Surgery and medicine. Two very different worlds living in the same house. And this discovery was quite a surprise for me going into medical school.
Anyone who has spent an appreciable amount of time around surgeons has surely heard them cracking jokes about the internists. For those who aren't familiar, internists (not to be confused with interns) are those who practice internal medicine. Internal medicine is an amazing field, very deep, dealing with extremely complicated patients, most of which have multiple chronic conditions for which they are receiving a myriad of interventions.
I knew there was a difference in those who wanted to be surgeons and those who wanted to be internists. But until I began to work with both I had no idea of the deep chasm that existed between the specialties. I was startled to discover that not only were they different types of specialists, but also different types of medicine.
With every patient that comes into the doctor's office, ER, clinic, etc. there is one fundamental question that must be answered: does this patient's condition warrant surgical or medical intervention? With most problems this never becomes an issue. Nevertheless the assessment is made, either deliberately or instantly and subconsciously. And the answer to that question leads to very different management strategies.
It will also lead to very different relationships and interpersonal interactions.
Surgeons are notorious for not being good "people persons". They are ridiculed for the often atrocious bedside manner. Internists, on the other hand, are often thought of as taking far too long with their patients, of being long winded, and overly sentimental. Two ends of a spectrum, and the truth lies somewhere in between.
The differences fall back on the fundamental question of whether surgery or medicine is warranted. Medicine often moves at a much slower pace. Interventions require long time courses, lifestyle alterations, support, altering medication regimens, etc. Surgery moves much more quickly. Decisions are often made in the spur of the moment. Many times the only intervention needed is one operation. The gratification is far more immediate.
And this draws different personalities. Both specialties require intelligence, but perhaps of slightly different natures. Medicine requires careful thought, studious examination of conditions and co-morbidities, and an ability to be patient. Surgery begs quick thinking, a willingness to dig in and work like crazy, and an ability to act thoughtfully at a moment's notice. I would never say one is better than the other, just that one draws me more.
I am a surgeon. Before I ever came to medical school I had an idea that was the case. But it was solidified last year as I was working on the wards. Medicine and related rotations (eg. Pediatrics, Neurology) consisted of hours and hours of conference and class. Papers, patient write-ups, lengthy history taking and physical examination, and hours and hours of looking things up were the norm. I learned a lot. But I was bored.
Surgery, however, energized me. It seems crazy to be energized when you day starts at 4 am and ends (if you are lucky) at midnight. But I was. From the second I arrived at the hospital I was running. Rounding on my patients, then to the OR, then up the floor between cases to check on other patients, back to the OR, sneak a 15 minute nap on the little wood bench in the locker room between cases, no time for breakfast, no time for lunch. I was exhausted, but happy. I felt at home. 80-100 hours a week flew by. I knew I was where I needed to be.
So the time approaches for me to apply for residency. Still months off, I have had time to examine my priorities. I know surgery is where I need to be, and have been fortunate enough to get an in into a surgical sub-specialty that won't require 80 hours of my time each week. Medicine is great, but deep down, I know I am a surgeon.