Nature vs. Nurture

Based entirely upon observational/ anecdotal data, I believe there are two categories of students who choose careers in surgery.

1.  The “born surgeon” and

2. The clerkship convert

I suspect that a number of my readers, and I know that many of my colleagues, were of the first variant.  They are those people who have known since they were 2 years old that they would be a surgeon when they grew up, and the trajectory of their entire life has been focused on that goal.  They were driven, obsessed even, in a way that few can understand.  When asked why they want to be a surgeon, they’re the ones who will give you a crazy look as if thinking, “Well, why would someone be anything else?”

While I find their determination admirable, I was decidedly not a member of that category.  I went to medical school thinking that I was going to do something in pediatrics; not general pediatrics because I knew that red ears and Mommy calls were not aligned with my personality traits, but a pediatric specialty.  Pediatric ICU and Pediatric ER were the two front-runners for my first two years of med school because I would get to take care of children but it would be acute and would require me to be decisive and DO things…quickly.  I also functioned under the (entirely unfair and generally untrue) assumption that surgeons were by nature unpleasant and difficult people, and I didn’t want to become that or work around it all the time.  I’ve been teased more than once about my proclamation during gross anatomy lab as an MS1, “I’m not going to be a surgeon so I don’t understand why some of these details matter!”

Foreshadowing take-home lesson:  Never say never.

And then, my conversion happened.  During our pediatrics rotation we had one elective week.  In the interest of seeing something different from the pediatric subspecialties I already knew a bit about, I opted for pediatric surgery.  I spent a week with the man who would ultimately become my mentor as a student- and who I still channel in the OR from time to time (“bunny ears” for 1 cm tails when cutting suture is a Danny Custer phrase that I have coopted).  I saw that he got to work with kids and that his job met many of my criteria for how I wanted to work; I also realized that he had the relatively immediate gratification of taking a problem and being able to fix it.  He is in no way unpleasant and difficult.  If anything, his absolute joy in what he got to do and his ability to convey that while teaching made him an inspirational clinical teacher.

I was hooked.

My surgery rotation itself was my last rotation of 3rd year, but it reinforced that I really love what we get to do as surgeons, and that many surgeons are wonderful humans.  I learned to cut.  I learned to sew.  I learned how to make sense of critically ill and injured patients.  And while I didn’t end up as a pediatric surgeon, I do still get to care for children.  When I was a 4th year student and was in town, Danny would call me if he had a really great case on to see if I could come scrub with him.  That’s a master class in how to be an exceptional mentor.

I tell this story for learners to encourage you to keep an open mind- you simply never know what experience is going to grab you and change your life, and if you’ve closed yourself off you might just miss out on a big adventure.  I tell it for teachers to remind us of the importance of communicating our passion for what we do to our students.  Had Danny been someone who sat around grousing about being on call every other night (because he was) or about different facets of the business of health care, I’m pretty certain I wouldn’t be doing what I am doing now.  Instead he showed me someone who valued his patients and their families, who loved his role he played for them, and who believed that teaching students was one of his most important tasks.