Surgery was my last class of the M3 year. The rotation consisted of six weeks on general surgery and three separate two-week subspecialty blocks. There seems to be a little something different about surgery to me that I can’t put my finger on. It has a certain aura about it that is lacking in all of the other clerkships. Maybe it is the rigidness of the OR and all of the sterile scrub techniques you have to deal with. Perhaps it is all the war stories you hear about some of the attending staff. Whatever it is, I did not have the same confidence going into it that I felt about the rest of the year. To make matters worse, I was to begin on General Surgery C. The attending physician for this service has more stories told about him than all of the other surgeons combined. Dr. Galen Poole’s reputation precedes him. There is the story about him hurling the box of instruments against the wall because it was the wrong kit. The forced anger management classes. The tirades in the ER on trauma call about none of the gang-bangers knowing how to shoot straight and just maiming each other instead of killing. I suspected that much of the litany had to be more legend than fact, but I would learn from experience that it was probably all true. I knew I needed to get off to a good start. I read all of the “How To Be A Good Surgery M3” sections of the review books. I got advice from my classmates who took surgery earlier in the year. I was going to be ready to dazzle the great Dr. Poole with my vast knowledge accumulated over 9 months of clerkships. There were two other students with me on Poole’s service and on Sunday evening we got together to go over the patient list and split them up. We were each supposed to see our patients early Monday morning, review their charts, get up to date with their hospital course, write a progress note, and be ready to present them on rounds at 7:30 am.

Unfortunately, my six-year-old, Manning, went into the hospital with pneumonia that weekend. I was spending the nights with him and I figured I could look up labs and radiology reports on the computers at the Children’s Hospital where Manning was. I also hoped maybe to run over to the adult floors and read through the charts to be ready. Because Angie had to get the girls off to school the next morning she wasn’t able to get to the hospital to relieve me very early. I tried to get as much done as possible but it just didn’t work out. By the time 7:30 rolled around I knew enough about my patients to know that I was ill-equipped to answer anything but the most straightforward questions. Like, “What kind of surgery did Mr. Johnson have?” or “Is Smith a man or a woman?” There is a Law of the Third Year of Med School that states that no matter how much time you allocate to researching new patients, it will never be enough. As I went to meet the team for rounds I thought, “well if I can’t dazzle them with my patient knowledge, I can at least be prepared for all of the wound dressing changes and such.” One of the tips for being a good M3 I had read so much about was to always carry a lot of 4 by 4 gauze sponges and tape in your lab coat. When you round, the surgeon always wants to take a look at the wounds (some of them quite nasty) and redress them. He expects the student to whip out the necessary supplies. So I jumped into a supply closet and grabbed a handful of the first packs I saw that had 4″x4″ printed on them. When we started on rounds, some of the other student’s patients came up first. When it was obvious that they too were not yet completely up to speed on their charges, I began to relax a little bit. After all, how could you possibly be expected to know everything about somebody who had been in the hospital for two weeks when it was you first day on the job? This wouldn’t be too bad. In fact I was feeling almost at ease when Poole looked over the perineal wound of a guy who had undergone a complete colonectomy. The rectum and anus had been removed also. The wound had been left open to heal by secondary intention, and when it closed up, the guy would have no hole anymore. A colostomy bag up on his abdomen would be the only outlet for the GI tract. Poole declared it “looking good,” as if any such thing horrific thing could qualify. He repacked it with some of the Kerlix dressing on the nightstand and then turned to me asking for some gauze pads. There it was. The moment to show my preparedness. I yanked a pad out of my white coat pocket and ripped it open to reveal … not a 4″x4″ gauze pad, but a 4″x4″ anti-microbial drain sponge. Poole looked at me in disbelief. How could anybody be so foolish? “That’s a DRAIN SPONGE!” he bellowed. I grabbed the whole stack out of my pocket to see if it was just a wayward drain sponge. Perhaps I still could redeem myself if I could come up with a gauze pad. Before I could further inspect my holdings, Poole went on, “Don’t open any more! They’re all the same thing! That’s how money gets wasted in the hospital!” Hmm. I would have sworn that accidentally opening a drain sponge when you need a gauze pad was not high on the list of cost containment snafus. Thankfully, my fellow student, Janet, turned out to be a much better M3 than I. She gracefully pulled out several gauze pads and when the guy’s significantly modified crack was once again properly dressed, Dr. Poole informed me that it would be my duty each morning to redress it just as he had done. Great. That’s what makes early mornings on surgery so much fun. Getting to the hospital at 5:30 a.m. to repack perineal wounds.

It turned out that I really got to like Dr. Poole. Sure he was volatile. But he was also funny and a good teacher. He kind of reminded me of one of my sports heroes, basketball coaching legend Bob Knight. I have read a couple of biographies on Knight and his teaching techniques and temperament are real similar to Dr. Poole’s. Poole will berate the residents and cut them no slack at all. I think they all start out hating him, but somewhere during the five-year residency they realize that through all of the bluster, he is making them better surgeons. By the time they are senior residents they will do anything for him. And when he writes their evaluations and letters of recommendation, he does so with glowing reviews. Even if he just finished telling them in the OR that they have got to be the WORST surgeon he has ever seen. A lot of it is kind of for show. He can just go off on a resident during a case and belittle their skills in front of everybody in the OR but then will look across the table to the M3 and wink. On the third day of the block he asked me if I was nervous about being on surgery. I knew I couldn’t deny it because it would appear cocky and he would move in for the kill. But letting him smell too much fear would be like tossing blood in front of a shark. I admitted that I was a little apprehensive.

“Why?” he demanded?

I explained that is was probably due to all of the unexpected, the mysteries of the OR, etc.

“You’ve heard that I’m the meanest sonuvabitch in this place, haven’t you?” he asked.

“Well there are stories out there, sir.”

He laughed at my forthrightness and told me to relax, that we were going to have fun. And we did. I am quite sure that surgery is not for me, but I did learn a lot and will always remember some of my experiences in the OR scrubbed in with The General of UMC, Dr. Galen Poole.