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.

Humanities and the surgery clerkship- not mutually exclusive

Relevant disclosures:  I was a liberal arts major (Poli Sci, minor in Econ) in College.  I took Latin in middle school and high school.  I have a profound weakness for literary fiction.  I embarked upon my medical career not because I had visions of being a great scientist, but because I had visions of being able to help people and take part in their stories.

My last group of students from the academic year finished up on Friday, leading into a two week break from the clerkship and all things associated with it.  This year marked the first year in which we had a Humanities option during the clerkship, an idea I’ll openly admit to having co-opted from colleagues at other institutions.  While the ultimate impact of humanities in undergraduate medical education is unclear at best, my passion for creative activity makes me believe that participation in medical humanities allows all of us to stay connected to those qualities that make us most human.

I offer the students the humanities option to replace a written assignment by telling them that the goal is for them to engage in some form of creative activity that relates to their experiences during the surgical clerkship.  I’m not any more prescriptive than that, mostly because it is a creative activity and I don’t want the students to feel bound by my ideas.  The experiences in response to that vague instruction have been remarkable, including intensely personal poetry about patients, tales of ethical dilemmas they have encountered, inspirational visual arts,  creative games, lots of food, and even a couple of yoga practices.  Some have been fun, many have been heartfelt, all have been transformational for anyone who has been present.  This week’s was no different- and was likely the most intense session we’ve had all year.  Several of the students who opted for the elective had stories they wanted to share as the basis for a discussion with the group.  As often happens, stories lead to more stories, and I was walked through the gamut of awe, frustration, shame, compassion, and wisdom that the students always seem to bring to the table when we have these sorts of discussions.

For those who don’t believe that the next generation is wise or that they truly care, I want to tell you that you are wrong.  Ask a student what they are seeing from their perspective as someone new to our profession.  Ask a student about their experiences in caring for patients.  Ask a student to tell you a story of an experience that impacted them deeply.  Once you’ve asked, listen.  Listen deeply, and listen carefully.  You won’t be disappointed. If anything, you’ll realize that the future is very bright and that they care deeply about medicine and about our patients.

I’m grateful that once every six weeks I get to sit in a room with a group of 3rd year medical students who share their talents, dreams, and fears with each other and with me.  They’re honest.  They’re brave. They’re inspirational, and I am always humbled by the reminders they give me about why we’re all in this crazy profession.

MT, self-portrait pre-clerkship
MT, self-portrait pre-clerkship