Sunday, November 09, 2008

Compare and Contrast


For the past 6 weeks, I was someplace far from home, on my Surgery rotation. I was at a hospital where the PA service is run unlike almost any other, and I had an amazing experience there. I've never worked harder, or been better-educated. I like to learn by doing, and I was in my element out there.

Here's an idea of what I mean: 6 weeks ago I could suture, and tie a knot... but I wasn't making sugical incisions, I wasn't the first-assist on several different types of operations ranging from hernia repair to hand surgery, and I wasn't solely responsible for sewing up lacerations. I had full, unrestricted Internet access (including Blogger, which was blocked by the network), but I didn't need to use it to research the 20-minute talk I had to give on a new assigned topic each day. I was sleeping in my own bed, rather than crashing at the dorm-style 1970s-era apartment building a block from the hospital's Emergency entrance, but I wasn't working 80- to 90-hour weeks.

I'd watched brain surgery on the Discovery Channel, but hadn't observed an awake craniotomy live and in person. And I certainly didn't have to excuse myself to respond to a trauma alert. I've known folks who had gastric bypass, and god knows I've played some video games, but I definitely hadn't operated a laparoscopic camera (by the by, this is something I have now done multiple times -- by the end, the surgeons were requesting me, and it's possible I may have gained -- gasp! -- a lucrative, marketable skill).

I mean, I really like Scorcese, but let's see how Gangs of New York would have looked if all he had was a fiberoptic light source jacked into a glass rod as big around as a wooden spoon handle, and the whole thing had to be filmed on location inside the abdominal cavity. Right?

Okay, true, I'd been present for a few hundred trauma activations. So those were nice.

I can tell some stories and talk some specifics at a later date, but basically this rotation (#4 of 8) seems to have been some kind of a turning point. Long-time readers will recall how I struggled all through Post-Bac and the first year of PA school; basically there's been a conflict (internal, external, or both) between studying to be a student, and studying to practice.

This rotation was one where the accent is on preparing to do the work. And not coincidentally, it's the one where I've had the best success. Sure, there's a lot to know, and every morning I had to be ready to stand at a marker board and give a talk, proving I understood the concepts and memorized the facts. But as the veteran PA* in charge said, "you're standing there because medical folks think sitting down, around a table. In surgery, we think standing up."

It's good to be back, to be sure. And it's a new world for lots of reasons. Next up, it's Family Medicine on the West Side.

* literally; there are a few bona fide Vietnam-era Army medic/ Navy corpsman-type 1st-generation PAs at this place