Level Up! (continued)

There are days during residency whether by fault of your own or indiscriminate criticism by an attending you'll feel like an incompetent failure. Sure, when you leave the hospital you're "the neurosurgeon," but how often does that actually happen? For the most part, day in day out we're with other neurosurgeons, and at this stage in the game are the moss that grows on the log that the frog sits on. This particular day I was pulled into a senior level case because we were once again short residents to staff the complex cases for the day. Maybe he was just frustrated to have a junior resident, but for whatever reason I just couldn't make him happy that day. I left the 8 hour case feeling like I didn't know anything, that my operating technique was primate-like, and that I should really work harder to learn everything there was to know about neurosurgery this year to avoid such moments of smallness again. Unreasonable goals set to appease the bruised self-esteem, squelching the fear that such a feeling will recur because you have a plan, which seems feasible in your sleep deprived emotionally battered state.

I stuck around for the red line that was about to go because it was my operative day after all. This attending guided me through the beginning half of the case and let me make the skin incision, cut down the muscle, drill off the bone flap, cut the dura, and buzz the brain and make the first cortical incision. I never actually had a chance to do the last couple of steps, so this experience was huge for me. Suddenly I was more than just a burdensome junior resident, but the primary surgeon on a complex vascular surgery. Shortly after my chief resident cut in and took over, but even getting there was more than I could have asked for.

The challenge of being a resident learning how to operate is that the only real time we have to practice or refine our skills are in the OR itself. But the attendings don't know what we've done to date, or how much experience we've had with one tool or the other. Each time I'm in the OR it seems I get a little more experience with a new tool, a new skill set. So we learn, but consequently always seem like we're just beginning. That day I frequented 3 new surgical instruments, a new tool set to add to my armament of operative techniques. I left the hospital a little after midnight with only hours before I had to come in to take my overnight call, but it didn't matter, I felt awesome.