The Resident who wouldn’t operate

This satirical essay was written by a former resident describing his journey through surgical residency. He describes his trials and travails with sardonic humour. He prefers to remain anonymous.

Sinbad had done his MBBS from a Medical College in Dakshina Kannada. An average student but often marked out by Professors as someone with ‘great potential.’ It was in internship that he had found his inner calling- Surgery. He loved the smell of spirit and the sight of blood and pus. He was quite eager to dress the burns patients and if ever a resident offered him a lacerated scalp to suture, he would gush about it for the next many weeks. The one time he was told his suturing was better than the residents’, he relived the procedure throughout the night. He enjoyed the company of surgery residents- there was something about them which was different, cool, macho.

The Professors had their quirks but were legendary- to see Dr. Thangam Varghese operating was to see an artist paint, Dr. Sri Ram Bhat’s left hand was spoken of among interns as much as his book was appreciated, Dr.Harish Rao’s diction, Dr. Ashfaque Mohammad’s humor, Dr. BM Nayak’s jogs and intra-op high-fives, Dr.SP Rai’s conduct. He certainly wanted to be a surgeon.

It isn’t clear where he spent the next two years. But he was preparing for the post graduate entrances. His seniors had advised him not to take up any clinical jobs, for they had understood that it was difficult to work and study for NEET simultaneously. As he wrote his first set of examinations he realised a cruel fact. They do not ask you what you should know in entrance exams. It is merely an exam of elimination to aid the filling up of post graduate seats. And so he wrote-ten, twenty, thirty, forty exams and more, across India, in two years and failed in almost all of them, qualified a few but was knocked out at the interview stage in a couple of others. Two years of loneliness, failure, rejection, helplessness and the lack of an identity.

This was when the heavens woke up to his pleas and he found himself a seat in Surgery, somewhere in North India. The years of misery were over. The Promised Land, the land of milk and honey awaited him. And unlike many others, who wanted Orthopaedics or Medicine or Radiology but were settling for Surgery owing to their ranks, he had actually found himself in the field he loved the most. This was going to be tiring but rewarding, or so he thought.

This was what he learnt in Residency.

First Year:

1. Humiliation is a way of life here. Most things you are shouted at for aren’t even your fault. Shouting at you portrays the Boss as a sinless God in front of the patient. Your senior can scream at you in public for his own fault and you shall put your head down and listen.
2. It’s all Divide and Rule brother. All the powers that be need do is make your passing conditional to their approval.That is enough for colleagues to find every opportunity to put another down through three years.
3. Do not trust your own brother if he is your colleague or senior. Nobody is here to learn Surgery the way you thought they would be. In an environment of insecurity, do not expect anybody to keep your secrets.
4. They will be polite to their wives and children for they need to be. They will be polite to their patients, for they are their livelihood. They will never be polite to you. You are the scum of the earth.
5. They will say do not eat till the job is done, but make sure you eat. Especially breakfast. They will not care whether you slept in days or not, but will disturb your sleep at midnight by taking an additional round, merely to feel senior.
6. Hydrocele is your cutting. Unless the Boss decides he wants to teach a beautiful intern what a tunica vaginalis looks like. And this will happen often. If your eyes brighten up at the sight of a hydrocele, teach them not to. Don’t blame the intern, put her to good use. If she can chat up the Boss in OPD, that will save you from a lot of pedal lactic acidosis.
7. Touch feet as often as possible. Even if your back hurts. You touch feet for years and then you get your feet touched for years. It means nothing. Just keep touching. Makes life easier.
8. If a wound gapes, it’s your fault. Seroma, Haematoma, Surgical site infection. All of it your fault. Even if you were not present inside the operation theatre and did all you could to prevent it.
9. Take time out to cry. You need to keep your system light. You might struggle from suicidal ideation, but it is documented that 30% surgery residents do too. So you are not alone. You can always jump off the hostel building like many before you have, but that won’t change the way things work around here.
10. Don’t work hard. Give an impression that you are hard-working. Both are two different things. Work where you can be noticed, when there is maximum possibility of being noticed. Exert yourself completely to the patient who is Boss’ relative/ mechanic/ driver. Your elaborate burn dressings will never be seen, don’t even bother.
11. Curiosity and Spirit of Enquiry is all bovine faeces(bull). Never ask questions. Be a YES man. It’s good for your health.

Second Year:

1. Get a car. Boss has his income. But Boss likes to save. Drive him around. Feed him till he chokes. Your father’s hard earned currency notes are actually confetti meant to be showered on Boss.
2. If he asks you to buy him a brownie, get him ice cream too. If he asks you to buy him a helicopter, buy him a space station. Why? He knows many ways by which he can ruin your life. He is Boss. The medical establishments have no way of assessing and admonishing the dinosaurs in the food chain.
3. Your senior is exam-going. He needs a good impression. Take the blame for his mistakes in the morning. You can always whip the juniors in the evening. Or tear up their files.
4. Hernia is your cutting. Unless the Boss decides he needs to teach an undergraduate damsel how a tension-free mesh repair is done. Or, the Lecturer would be in a mood to finish three hernioplasties under 45 minutes by himself, some silly personal record of his . You will be second assistant forever, or so it will feel. Don’t run throughout the night trying to get the patients fit for surgery. You will get peanuts at the end of it.
5. Lecturers don’t care about you more than they care about their job. And for many reasons they need to be in Boss’ good books. Else he’ll load them with more cumbersome work and stall their promotions. So anything you tell them in good faith shall be duly reported. And if they tell you something personal, they are merely venting. Don’t read too much into it.
6. Humour in Surgery sucks. It is almost always slapstick. Almost always centred around boobs and balls. Few get sarcasm and almost no one will understand a pun. The older they get, the more funny they try to be, the worse the humour that comes out. Laugh anyway. Else you stand out as a sore thumb.
7. Start holding the Boss’ suitcase as he walks in and walks out. Go up to the car. It is all a colonial hangover. It makes absolutely no sense, but do it anyway.
8. Anaesthetists are almost always women. They almost always are in a rush the moment the scalpel or needle-holder is thrust in your hands. She will insinuate your lecturer or boss about how fast things would have gone had he been operating. Your superior is hormonal. He takes her comment as instruction. Walk over to the other side buddy, again.
9. They’ll say how their residency was far busier, far superior and far fetched things like how they did Whipple’s alone in a dark room under local anaesthesia. You’ll wonder why they don’t teach you how to drape, hold a needle-holder, place a suture. Never vocalise it.
10. Flatter. Suck up. You’ve never done it? Well, now’s your time. Flattery always works. Remember, your goal is peace of mind. Nothing else.

Third Year:

1. Do not ask for surgeries. Ever. Somebody in the food-chain above you will wait till you make the smallest of blunders, and then announce it to the whole wide world. This, despite you going out of the way to hide their own errors from them, and others, for 2 years now.
2. If you are complimented for your work, deflect it to someone senior to you present nearby. Some patients will want to tell the world how much you have helped them, make sure they do not reach Boss’ ears. He sees you as competition, not as a disciple.
3. Almost all surgeries in the operative list are supposed to be your cutting. Don’t believe it? Check your logbook. But of course, now that you do not know how to do a hernia well, how can they trust you with a mastectomy or a thyroidectomy. You should have worked harder in your residency. For now, you get nothing.
4. Buy costly stuff for Boss and his wife. Give it to him as a Diwali present. He will refuse. But that is a token refusal. He is an abyss. Coax him till he takes it home. You need your thesis signed.
5. Stop entering the O.T. Boss doesn’t think you need to learn surgery nor does he think you need time to study. He will remember to make you write his wife’s research article days before your university exam. Stay out of his sight, stay out of his mind.
6. It’s a tree of monkeys. Your senior will see only monkeys below him. Your junior will see only Hilton-lined holes above him. The cycle continues.
7. They’ll tell you observation is learning. It is, but it is not. You can observe a hundred perforation closures but still think of it as an insurmountable mountain. It is only when the scalpel and bovie are in your hand do you learn the trade, which you probably won’t till you are here.

Sinbad received a call from his Boss weeks before his University exam that he was going to be failed. Thanks to the insistence of two Senior Examiners who voted against the pre-meditated verdict, he was passed, in his first attempt. The God who saved Peter from drowning had saved him too. He has come to appreciate the few friends that stood by him in residency, the love of his life was a God-sent balm, his parents helped him stay sane with their regular visits and daily prayers. Now he works in the suburbs under a kind mentor- learning to drape, suture, operate. He insists that not all residents are selfish, lazy and lacking in passion. Some lose their passion in residency.