Thirteen: the Prequel

DAY 1:

Hey, I'm Thirteen. This is my life story long before I became a fellow in House's team. Even long before residency. This is the story of my life at the bottom of the ladder – the life of a 3rd year medical student.

See, the first two years of med school two are simple – go to school, sit in class, study your ass off for the exams. Third year is when you get to actually go into the hospitals, work with doctors, have your own patients, even suturing them up. What we call "the clerkship years" or "rotations."

Third year med students are like 11-year-olds going through puberty – everything is changing. What was once a nice, safe world of learning medicine by the books is replaced with random pimping by Attendings and Residents, being put on the spot by insecure nurses, and long 28-hour shifts.

Now fourth year med students have it much easier. They are done with the "cores of medicine" – ie, Internal Med, Surgery, ObGyn, Psych, Pediatrics, Family Med. They are like 14-year-olds. They kinda know how the world works, but not yet ready to drive. Fourth year is when you do your elective rotations – Radiology, Anesthesiology, Pathology, Infectious diseases, Cardiology, etc. Your schedule depends on you Attending, and since Attendings only show up from like 9:00-12:00 noon, your schedule is pretty much downhill from the crazy schedule of the third years… But that's another story.

Once you're a resident and have that MD, it's like being behind the wheel when you turned 16. Freedom! After all the years of hard work, you can finally, finally (finally!!!!!) drive! Fellowship training is like being an 18-year-old. You are free to move away from your parents, but can't yet buy drinks. Attending status is like being a full adult. Once you hit 21, you can pretty much do anything. Just like House. So rankings go: med students residents fellows attendings.

Anyway, I went to med school in Johns Hopkins University in Baltimore, Maryland. (House also went there, but got kicked out). Everyone says that third year of med school is the hardest year. They are right. Family Med wasn't bad. Internal Med (IM) had ridiculous hours. And now today, I am starting Surgery rotations.

We were at the Grand Theater in John Hopkins hospital at 7:00AM, waiting for the Surgery Attending to arrive and explain the rules of the clerkship. There were 15 of us med students, split into 3 groups – the Blue Team, Red Team, and Gold Team. Blue Team does gastric and thoracic surgery. Red Team is vascular. Gold Team is plastics and miscellaneous.

My friend Jenny and I were in Blue Team, along with Unusha, Anthony, and Steve. Jenny is a nice asian girl, but she kinda gets on my nerves because she is way too talkative. Unusha is a really nice (but rather bossy) Indian girl. Anthony is really annoying, I honestly don't like him. Steve is a wannabe-surgeon. He's not very smart. We did Internal Med rotation together, but he barely passed. Which is so stupid because in order to be a surgeon, he needs top grades! He bothers me sometimes, but at the end of the day, he bothers me the least because he also just wants to finish the job and go home.

The Attending finally arrived. Dr. Merkel, a thoracic surgeon. Seems like a nice guy, but can't really tell on the first day. He explained what was expected of us, blahblahblah, and told us to go introduce ourselves.

Of course, Steve went first. "Hey, I'm Steve. I have done Pediatrics, ObGyn, and Internal Med rotations. I wanna be a plastic surgeon because surgery is my field of choice, and Internal Med just doesn't interest me."

I rolled my eyes. Omg, seriously, Steve? Just sit down. He should know better. Attendings can smell kissasses from ten miles away.

Then it was my turn. "Hello, my name is Remy. MS-III. Prior to this, I have done Family and IM. I'm not really sure what residency I would apply to just yet…"

Such a lie. At that time, I already knew I wanted to go into Internal Med and then into Cardiology. Because what's the number one killer of Americans? Heart Disease. But I am not stupid enough to proclaim my love for cardiology in front of a surgeon!

After the breakfast and the intro, we headed off to the Residents' Lounge to meet the Blue Team. The residents were just hanging around, drinking coffee. Just waiting for the Attending to arrive for the next case. Residency is what we call the "Post Grad" years – aka PGY. "PGY-5" is post grad year 5 of surgical residency, which is the last year of residency training. The PGY-5 is the chief resident, who is in charge of the interns (PGY-1) and the rest of the team.

"Hey guys, you must be the new students," The PGY-4 said. "I'm Dr. Shaw." The PGY-4 is the one that's usually in charge of the med students. We introduced ourselves.

The rest of the residents didn't even bother introducing themselves to the "lowly" students. They expected that we had already knew their names. Man, those ridiculous egos!

Chief resident was Dr Frank, PGY-2 was Dr Stockholm, PGY-1 were Dr Benny and Dr Hermes.

"Ok, let's go." Dr Frank led the way into the OR at the ground floor. He basically told us that the residents had cases, and for us to just pick one and sort of help around. I had no idea what to do. I was supposed to read the pre-surgical clerkship manual for students – it taught how to wash hands appropriately, how to dress in surgical gowns, etcetc. But yesterday, all I did was crash in bed after a night of partying to celebrate the end of Internal Med rotations.

So I decided to follow Dr Stockholm into his surgery. Since he was a PGY-2, I figured the surgery can't be too hard, right? We had scrubbed in and were just waiting for the Attending when my stupid face mask was starting to slip off. I casually brushed it back in place when the egotistical scrub nurse was like, "You are now UNCLEAN! Go scrub AGAIN! You TOUCHED. YOUR. FACE!!"

What a bitch! What the f-ck! Seriously lady, I did NOT touch my effing face. And I don't even plan on participating in the surgery, so why does it even matter! This is my freaking first time into an Operating Room! It was already an accomplishment that I gloved and gowned without watching the stupid pre-surgical videos! Damn what a bitch. I was seriously just seething when I was scrubbing my hands at the sink AGAIN. I HATE egotistical nurses. Who do they think they are?? In a few years, I will be the one to bark out the orders anyway! Damn.

"Guh! Omg." I muttered under my breath. I purposely didn't wash my hands as well as before. I marched into the OR, waiting to be gloved and gowned…AGAIN.

Nurse BitchFace goes, "Too late! I am already STERILE! I can't touch you anymore!"

What the f-ck! I was sooooo angry. What a bitch! I was just seriously going to throw my hands up and be like, "Fine, I'm outta here," when someone asked, "What's your glove size?"

I spun around. Omg, it was Dr Stockholm. Not good. If he is mad at me, I'll get a bad grade!

"Um…6," I answered.

He put the gown on me. He gave me the gloves. I was shaking.

"Next time, don't let those scrub nurses get to you," he said, leading me towards the operating table in the middle of the operating room. I could've sworn he was smiling under that mask. Omg, so cute!

"Thanks Dr Stockholm," I said. Quite flirtatiously, of course.

I'm sure Nurse BitchFace noticed.

So the Attending finally showed up. The surgery was for a placement of a Peritoneal Dialysis catheter to drain the patient's fluid due to renal failure. And also to repair an epigastric hernia. Laparoscopically, of course, cuz nobody does open abdomen anymore.

Seriously, it only took like 10 minutes. The Attending was sooooo fast. Wow, I was impressed. Then he just left, leaving the suturing to Stockholm and me. Of course, I was useless. Shoot, I don't know surgery! Stockholm just told me to cut whenever he needed scissors. Of course Nurse BitchFace criticized every single cut I made. Cuz apparently, there is a sacred method to cutting with scissors… whatever.

Anyway, I was watching Stockholm suture the incisions, and omg he looked soooo hot/cute. The way his hand had total control! Omg, I couldn't help but fantasize how good those hands were at doing other things….heh heh. And the look of cool concentration on his face. His blue eyes. Omg, I was seriously like drooling. Yah, I have a thing for guys with blue eyes.

He was done fairly quickly. We were walking out to the post-operating recovery room.

"K, so you can write a post-op note now," he said.

"Ok," I said. The whole time on writing the note, I was like eyeing him from the corner of my eye. He was really cute in the green surgery scrubs. Tall guy, nice eyes, a surgeon. Any girl's dream.

I was floating on air. I LOVE it when I have a hot resident. It makes all the difference in the world. Imagine going to work everyday and seeing a hot guy, working with a hot guy – it's definitely something to look forward to. And with surgery's ridiculous schedule of being here from 5:00 AM to at least 5:00 PM…man, so ridiculous. And that's on a "good" day! If you're "Short Call," expect to stay till 9:00 PM. And "long call" is from 5AM to 5AM of the following day – 24 hours! Plus rounds and morning conference can easily add up to 28 hours.

"Hey, so you can go study at the library or something," Stockholm said.

"Ok, please page me if you need anything. Cya later!" I chirped. What a schoolgirl!

But school girl crushes is what I love most. I know it can't go anywhere, and that's what makes them the best. I want what I can't have.

Last rotation I did was Internal Med. And I had the biggest crush on my resident, Dr Gould. I was assigned to him for one glorious month. I was the absolute best student for him. I loved every second. I was there early, had perfect attendance, etc. Having Dr Gould as my resident made me want to be an Internist.

I decided to go say hi to him, so I went to the Medicine floor. It was only 10AM in the morning, so I figured he was still rounding with his new student.

The medicine floors at Johns Hopkins Hospital were slightly different from the surgery floors. For one, only a very few people wear scrubs, as scrubs are the trademarks of a surgeon. And Internists have this thing against surgeons. While surgeons have this thing against Internists.

Let me tell you about the wide field of Internal Medicine (aka "IM" aka "Internal med" aka "Internal"). Doctors who finished a residency in Internal Medicine are called "Internists" or "General Internists." Internal medicine is the study of adults. There are several fellowships of Internal Med – Cardiology, Pulmonology, Nephrology, Infectious Diseases, Endocrinology, etc. Fellowship training is usually around 3 years. After which, the "General Internist" can now be called a "Cardiologist" or "Endocrinologist," depending on what fellowship he/she has done.

Cardiologists would rather use their brain to diagnose and treat Heart Disease. They would insert catheters into the heart, make the most minimal incisions, so as to prevent unnecessary pain. Cardiac surgeons don't do too much diagnostic work. When a cardiologist says the patient needs bypass, the cardiac surgeon does the dirty work and gives the bypass. Internists "own" the patient.

Internal Med is the brain. Surgery is the brawn. Case in point: House is an Internist. He is an Infectious Disease specialist, but he is an Internist nonetheless. Thus, House does all the thinking, while his lackey Chase does the surgery.

The thing I hated about Internal Med is that there was way too much paperwork. A medicine note was about 6-7 pages long. History + physical exam, etc, Assessment and Plan. A surgery note is seriously just half a page. Half a page! Surgeons would laugh at the length of a medicine note. Because in surgery, who cares what the patient does for a living. If you see a broken leg, just fix it! No questions asked. Medicine would go on and on (and on and on) about a patient's way of life, fave meals, fave five, blahblahblah, who cares.

If there was an intermediate between surgery and internal med, I'd take it. Cuz honestly, I don't like scrubbing in. What's the point of waking up early to do my hair if I'm just gonna cover it up in a hairnet thing? At least for Internal, I got to wear makeup, do my hair, wear cute outfits, etc. Surgery is just wear green scrubs, wear a mask, wear a hairnet.

Actually, I think the intermediate between internal med and surgery are the "Interventionals." Especially Interventional Cardiology – they do PTCA (percutaneous transluminal coronary angioplasty), in which the anesthesiologist sedates the patient, the interventional cardiologist comes and, inserts a catheter, fixes the coronary artery, and the patient is forever grateful, cuz he has a speedy recovery plus no need for open heart surgery. Would I need to wear scrubs for that? Not really sure.