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Cut and Run

Why I quit surgical residency

The New Physician November 2007
It’s painful for me to write this. I’ve never loved anything more than surgery. Even now, a full year after resigning, answering the question of “Why?” hits a tender spot.

This is a raw confessional for medical students ready to take the plunge. My goal is not to discourage you from entering surgery, but to speak to those like me: someone who had all the signs of a star surgeon in training, yet was doomed at the outset.

As a fourth-year at a prestigious private medical school, I was a surgery nut. My fourth-year “Pig Surgery” elective found me staying up all night, poring over The Atlas of Surgery. When I successfully completed an open left nephrectomy on that poor pig, I celebrated by buying myself Sabiston to start reading for residency. Operating was the ultimate high.

After matching at my No. 1 choice, I started my intern year full of energy and high hopes. Every operation was fascinating. But as the year drew on, a more sinister side of this work became evident. I began to notice that while the interns were exhausted, and the junior residents miserable, the senior residents had a residing bitterness that permeated every corner of their lives. They snapped at the floor nurses, spoke of deteriorating marriages and even harbored anger toward the guy who served their lattes every morning. But that was not me…not yet.

During my first month, I posted an article in the residents’ lounge about Médecins Sans Frontières pleading for surgical residency graduates to fill volunteer spots in the war-torn regions of Africa, and describing the shortage of surgeons in particularly needy areas. I found it both interesting and relevant to our careers. The next day I was shocked to read a new message scrawled across the article: “Inappropriate. Get back to work.”

Where did the surgical residents learn this cynicism? From the attendings, of course. It was modeled for us every day in the operating room.

Our attending used to enter the OR asking me what the interns had screwed up today on his service. He would yell at the scrub nurse for not prepping in his particular style and ask the anesthesiologist demeaningly what med student had taught him how to insert lines. By the end of one particular appendectomy, my nerves were so shot from the constant barrage of insults and having my hand repeatedly slapped—literally—that it was no wonder I screwed up my subcutaneous stitch a few times.

And like the good students we were, we modeled the behavior that was modeled for us. Raymond, one of the chiefs, replicated the attending’s insulting style later that day when he berated the junior resident over his choice of antibiotics for a post-op patient. Hours later, I was on the receiving end when the same junior resident laid into me over the type of tape I had used to dress the wound. I went home and took it out on my loving dog.

By halfway through the year, the junior residents had become proficient in the art of abuse. In horror, I watched people whom I deeply admired evolve into replicas of the malignant attendings. The progression was subtle, but inevitable. To justify my guilt over tolerating the abuse, I fooled myself into believing that I would somehow be different.

Then one evening in the doctors’ lounge, the director of the hospital’s medical staff approached me. I assumed he was going to congratulate me on getting the highest ABSITE score in my class. Instead, he whispered in a husky voice, “You’re lucky I’m a married man. If I were 20 years younger, and single, you’d be in trouble.”

My silence was less one of intimidation than of shock. Still, as a female—and a blonde one at that—I had accepted that I would face challenges my male colleagues would not. I stand by that statement even now: The sexual harassment and uncomfortable attention I received was not what made me throw in the towel. But it didn’t help.

Then there was the problem of reproduction. (“What do you plan to do with that uterus of yours?” a surgical director asked me in one of my residency interviews.) During my first few days as an intern, Shannon, my chief on GI surgery, gave our entire team a lecture on how critical it was that women wait to bear children until their careers are well established. Later, and privately, I asked her why she had such strict policies on something so personal. “You would be abandoning the program,” she replied vehemently. “You want to be a surgeon, don’t you?”

Over the year, I also began to understand how my attendings lived. One morning at 2:00, we were waiting for the on-call surgeon to finish his last appendectomy so we could do a rectal abscess drainage. As he shuffled into the OR, his shoulders drooped in exhaustion. “Don’t you want the billing sheet?” the circulator asked him. “For what?” the surgeon grumbled. “You really think this guy’s got insurance?” He later explained to me that 30 percent of his on-call work was done for free.

Imagine any other professional working for free almost one-third of the time. I began to grasp the private surgeon’s dilemma as reimbursements continue to fall and more Americans are without insurance. Veteran surgeons, who labored through residency before the mandatory work-hours restrictions, are still working like dogs. And unlike us, their hours have no compulsory limit. At the end of this difficult yellow brick road, there is no Emerald City. In fact, there is just more of the same, stretching as far as the eye can see.

Everything became clear for me one warm Sunday morning. Exhausted from a rigorous call night, I plopped myself onto the deck in my scrubs. I cracked open a beer and lit up a cigarette, still fuming over my fellow intern’s mistake that had earned me a good whipping on morning rounds. My fiancé came down and frowned at the cigarette. “Aren’t you going to church for Easter?” he asked.

Easter? I gave him a blank look. Then it hit me. There I was, downing a beer, smoking a cigarette and calculating my revenge on a fellow resident—on Easter Sunday. The day of the year that I held as sacred and holy. Never, even during the throes of medical school, had I neglected to honor the holiday, much less forget it all together. My faith had always been the central pillar of my character, and without recognizing it, I’d traded that in.

Over the next month, I took an inventory of my own character. In place of the vibrant, tender spirit who had started surgical residency was a deflated cynic. I dissected all the aspects of my chosen career, from the challenges I would face as a woman and mother to the fatigue I’d seen in older surgeons. This analysis led to the very difficult decision to leave my passion, surgery, to pursue a kinder field of medicine.

Maybe it is throwing in the towel, or maybe it is succumbing to surgery’s scheme to weed out the weak. Either way, I accept my fellow residents’ criticism, and I accept that I will never again get to operate. But I see myself as the winning player in this game. After all, I ended up happy. Will my former peers feel the same?

The hard-core surgical residents reading this will dismiss me as a softie. The veteran surgeons may sigh and reminisce about times when the pot at the end of the rainbow was, in fact, full of gold. But medical students seeking to avoid becoming an intern with a fate like mine will listen.

I want to tell you some things I wish someone had told me: Know what you’re in for. Program directors who sugarcoat the lifestyle may be misleading you. For women who want to “have it all,” don’t assume the genders are equal in this profession. You will be asked to choose between being a great mother and a great surgeon. Finally, be prepared to tolerate an abusive environment in silence. Humanitarians with a strong sense of justice may deteriorate emotionally, as I did, from the chronic mistreatment.

The greatest risk you will face is losing the compassion and integrity that drove you into medicine in the first place. Thankfully, I have not.
Dr. Charity Thoman is a first-year internal medicine resident in Southern California.

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