Intentional Reset

I have never been one for New Years Resolutions. In fact, I’ve actually never made one. Not that I have anything against them – I just don’t have the self-control or will-power to complete them. Now I know what you’re thinking:

“Tess, you’ve made it through medical school, how can you say you have no self-control?”

Solid point. I suppose it’s a false statement to say that I have no self-control, but rather that all the self-control and will-power that I do have is put into furthering my career, so I have nothing left for the rest of my life. Or something like that.

I have great admiration for those who have accomplished these resolutions. My sister-in-law, for example, gave up cheese for 2017. Considering the fact that I had cheese in my ice cream yesterday, I find that feat rather impressive.

While I don’t find myself saying things like “new year, new me” I do find that there is a lot of value in the place within us that these resolutions originate. It’s that desire that we have to be and do better and the New Year gives a concrete point to set out on that journey. I love the intentionality behind these actions, and I love people who live intentionally.

I started thinking about “Intention” when I started practicing Yoga at the beginning of medical school. During the warm up period of class the teacher would have us take a moment and “set your intention” for that particular class. When I finally started actually setting my intention, my practice improved dramatically. Well maybe my practice didn’t improve, but my experience of my practice did.

I found that when I set an independent intention for each class, I was no longer trying to do it all. My intention didn’t always have to be the same. Some days my intention was to sweat and work as hard as I could. Some days it was to find a thoughtless headspace. Others it was simply to stay calm in the poses. I had an overarching theme for that class I  was able focused on. It allowed me to get what I needed out of the class, not what I thought I was supposed to get.

I try to apply this same Intention to my daily life, but I’ll admit that I really suck at it. It’s one of my greatest fears – to look back at my life and to have been a passive participant. To let life happen to me and not get anything out of the experience.

At this point, 2018 is a year full of uncertainty for me, but it’s also going to hold some of the most important days of my life (match day and med school graduation to name a couple) and I don’t want to be a passive bystander of it all. So while my stronger friends out there set their Resolutions, I am going to use this same finite point to set my Intentions for 2018.

In 2018, I intend to push past common courtesy and politeness and treat those I contact with kindness. I intend to appreciate every sunshine filled afternoon I get to spend hiking in the hills behind my house. I intend to foster my adventurous and independent spirit every opportunity I can. I intend to be kinder to myself. I intend to surround myself with the people I love and to expand that circle.

Here’s to 2018, may it be a beautiful step on your journey to becoming who you are.




p.s. In the last week I have purchased plane tickets to Iceland, Norway, the Netherlands and Patagonia, so from an adventure standpoint, 2018 looking pretty good already 😉


Acting the part

For the last 5 months, I have spent the majority of almost every day in or around the operating room participating in Sub-Internships (also known as Acting Internships at some institutions). What is a sub-internship? Good question. I’m not sure I actually know, other than it serves as a fourth year medical students’ time to attempt to function at the I️ntern level – without the ability to put in orders, make decisions or do anything of consequence.

For me, these months were about gaining more experience in several different areas of General Surgery and showcasing my surgical prowess to some residency programs I am interested in. It also gave me the opportunity to experience what it is to live a “surgical lifestyle” for an substantial period of time. I worked a lot, slept a little, ate sporadically, worked out seldom, and learned exponentially. Here is a compilation of some of these things I learned, overheard and experienced:

  • Rule #1 – Never lose the wire
  • Rule #1  – Stay focused
  • Rule #1  – Sew Fast

Yes, I realize these are all called rule #1, they were all told to me by the same Vascular Surgery attending, and they were all his #1 rule. His other rules consisted of:

  • Rule #2 – Don’t talk about fight club
  • Rule #7 – Failing to plan is planning to fail

What were Rules 3-6? No idea.

  • My spirit organ is the Pancreas – cause it’s big and white and you “don’t mess with the pancreas”
  • “That’s what I call snatching defeat from the hands of victory.”
  • One day, while I am sprawled over the operating table while my Attending is sitting in a chair sewing an anastomosis, he glances at me and says “you really should stand up straighter. You’re going to get back problems.” This is Surgery – where you can literally bend over backwards for your superior and they will still criticize you… and then we thank them for doing so.
  • “1,2,3,4,5- keep the anastomosis alive – 6,7,8,9,10 – so we don’t have to come back and do it again.”
  • Burn surgery is like normal surgery, but in a sauna.
  • You have to take care of yourself first. Some people will encourage you on Sub-I’s to not take your days off and work all the way through to show people that you work hard and want to be there. This is ridiculous and unsustainable.
  • The best thing about colorectal surgery is the endless supply of butt jokes.
  • Having family around is life changing.
  • When will the trauma transfer arrive? The moment you try to grab food, write a note or take a nap. Obviously.
  • Being at work for 32 hours is my current limit before I️ start crying in the operating room.
  • Almost any residency program can train you to become a competent surgeon if you study and work hard. The real question I️ ask myself is if the environment will make you a better or worse person.
  • When sleep is limited, you get much faster at your morning routine. What used to take me about an hour now takes me 20 minutes. Coincidentally, I also look a lot worse.
  • Theres a uniquely terrifying feeling when you are presenting to a room of people about a topic they are all experts on and are presenting a paper that is literally written by the person in the front row.
  • The people you work with make all the difference.

I’m sure there is so much more, but lets have some real talk for a second. These last few months were exhausting – emotionally and physically. There was a lot of the time where I was just tired. Tired of being cheerful all the time, of volunteering to stay for late cases when all I really wanted to do was go home and sleep/cry. Tired of being criticized constantly. Tired of being barrated for being left handed (which to some is considered a cardinal sin). Tired of being evaluated based on me knowing (or not knowing) the answers to the two random questions the Attending asks me at the end of a 10 hour case.

But in the end, I wouldn’t change the last few months for anything. I LOVED the majority of the people I worked with and there was always something I experienced in a day that reminded me why I crawled out of bed at 4 AM. I am so excited about the next chapter of my life and my career in surgery. However for now, I am exquisitely glad to part ways from this life consuming beast and enjoy the beauty that I hear 4th year is supposed to be.

Next stop – Interviews.

Wish me luck



Wait for it

I’ve been going to Sunriver, Oregon at least once a year since I was 2 years old. My family has spent numerous winters shredding the slopes of nearby Mt. Bachelor and going for snowy strolls along the beautiful bike paths. Summers were spent playing tennis, golfing and floating the Deschutes river. I have more cherished childhood family memories in that place than probably anywhere else in the world.

One of our favorite things to do while being in Sunriver, is biking. There are miles and miles of beautifully paved bike paths that wind through the vacation village. In fact, it was on those very bike paths that my dad taught me how to ride a bike. I always loved going for family bike rides as a kid – well, except for when we had to go up The Mountain.

The Mountain – the dreaded slope that we were destined to encounter at some point during our stay. No matter which house we had rented or where we were planning on going, eventually I would be faced with my kryptonite. It came to the point where I knew when it was coming up. I recognized the approaching terrain and I can remember a few times when I would start bawling as soon as I realized what was to come (I’ve never claimed to be a non-dramatic child, so this shouldn’t be too much of a shock). Year after year I would try and get my bike up this colossal slope, often I would end up walking with tears streaming down my little cheeks.

I recently spent two weeks back in Sunriver staying at my family’s house, studying for the second part of my national boards exams. One evening I decided to go for a ride and what do you know – I came upon The Mountain. Only this time there were no tears. In fact, this time I didn’t even have to downshift. My long legs didn’t even break a stride as I gilded up the slope and continued on my journey.

It turns out my childhood nemesis was not in fact a giant mountain, but a small hill. It appears that as with most things – this got easier with time.

I was reminded of this phenomenon a few months ago when a first year medical student came into the OR with me to see a case. I was on my elective at the end of my third year, and by this point, being in the operating room felt natural. The process of scrubbing in, gowning up and draping the patient like a dance I had rehearsed numerous times. As I walked this younger student through the process, it felt like teaching a bird to swim.  Some of the mistakes he made were comical, and I found myself thinking “why on earth would he even do that?”

But then I remembered the first time I scrubbed into a surgery – well, not the first time. The first time a senior resident walked me through it and helped me gown and everything (it was magical). But the second time…

It was my last day of my first two weeks of medical school. I was a first year who hadn’t even had a single lecture yet. I was on OB/GYN and was sent to the OR to scrub into a C-section. Everyone was rushing, no one was paying any attention to me. While I tried to remember all the things I had been taught, as I attempted to gown I ended up contaminating an entire sterile table.

I have never been so mortified. In fact, my parents are the only people I have ever told that story to – which should tell you something about how embarrassed I was, as I am usually all about laughing at myself publicly.

It’s hard to imagine now how I would have made such a dumb mistake, but at the same time, being in a place like the operating room is such a foreign experience, until you get used it. You can learn all the steps in a scrub class, but until you have spent hundreds of hours being sterile, it’s hard to not automatically scratch your nose when it itches.

Successfully existing in the OR takes practice, time, and experience. It’s not something you can will yourself to become an expert at and it doesn’t feel natural overnight.

There are so many things in life that are like this and if you’re like me, you struggle with them all. I HATE being bad at things, I want to learn fast and be an expert immediately. Whether this is something in medicine, sports, relationships, emotions… but unfortunately there are some things I just can’t rush. I can’t will myself to get over someone I loved or make my anxiety and sadness disappear simply by deciding to. Some things take time to allow yourself to grow a little. To let your metaphorical legs grow a little longer and stronger to propel you over that challenge.

I struggle with this concept a lot, but I am trying and I’ll pass along some of the best advice I received, which was – “Tessa, just relax. The rest will come.”

While at the time I was given this advice I thought it was literally the dumbest thing ever (as it occurred after a particularly frustrating lap chole in which I couldn’t do a single thing correctly), I am starting to see some genius in it.

So I’ll give that same advice to you. If you’re like me and struggle with allowing yourself to be imperfect – in relationships, school, emotional state, your job – just relax, give yourself some grace and time, and the rest of it will come. With a little bit of inner growth, maybe that mountain won’t feel so big anymore.

Too much, but not enough

We all face moments when we ask ourselves, “could I have done more?”

In medicine, we fear this juncture, run from it, and do everything in our power to be able to pat ourselves on the back and say “we did everything we could.”

Then there are the times when we are faced with the more challenging question. What about when we are forced to wonder, “did we do too much?”

The moment when we are sitting in a quiet room with a weeping family searching for the words to explain why their beloved family member is dying after a procedure we insisted would prolong their life. Why the grandmother who was so delightfully infused with life just yesterday was now in multi-system organ failure, maxed out on pressors and neurologically devastated.

The family voices what we’re all thinking:

“I just wish we hadn’t done the operation.”

They would have died without the surgery. That’s what we tell ourselves. But looking around the room I see reflected in the eyes of my fellow team members a question echoing my own:

Did we just kill this woman?

But no one says it out loud. Not in the room with the family, not on the miserable walk back to the ICU to inform the team we are making our patient DNR and only providing comfort care.

If we had sent her home with this ticking time bomb in her chest would we have been morally responsible when that bomb had exploded? Wasn’t it our obligation to provide her with all of the interventions we had at our disposal?  Are we acquitted of this horrific outcome because our intentions were pure?

How is it that we did too much, and yet I still feel as if we didn’t do enough?

The phrase “the possible benefits outweigh the risks” means something different when you’re left explaining why the risk are the only thing present in the end.

Did we push too hard? Were we the scalpel-happy surgeons that we are assumed to be, operating on anything we can get our hands on? In all of our good intentions did we snatch the precious time this family had left?

I’m really asking.





To End on a Positive Note

If you’ve come into contact with me at some point in the last 8 weeks, I’m sure you know how I’ve felt about my pediatric rotation. To be fair, it never really had a chance. Coming off the amazing high that was surgery, peds had a lot to live up to. Not going to lie – it didn’t even come close.

However, instead of telling you all of the things that I loathed about this rotation, I’m taking the advice of a friend and mentor of mine and I am focusing on the positive. So here is a list of the things that I enjoyed over the last 8 weeks:

  • Outpatient pediatrics allowed me enough free time to work out twice a day, including long hikes to watch incredible sunsets.
  • My incredible team of Residents allowed me to ditch out on an afternoon of doing intake H&P’s so that I could scrub into my patient’s surgery, which turned out to be a fantastic example of the beauty of continuity of care.
  • I became unrealistically attached to two of the most amazing ladies I know (someday we’ll write a memoire together and it’ll be hilarious, just wait).
  • Being mistaken for an Attending or Resident on multiple occasions – frustrating for my senior resident, but helpful for getting morning report from the nurses.
  • Pediatrics gives you a few morning’s off to do some online modules – I was lucky enough to spend those mornings jumping in on surgical cases.
  • I got offered an away rotation at one of the top surgical programs on the west coast for the month of July.
  • I was able to take a spontaneous 18 hr trip to Vegas to attempt to see The Chainsmokers.
  • I once explained to an outpatient Attending that I liked surgery because I find that I thrive in an environment where I am spoken to like a dog.  To his credit, about 10 minutes later I hear from across the clinic “Tessa, Come!”

The amazing Team D. Just another example of how fantastic people can make anything tolerable.

On the other hand, here are a couple experiences that describe my feelings for most of pediatrics:

  • While doing an intake physical exam on a 5 year old child around 9:30 pm on a Saturday night the child begins to scream “I don’t want to do this! I just want to go to bed.” to which I yelled back “Me too!”
  • On my last day on outpatient pediatrics I was struck in the head with a dinosaur shaped reflex hammer by a 7 year old child – a perfect analogy for my experience of outpatient pediatrics.

The good news is that other than 2 weeks of intense study for the USMLE Step 2, I will be spending the next 5 months in or around the Operating Room.

So check back with me after that, maybe by that time I’ll agree with the unbelievable rude resident I met in Las Vegas who told me that going into surgery is the worst decision I could ever make (spoiler alert: I have definitely made worse decisions).


Night out in Las Vegas with these amazing women that fill my life with so much joy and substance.

Speaking of the reactions that I get from people who find out that I have chosen to apply for surgery,  these are some of my favorites:

  • “I loved surgery, I just couldn’t do that life style.”
  • “You must really not like sleep.”
  • “Your life is going to suck” (my personal favorite right there)

I’ve realized something after hearing these statements and experiencing a non-surgical lifestyle these last two months.

We all value different things according to the amount of  self-worth, enjoyment and meaning we gain from each respective item. When coming to choosing careers within medicine, people prioritize different aspects of the careers in accordance with these values. Some people really value having lots of free time to do other things that they enjoy. Other people really enjoy connecting deeply with others and require a setting where that is encouraged.

I have realized that a large part of why surgery makes sense for me is that I really value having a career in which I can tangibly see the difference I am making. In addition to this, when I work, I like to work hard. I’m a single minded and intense individual that thrives in an environment that challenges me. Being in a place of  work that utilizes my intensity allows me to be more relaxed in the rest of my life. Something that I noticed over these last 8 weeks, is that when I don’t have a place to channel this energy, it starts to manifest itself in the rest of my life in the form of anxiety.

Do I look forward to the “surgery lifestyle”…. not necessarily!

I do find that like most morning people, if I haven’t accomplished at least a substantial amount of things by 7 AM the day is just over. However, I don’t crave getting few hours of sleep, missing meals, and not going to the gym as often as I would like.

But the things is, these last 8 weeks of Pediatrics my lifestyle has been pretty sweet. Like I mentioned above, I worked out a ton, I hung out with amazing people, I took spontaneous trips – and yet the majority of the time I was a miserable and anxious wreck. The value I place on myself and the meaning I get from life is not directly related to my extracurricular activities. The peace that I am able to maintain within requires a safe space to send all the turmoil, and unfortunately a 9-5 clinic job just doesn’t do it for me.

Moving forwards, when I hear people’s opinions about me going into surgery, instead of getting into midnight arguments, I’m going to try and just smile and be thankful that those people found their passions and are living them out.

Our inner fires burn at various temperatures and ignite for different things. The more comfortable you get with your own flame, the more you can appreciate the inner power and drive of those around you. Being aware of what motivates you changes the conversation from one about getting the most competitive specialties, to finding the most compatible ones.

Thank goodness we’re all unique and that medicine has a place for us all!


Fantastic views from Angel’s Rest in the Columbia River Gorge

In other news, that’s the end of my 3rd year of Medical School! It’s been a whirlwind journey, and one that has facilitated more growth than most years of my life combined (no, not physical growth. I’ve been this tall since I was 16. I swear). Through it all, here I stand – a terrifying step nearer to the ledge of responsibility that is becoming an Intern.

Thank you all for your support along the way. I’m ready for 4th year now.



The Switch

“Who are you?”

I’m walking next to the gurney, transporting the patient from the emergency department to the OR, when I hear this dreaded question. Rarely have I experienced a positive reaction from a patient when you explain that there is a medical student *gasp* scrubbing into their surgery, so I try my best to avoid disclosing that fact whenever possible.

“I’m Tessa,” I smile and keep walking.

“And you are a….”

I sigh, “I’m the medical student working with your surgical team.”

“Will you be there for my surgery?”

“Yep!” I attempt to stay upbeat despite it being 4 AM and I’d been working all night, “but don’t worry, the Attending will be doing everything, I’m just there to make sure they don’t do anything too crazy.”

He laughs, which surprises me. This man is supposed to be really sick, that’s why we were heading to the operating room in the first place.

We’d received the consult at around 3 AM, I had been sitting in the OR watching a rather laborious laparoscopic cholecystectomy that my fellow medical student had scrubbed in on, when the Intern had requested my help with this particular patient. He was a 55 year old man with cancer who had recently finished a course of chemotherapy and had presented with acute onset abdominal pain. Not super exciting on it’s own – but the CT scan peaked our interest.

“Free intra-peritoneal air” said the preliminary read. I remember trying to contain my excitement – this meant I was getting a surgery tonight.

When we approached his room I could see from outside the glass that this wasn’t looking good. His blood pressure reading 85/50 and heart rate in the 170’s, before we even entered the room the Intern sent me to call up to the OR to inform our Attending.

We started a fluid bolus, got a quick history and I started working on the H&P that would need to be done before we went to surgery. When our Senior resident and Attending arrived I followed them into the room. Even after the administration of 2 liters of normal saline his blood pressure had continued to drop to 75/40. I listened to their conversation while my eyes stayed pinned to the monitor, half expecting him to crash any moment.

“It looks like you may have perforated a part of your bowel.”

After allowing the patient a brief moment to finish the string of obscenities coming out of his mouth, the Attending continued:

“This can sometimes happen after undergoing chemotherapy, or it could be due to your malignancy itself. Either way, we’re going to need to take you to surgery to remove the damaged piece of your bowel.”

“What are the risks doc?”

“Well, you’re very sick. There are always risks to undergoing a procedure, but even more so with your co-morbidities. I have to be honest with you, the prognosis doesn’t look very good. This very well may kill you.”

He takes it in for a few seconds, “how long would I have? Weeks? Months?”

There was an uncomfortable air that settled over the room.

“No,” my Attending clarifies, “I mean that this could kill you tonight.”

I could see the flurry of emotions cross his face like a blizzard turning him a paler shade of white and I was struck that even a man carrying a terminal cancer diagnosis could be surprised by his mortality.

“Is there someone that we can call for you? Does anyone in your family know that you’re here?”

“There’s my daughter, but she doesn’t know I came. I’ve been in the hospital so much recently I figured she didn’t need to know.” He checked the clock, “It’s the middle of the night, I can’t call her now.”

The intern and I were left to consent him for the operation, and I was given strict instructions not to let him out of my sight. I took my post at his bedside as the operating room called for us to bring the patient upstairs.

“I do hope you get to learn something at least, since you have to be up in the middle of the night for this.” He’s smiling kindly at me and I reciprocate. He continues on, “Tessa is a very nice name, where is it from?”

“It’s Dutch,” I respond, prompting a conversation about Europe, his military service that took him to Germany and the bitterness the Dutch hold against the German soccer team. I ask him about what he did in the service and about his family. We arrive outside the main OR board and wait for anesthesia to arrive. He’s telling me about his daughter who he believed to be about my age. I don’t know when, but sometime along the ride up the elevator I had ended up holding his hand.

We’re silent for a moment and as I look at him I feel a sudden rush of emotion. There was something about him that personified my own father. The words my attending had spoken just a half hour before rang in my ears: this could kill you tonight. 

“You really should call your daughter.” I urge earnestly, “she would want to know.”

His eyes meet my own in a moment of shared desperation, he nods his head.

I help him get to his phone and wait, desperately trying to hold back the tears as I listen to this man leave his daughter a voicemail verbalizing the direness of his situation, his unconditional love, and how proud he was of her.

By the time he hung up, Anesthesia had arrived. I take hold of his hand again as we’re rolled back into the OR.

Normally, at this point I am assisting the nurses in getting the patient connected to the SCDs, correctly positioned, and grabbing my gloves and gown for the scrub tech. But this time I just stand there holding his hand, his unrelenting grip capturing me in place.

At this point my Attending comes and stands next to me. I wonder what he’s thinking of me – this useless medical student just standing there, being of no help to anyone. I fear he can see the tears welling in my eyes. We stand there in silence for what felt like years as the Anesthesiology Attending arrives and initiates the induction of anesthesia.

When he’s finally asleep, I let go of his hand and glance towards my Attending. He considers me for a minute, and I half expect him to kick me out of the OR and tell me to go get my emotions in check.

Instead, he simply nods and states, “I think we’re going to need some music for this one, don’t you?”

So we performed the operation while blasting Shakira and Enrique Iglesias.

This experience demonstrated to me the dichotomy of what it means to be a physician, and especially to be a surgeon. It’s a balancing act. We must be human, we must feel and connect deeply with our patients. We also must be able to turn it off, put our heads down and charge forward at the top of our game.  Both roles are required in providing complete patient care.

If I had been the lead surgeon, I never would have been able to be objective and thorough in that operation if I had spent the entire time worrying about the daughter who may not get to see her father again. But I also wouldn’t have been able to facilitate this man’s calm journey to the operation if I hadn’t embraced my humanity and made a connection.

So we have to develop the switch – the one that puts a pause on our humanity and turns on the well-oiled-machine that is the experienced surgeon. We turn on some 80’s rock, latin pop or EDM and fix the problem.

I think this is essential in nearly all areas of medicine – to have the ability to suspend our emotions and do what needs to be done. It’s healthy and it’s required.

But what happens if we forget to flip the switch back once the surgery is over or we’re finished running the code? When the outcome is bad, isn’t it just simpler to leave it off? We have more patients to take care of, more surgeries to do, more lives to save. So yes, it’s easier to remain disconnected. I’ve seen examples of that happening throughout this past year on the wards. But I’ve also been shown amazing demonstrations of courage, vulnerability and compassion when physicians have purposefully made the decision to flip the switch back, to embrace their humanity and with it, their humility.

On my pediatric rotation this last month an Attending of mine reminded me that sometimes I need to rein in my intensity to a level that my patients can handle. To read the room, take a step back, and make a connection before I rush into my plan for their care. I think that fits well with this concept, because in the same way as I consciously decide pump the brakes when it comes to my level of directness with my patients, it is also a conscious decision to lay down the suit of armor that is medicine and meet our patients and their families where they are.

I hope that moving on in my career that I can continue to remember the importance of this decision and fight against the lazy temptation of disconnection.

The First Cut

They say the first cut is the deepest. For me, this was definitely not the case.

It is a typical tuesday afternoon and I am preparing for my 3rd case of the day when the intern I am working with informs me that he needs to leave for clinic. It will be just me and the Attending for this next one.

I report to the OR, feeling a little nervous and not sure how this Attending will react to a 3rd year medical student being the only one around to help. I grab my gloves and am helping position the patient on the table when he arrives.

“Good afternoon Dr. Lamberton,” he chimes, “will you be helping me out on this one?”

“Yes sir, it looks like it’s just you and me today.” I brace myself for his response.

“Well that sounds just fine.” He smiles and motions for us to go scrub.

We re-enter the room and drape the patient in the usual fashion. I’ve never been to the ballet, but I have been to the operating room, and when you watch this choreographed dance, it feels pretty similar.

“Alright now Dr. Lamberton is going to read the time out.” my Attending’s voice thunders.

I look up from the suction I’m securing to the drape, surprised, and make my way to where the scrub nurse is holding the patient’s chart. My voice is only mildly shaking as I muster my most commanding tone.

“This is patient _________________, MRN ________________ born ___________________. Consented for a ___________________ under general anesthesia.”

I look to anesthesia and they take over, the rest of the team following in suit. I’m grinning behind my mask as I step back to my place across from my Attending. He nods to me with a fatherly-like approval. We work together to mark our incision site. The scrub tech hands me a lap-sponge in addition to my suction so I can keep the field dry for the Attending while he makes the incision.

“Please hand the scalpel to Dr. Lamberton.”

I drop the suction I’m gripping (almost off the sterile field) and try to maintain my calm as the scrub tech hands me the scalpel.

This is it, I’m thinking as I place the scalpel on the skin, This is my moment. I’m a surgeon now.

With all the concentration and focus pinned on the tip of the blade, I begin to carve my masterpiece. Commanding my hands not to shake as I bring the knife along the 5 cm of marker that directed where my incision would go. I reach the end of the line, removing the blade from the skin. I turn to hand the scalpel back to the scrub tech and as I’m preparing to state the words I had heard so many times before – my Attending clears his throat.

“Why don’t you try that again.”

I look down at my work of art only to discover, to my horror, that I had barely cut through the dermis. Sheepishly, I take another stab at it. I see my attending nodding his head slightly as he grabs the Bovie and continues the surgery.

My great moment wasn’t as graceful as I had dreamt it would be – but when are they ever? For me, some of the most influential moments in my life have been ones that occurred completely on accident. You can’t plan for moments of growth and progress, you can only capture the opportunity placed in front of you.

This story isn’t about me capturing a moment. While it’s certainly cool that I got to make the first cut (and a moment I won’t soon forget), the real amazing thing to me was the opportunity that was placed in front of my Attending that afternoon. He was burdened with the load of an inexperienced assistant, and instead of complaining or ignoring me and my tightly clenched suction, he elevated me to a position in which I did not belong and gave me the tools to inhabit such a place.

That’s the beauty in really teaching someone – it’s not about asking the hardest pimping questions or assigning the latest articles to read. Those are great tools in assessing someone’s preparedness and self-directed learning process, but to truly teach means lifting the student from where they were so that they can take in the view from where you are.

I was blessed with such a teacher that afternoon, and I hope that one day I can strive to be a surgeon who raises up those around me in the same way he did with me.

The Power of Love – Surgery Style

At MS3 orientation in July of 2016, they warned us about the “slump” in student moral that tends to occur around February of the 3rd year. When the pressure to perform and stress scheduling away electives, deciding on our final career choices, and getting letters of recommendation becomes just too much and we all crumble. Hearing this, I remember thinking to myself “I’ll be on surgery. What a disaster that will be.”

Little did I know that February and March would wind up being my favorite months of all of medical school and that surgery would be exactly what I needed.

I felt the slump starting in January – coming back from my great Australian adventure and landing in the purgatory of the neurology rotation. I had all the signs of a great depression on the horizon. My attitude starting surgery was pretty much “at least now I’ll be too busy to perseverate on how sad I am.”

And then I was hit by the semi-truck that is love and it appears my life will never be the same again.

As I realized that yesterday was the last time I will scrub into the O.R. for a few months, I spent a few minutes reminiscing on some of the revelations I’ve stumbled upon along my recent discovery that I want to be a surgeon:

  • The most dangerous thing about using Meth is that it seems to make you determined to climb ladders.
  • I have never met a group of people as enthralled with the fact that I am left handed as a team of surgeons.
  • Life tip: Don’t get a tattoo you would be embarrassed to have your surgeon see right before they cut you open.
  • I don’t belong on the anesthesia side of the curtain.
  • Nothing screams diagnosis in an exploratory laparotomy like finding a Foley catheter floating in the peritoneal cavity.
  • I’m happier working 14-hour-days on General Surgery than I was working 8-hour-days on Internal Medicine.
  • Lethal triad of death: hypothermia, coagulopathy, acidosis
  • I need to learn Spanish.
  • Food and sleep are not required.
  • The canal stitch is all about bar hopping.
  • Sometimes you suggest a plan, and spend the next 3 minutes hearing how explicitly wrong you are. Other times you’ll get handed the Bovie and told “if you want to take it out, go ahead and take it out.”
  • If you are forced to spend a day in clinic – surgery clinic is the place to be.
  • Surgery life is literally nothing like Grey’s Anatomy.
  • Apparently for Lent this year I decided to give up my dignity (ok, so maybe that part is slightly like Grey’s Anatomy).
  • A patient that leaves AMA because he hasn’t eaten in 12 hours sparks very little sympathy from a team who hasn’t eaten in longer than that.
  • When a General Surgery resident asks you why we’re giving Demeclocycline to a patient with hyponatremia – they’re pimping you. When an Orthopedic resident asks the same question – they genuinely want the answer 😉
  • Don’t drink coffee for the first time in a month right before you scrub in – your Attending will wonder why you’re shaking life a leaf while throwing an anchoring stitch.
  • There’s a real gift in having residents who invest time in teaching you. On the other hand, there is nothing more frustrating than someone who refuses to teach an eager student.
  • If you scrub into the wrong surgery – just go with it.

Perhaps the most important thing that I learned, is that I belong in the world of surgery and I can’t wait to continue pursuing this career.

But first I must conquer my final rotation of 3rd year – Pediatrics ( I can feel the depression setting in already).



The Storm

There’s a calm that comes before the storm.

*beep beep beep beep*

The trauma pager goes off and I feel it to my very core. A shot of norepinephrine through the system – a sympathetic response to the stress of what is to come.

The message reads “Level A trauma, ETA 20 min”.

“Crap, I never got to eat,” my chief resident mutters. If this trauma is anything like the last few days, we’ll be spending the next several hours in the OR, and food will be the last thing on our minds.

I nod sympathetically, suddenly very thankful for the tamale that I shoveled down a few minutes earlier. We stop by our call room and she inhales the salad she brought from home, and we’re moving again.

When we walk into the ED, all eyes are on us. People pay attention when the trauma surgeons enter – something must be about to go down.

From this point, each trauma goes about the same.

We meet up with the ED attending and residents outside of the room – the patient hasn’t arrived yet. Making small talk, we don our trauma gear: cheap blue gowns, hair nets, gloves, and protective masks that cover our mouth, nose, and eyes (you never know where blood will be going in a trauma).

In the moments before  the patient arrives, an eerie calm settles over the room filled with doctors, residents, nurses, respiratory therapists, and med students like me. We’re standing in a circle around the empty hospital bed, preparing  ourselves – knowing that literally anything could be coming through the doors.

It could be a meth addict who fell of a ladder. A hiker who slipped off a waterfall. An unrestrained MVC with the driver thrown 100 ft from the vehicle after going over a 150 ft cliff. A GSW to the chest, abdomen, or head. A man who fell out of a tree trying to rescue a cat. A kid who was stabbed in a road rage incident.

From in the hallway someone announces “make way” and we watch as the EMTs roll the patient into the room.

The thunder starts to roll.

The EMTs are giving report, and before the patient is even fully transferred to the hospital bed the nurses are searching for IV access. Vitals are being taken, both by hand and machine. The junior resident starts the primary assessment, calling out the ABCs (airway, breathing, circulation) and head to toe inventory of injuries. My senior resident is standing at the foot of the bed, taking it all into account, making the decision of when to escalate. We’ve called for the “black blood” and packed RBCs and FFP are running.

As they work, I’m writing it all down. As a medical student my job, second only to not getting in the way (the  golden rule for any trauma situation) is to take notes on everything happening. All the damage called out, questions asked to the patient, details about the incident – we’re going to need it all for our note, which must be completed before we can take the patient to the OR. That’s also my job.

The first few trauma’s I’m massively overwhelmed, but after a couple of times I learn to tune out the unimportant voices, and I begin to recognize the voices of my team amongst the crowd. By the end, I’m grabbing staplers, gaze, c-collars – anything my senior resident calls out for.

It’s time for a chest x-ray: the eye of the hurricane.

It’s our first step to analyzing the internal damage to the patient, and requires us all to take a few steps back (outside the room to be exact) and regroup.

During these moments our ACS team gathers together. Our chief tells us the imaging she wants to have done, and the junior goes to put in the orders. She turns to the attending and they decide if the patient is stable enough to go to CT, or if we need to go straight to the OR.

The x-ray is captured, and we walk back into the room to take a look at the result on the machine.

The eye has passed, and the winds howl once more.

From there, we’re either placing chest tubes or rolling the patient – time to see the damage on the other side and discover spinal tenderness and decreased rectal tone. This is where I end up with blood on my gloves and gown, rolling trauma victims is not a clean business.

We’re off to CT, and the whole trauma team accompanies the patient. My junior resident logs into the computer in the control room and I start writing the note, we only have about ten minutes until we know if we’re going straight from here to the operating room.

We watch with bated breath as the scans appear on the screens. None of us are radiologists, but years of looking at similar images has made our attending adept enough to see when something is wrong.

Some of the results are obvious enough for even me to see – a massively bleeding spleen, free fluid around the bladder, air under the diaphragm. Sometimes it’s subtle. Sometimes there’s nothing at all.

Sometimes they’re gone before we even get to the scanner, and we’ll never know why.

The dichotomy continues. We’re breathing a sigh of relief or we’re already on our way to the operating room. I’ve already finished the H&P, written a progress note and an updated H&P. If we’re heading up, it’s all about damage control. We plan the operation to get the most dire things finished before they become to unstable and we have to pack them – we’ll close after a few days of cooling off in the ICU.

On occasion we get to finish it all, surprised as we close the skin that our patient is still rock solid.

If we’re lucky, we haven’t gotten more trauma’s while we’ve been operating. When we’re not, the senior has run out to meet the next level A, with the attending not far behind and sometimes I am the only one of the surgical team in the room with the open patient for a few minutes until the back up attending arrives.

When we’re finished, it’s back to rounds. No chance to take a break or sitting down. We have lists of patients to manage, and we must be efficient.

For only one thing is certain in this business – another storm is coming.



Upon Traveling Alone

The first trip I did by myself was in June of 2016 after taking  the NBME Step 1 exam. There were plenty of reasons why I went traveling (#1 being the near continuous 2 years of studying in coffee shops leading up to the exam), but there were several specific reasons why I felt the need to go alone.

The greatest of which was the fact that I wanted to prove to myself that I could.

Looking back over the years that I have been single, I have kept myself from doing a lot of things because I didn’t have anyone to do them with. I’m envious of people who have a built in travel and adventure partner in their spouse or significant other. I also have this pathological fear of showing up to things alone. I HATE it more than almost anything. So if I don’t have someone to go to a party, movie or even church with me, I probably won’t go.

Combine this with every single 20-something woman’s deep dark fear of ending up alone (insert me singing “On My Own” from Les Mis at the top of my lungs), and the bleakness of my situation brought me to a realization:

if I am always waiting around for someone to see the world with, I may never actually get to see it.

So I took matters into my own hands and I went out on my own.

In that limited time, I had moments where I absolutely hated being alone. I remember standing on the train platform in Berlin heading to Prague with tears in my eyes, and hearing them call out a train leaving for Amsterdam. I realized that I could be heading back to the safety and comfort of my mother and grandfather and I wouldn’t have to be alone for another second.

But then there were the rest of the moments, the moments where being alone was the most serene, existential experience that there is. The day before I was in that train station, I had walked through Berlin early in the morning while the rest of the city slept. I found myself standing at the base of the Brandenburg Gate completely alone. Chills shot through my entire body as I embraced the magnitude of the monument and the history that surrounded that place. I learned in that moment that feeling infinitesimal and insignificant in the course of time also has the ability to make you feel powerful and untouchable.


So with that memory in mind, I got on the train to Prague. To this day I believe that was one of the best decisions I have ever made.

After that moment, I went on to meet people who were also out there on their own, and suddenly being together in our aloneness made us not feel so alone.

In the end, I loved it. I felt empowered and liberated! “I don’t need no man” (insert sassy finger waving).

So I decided to go again.

This trip was different in a lot of ways. One of which was that it was over Christmas: A holiday famously known for spending time with family, and I was leaving mine behind (not because I don’t love my family, but because it was literally the only 2 weeks I have off all year). Because of this, there were less solo travelers for me to meet and I experienced intermittent feelings of homesickness over the holiday.

In many ways I went though the same emotions as the first trip. There were moments that I LOVED it, and moments that I sat on park benches in near tears because I felt so lonely.

But this trip was also different, in that I learned a very different lesson from it.

What I learned on my first trip is that I CAN do it alone – what I learned in this one was that I don’t necessarily want to.

I think that’s a scary thing for women (or anyone) to say: I don’t want to be alone.

I’ve always seen that desire to be a point of weakness. Like if I want to be in a relationship that somehow makes me pathetic and desperate. Instead I should desire to be alone, and if I end up NOT alone – eh, I’ll be happy too.

But perhaps, admitting to yourself that you want a partner to do life with isn’t a weakness. Perhaps this honesty with yourself actually requires significant strength.

After my first trip I told everyone I saw that they MUST travel alone at some point. I certainly have not changed my mind of that. I believe that simply possessing the knowledge that you have the ability to do things on your own is priceless, even if you are in a relationship (besides I have learned so many other valuable lessons and grown in numerous ways from traveling alone, so I think it’s just generally a good idea).

Especially as women, we need experiences that bring out our inner Viking Warrior Princess. I don’t know if it does it for everyone, but traveling alone certainly channels mine 😉 I also find that I am more purely myself when I travel on my own and it bleeds into my life even after I have come back to reality. I am less likely do go along with things I don’t like or worry about what people will think of me if I disagree with them after I have been spending time channeling my Viking Warrior Princess self.

Yes, I can, and will, do life “on my own” if I have to. I will definitely not stop traveling or living my life just because I don’t have a significant other at the moment. But that doesn’t mean I have to DESIRE to always be “alone”.

I can be a strong, independent, powerful woman while also acknowledging the desire in my heart for a deeper connection and relationship.

I’m sure you all probably figured that out years ago, but what can I say – I’m a little delayed in the whole relationship area 😉



**disclaimer: I wrote most of this before I got o Sydney, where I met some INCREDIBLE people and enjoyed the comradery of fellow travelers leaving home for the holidays. It definitely changed the perception of my trip a bit from what’s above, but I still thought what I wrote was important, so I’m posting it anyways 😉