Throughout my sister’s pregnancy, we emailed and phoned regularly, discussing glucose tolerance tests, car seats, breastfeeding, and hemorrhoids. I interpreted ultrasound images for her and explained what labor contractions would feel like. When the baby became breech, I assured her that a Cesarean section was the safest way to go.
On the day my sister scheduled her c-section, I met her doctor for the first time. I was faced with a tricky question. Do I announce that I’m an OB/GYN, or do I let this well-established, competent doctor do his job without my interference? I stood quietly in the back of the room as my sister’s obstetrician counseled her on much of what I had told her the night before.
The day of surgery, my only task was to carry a backpack of my sister’s things and wait. I have lived and eaten and slept in hospitals for 6 years, but walking those familiar hallways as a patient’s family member was surprisingly disorienting. Hospitals are places where I generally feel in control, and here I was, knowledgeable yet powerless. Sitting by the window, I made mental notes about the facility, the names and jobs of every person who came into the room, and whether or not staff washed their hands – just to satisfy myself that everything was up to standard.
When a friendly, enthusiastic resident introduced herself as someone who would be “assisting” during the c-section, my brain went into overdrive. I wanted to ask the resident what training year she was, and anxiously searched her ID badge for clues. Should I suggest to my sister that no interns be involved in her surgery? Would my sister get better care if they knew I was an OB/GYN, or would that unnecessarily complicate the issue? This was a teaching hospital afterall.
I thought about the times my fellow residents and I whispered behind the backs of patients who demanded ‘special treatment,’ i.e. no students or residents in their rooms. “Then, why did they come to a teaching hospital?” we’d ask. They clearly didn’t appreciate that the residents are the ones who run the floor, put in the orders, kept an eye on the vital signs, and made it possible for the attending to do the surgeries.
With deep resignation, I forced myself to go with the flow. I sat on my hands and bit my tongue when the nurse failed to get the IV into my sister’s plump veins. I scrutinized the fetal monitor; contemplated the anesthesiologist’s overview of pain management; hovered over the family practice resident who did an ultrasound to double-check the baby’s position; and yes, took a peek at the orders in the chart when the nurse left the room. When I stepped off of the elevator to go to the family waiting room while my sister went to surgery, I squeezed her hand and told her that she’ll be fine; there was nothing to worry about.
For what seemed like forever, I paced the waiting room. I googled the residency program and tried to assess if the residents were above average. I googled my sister’s doctor…again. I listened intently for overhead announcements calling for additional staff to help with an obstetric emergency. I imagined what was happening to my sister: sitting up for regional anesthesia, lying down, being draped, being cut, baby emerging from the abdomen. I would never know whose hand made the incisions, the attending’s or the resident’s. But, did it matter?
I was an intern once. I too fought to legitimize the “M.D.” after my name in front of skeptical patients, behaving more confidently than I truly felt. I used vague phrases like ‘assist the attending’ when I knew I was doing the cutting. I learned to not take it personally when a patient, usually someone with connections to the health care world, asked that no residents be involved. I had added respect for the more senior doctors that stood up for my education.
People don’t have to seek care at teaching hospitals. There are private community hospitals that have no trainees in-house. In those generally smaller facilities, the nurses would directly call your doctor and take orders over the phone or if more serious, your doctor would come in to see you. These facilities tend to be less resourced and do fewer surgical cases.
At teaching hospitals, residents are present 24 hours a day. The more junior residents are essentially ancillary staff, while more senior residents are often licensed physicians who can manage most clinical situations, but defer to the attending for the big decisions. Teaching hospitals have full doctor and nurse staffing at all times, and do more cases and more difficult cases. They are better prepared for serious complications.
The reality is, surgery is a collaborative endeavor that requires a primary surgeon, but also a surgical assistant, nurses, technicians, anesthesiologists, up-to-date equipment, and a well-stocked blood bank. For the surgeon, experience is key, but age or number of years in the OR is not necessarily the best marker for skill. After the initial learning curve, other things like innate fine motor control, hand-eye coordination, grasp of anatomy, leadership ability under stress, maintaining high surgical volume, and staying abreast of medical advances probably play bigger roles. The knowledge of a senior physician combined with the younger eyes and hands of a junior physician may be an optimal scenario. Ultimately, the surgeon is just one member of an interdisciplinary lineup.
I breathed a sigh of relief when I saw my sister with the baby in her arms, coming back down the hallway, exactly one hour later. Given the short operative time, I concluded that either the attending or a senior resident had done the surgery. But again, did it matter? Everyone was smiling, and I finally started to relax. I gave myself away soon after by reflexively checking the urine output and asking for the baby’s Apgar scores.
I learned something that day about myself. When push comes to shove, when the situation isn’t just professional but deeply personal, I trust the system that trained me. Quality care and education are synergistic. I’m willing to bet my and my family’s health on it.