #2—she would not fall apart under pressure, even in the operating room.

“That’s good Dana,” I replied. But she really didn’t hear me, as she rushed on to the next operation.

“Then we had a perforated bowel (a hole in the large intestines) and the patient was really sick. It was the first time I had seen the intestines. They were sooooo beautiful, orange and shiny and glistening. We did a side-to-end anastamosis. It was so cool.”

Dana continued to report about the personalities. She heard others complain about the all night call which didn’t bother her. And even though it was suggested that women might not (yet) have the physical stamina, Dana was quiet. She has a lot of knowledge about that sort of thing and knows that her surgeon Mom is far better than her surgeon Dad at staying up all night and handling all sorts of physical and emotional trauma surgeons must learn to endure. Good move, Dana, I thought. Hurdle #3—she knows when to speak up and when to keep quiet.

Then, I couldn’t believe it. She said, “Mom, I could so totally see myself in surgery. I love it!”

Will Dana really become a surgeon? Maybe. And maybe not. It’s really too early to say. After all, it’s her first clerkship, and I am sure she will be drawn in many directions before her journey is complete. (But it would be really cool if we were the first mother-daughter ENT doctors!)

So after we hung up the phone, I heaved a sigh of relief as I thought, ahhhhh, she’s over hurdle #4. She is going to love being a doctor, and that’s a great feeling. I know.

About Linda Brodsky

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