Introduction

I am a surgeon-in-training. I used to be an actor, and a journalist, and a thinker of indepdendent thoughts. This is a description of what that means. Names and descriptions of specific locations have been changed.

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My residency begins in the emergency room at Overlook Medical Center. To put this in perspective, consider that where most hospitals cover the neighborhood around them, or perhaps, if they are large and have helicopters, a part of the surrounding state. Overlook, by contrast, has 5,500 trauma admissions every year from all over the western UA, and well more than that who don't get admitted. It's a thing to see, and something else again to experience. You wake up in the morning and look at the newspaper and the front page is covered with things you saw the day before...plane crashes, bear attacks, accident after accident after accident, flesh-eating bacteria on cruise ships -- news organizations have taken to stationing semi-permanent crews outside of the ER entrance for it's never-ending tide of human-interest human suffering.

The former newsman in me is always interested in comparing my eyewitness account with the renditions on the evening news, and my time at Overlook proves a sobering reminder of the fallibility of journalists, and more importantly, journalism. All of the stories I read about my patients had most of the details wrong -- simple errors of reporting from poor sources. But they also fail to capture the reality of injury in a way that I've never appreciated before, having never been exposed to it to this degree before. The difference between "a man suffered severe burns in an apparent cooking accident and was transported to Overlook Medical Center, where he is said to be in critical condition" and the visual and visceral reality of such a simple sentence is astounding.

The next month is on the Cardiothoracic Surgery service at the University. During the week, I am charged with the care of the patients on the thoracic surgery floor, which keeps me running. On Sundays, I am the sole representative for cardiothoracic surgery in the hospital, meaning that I, with the occasional aid of one of the CT surgery fellows on the phone, am responsible for the care of the cardiac and thoracic floors, all of their respective ICU patients, and all of the patients we'd been consulted on. Sound a little crazy for someone who'd been a doctor for a month? Let me assure you that the difference between that description and the visual and visceral reality was astoundingly more so, and leave it at that.

I emerge from that month with some serious questions about the philosophy of modern medical care, and the suitability of a program in which the intern is charged with making decisions on patients that the attendings never bother to see except when they are unconscious in the OR. I get the feeling that much of my training will prove to be a trial of my faith in the essential nobility of medicine, and of the magic that is possible in caring and providing care. I am committed to pursuing this path in this place so long as those trials act to temper my resolve to practice the kind of medicine that I believe in - a fundamentally joyful and humanistic enterprise. The defense of an ideal, I think, is the basis for its definition. Up to a certain melting point.

Still, I'm glad to have moved on to the General Surgery service at Overlook. Those 5,500 trauma admissions through the ER? Half of them come through my team. But we're a small army of residents, and the system for handling the deluge is, for the most part, efficient and well-planned. And for the first time in my residency, I've had the chance to be a surgeon. One hernia, a couple of abscess drainages (the continued injection of heroin in the face of the ravages of its long-term abuse are a constant marvel to me), and a late-night vascular surgery in an attempt to restore blood flow to a man's dying feet, all over the course of my last (34-hour) shift. Being in the OR, part of a team solving problems and realizing immediate care, is the reminder I need of the fundamental -- and majestic -- privilege of this career.

Where do we go from here?