Lucky

I didn't envision this blog as any kind of web diary, or a forum for me to vent into ether. I would have liked that all of my entries be discrete and, if not polished, at least with a semblance of structure. But it's just too hard on this rotation to find the time to sit and shape everything I blog, and I think that it's better to write freeform than not at all. Congratulations! You are now the recipient of my unedited ramblings.

I am in the midst of furor over dates. People don't like the dates I've put together for their rotations. Or rather, one person is complaining. He doesn't see that my colleagues and I have had to fit fourteen people into thirteen rotations, and that some subspecialties have specific requirements.

The problem, I think, is one of caste. Whether we like it or not, almost every training program has some sort of pecking order. In general surgery in particular, there is so much attrition that sometimes programs have to keep human aces in the hole, meaning people who do an internship year but don't have a guaranteed spot later on. Only if someone drops out, or stays an extra year in the lab, does the person get to advance. Sometimes they have to go to different programs, and sometimes they even have to repeat a year, which is like someone telling you that to progress to hell you have to do a remedial year in purgatory.

Residency makes most people wish they could be selectively amnestic. If I had to repeat a year of residency, I think I would quit and become a pastry chef.

Anyway, in our internship year there are six Brahmins, or Categoricals, who are guaranteed spots in the general surgery program for all seven years. Then there twelve of us (Ortho, ENT, Urology and Plastics) who are already attached to other surgical programs, so we are a protected upper class. We're not the same, but we're treated with respect. Then there are one or two prelims, a kind of untouchable class of people who don't have a place - who have a conditional spot that may some day turn into a full General Surgery spot, but may not.

In our year, the Prelims have become the dumping ground of our scheduling attempts, simply because they don't have a home program who dictates the kind of requirements they need to fufill. Because they have the most flexibility, they're invariably the people who end up doing what doesn't fit into other people's schedule, so they end up with duplications.

I'm having particular trouble with one Prelim because he is being very inflexible about his requests. He wants to be at our home hospital in December because he wants to be guaranteed a six day holiday break. Of course, so does everyone else. But there are only three slots. Yet when I change the schedule so he is in one of the coveted December slots, he complains because there are duplications in his schedule and "he doesn't think it will be a very good educational experience." He tells me that I am being "underhanded" and peppers me with emails and pages. Meanwhile, we have spared him one of the hardest rotation months, and he gets an extra month of a "fun rotation". But he just wants more.

The kicker is that this is an intern who had a Categorical spot two years ago, but dropped out after a year because he couldn't take orders. This is person who as an intern skipped a whole week of the toughest month, leaving his team to pick up the slack, and who would just not show up on certain days.

Part of me wants to just throw up my hands and say, "whatever you want." But part of me, the part that is biased by his past history, wants to prefer the people I know and who have sheltered me and had fun with me. A final part of me just thinks, what's the big deal? We're lucky to be here, at a place where we have home call, and only twice monthly call when we're in-house call. We're lucky to even be at a program that gives an additional Christmas break.

We're lucky not to have breast cancer, and to get free food on our call days. We're lucky to be continent and not have an ostomy. We're lucky to have health insurance that will cover the medications so we don't even know what they cost. We're lucky to be able to breathe without an oxygen tank. Lucky.