Surgery and the Blowfish

Ben Bryner -- I like talking about medical school with people who are in different programs or careers. I like explaining what it is I want to do and what I’m studying, and I like hearing about what other people are into. But when people who are less familiar with medical training ask me how long my upcoming residency is going to be, the answer (seven years of general surgery residency including two years of research, followed by two more years of fellowship) often makes their eyes glaze over. And rightly so; it's a long haul. But it’s not like my law school friends are going to be taking the lead in litigating right out of law school. (At least I hope not.)

True, medical training is more formal and longer than that for any other gig I can think of. But in some ways it's hard to believe that that's all the time there is. Especially when you compare the length of surgery residency to things like the two-or-three-year apprenticeship required to serve fugu. (Fugu, the infamous pufferfish that carries the potent tetrodotoxin in most of its organs, is a delicacy in Japan; you can get it at a few elite, licensed restaurants in the States that, by law, must import it all through New York City.) It has to be prepared just so, with the right organs taken out and meticulous avoidance of contamination. If it's done right, you get a delicious meal. If not, you go into respiratory failure and die unless supportive measures are instituted in time (there is no antidote).

High stakes -- hence a two-or-three year training period capped by rigorous examinations. And that's just to learn one procedure, the proper disassembly of a fish. By the time a general surgery residency program graduates one if its trainees, it's certifying that the newly-minted surgeon can safely perform all kinds of procedures, in addition to management of patients before and after operating. The range of skills expected from a new surgeon, or internist, or pediatrician, is astounding even given the length of training.

I remember one time listening to an ER attending explain that although he learned a fair amount in residency, the time when he learned the most was when he was an attending for the first time. He had a lot more time to stop and think about what he was doing, for one, due to the nature of the ER as an attending. But it was also because the new responsibility was a strong motivator for learning, as well as a new perspective. He said he was also fortunate enough to have a good department chair who taught him a lot. This made an impression, since at that point I was pretty new in med school and hadn't really grasped the constant process of learning that is involved in clinical medicine. But it makes sense.

Medicine is so overwhelmingly complex and changes every day; unlike the anatomy of the blowfish, it can never be comprehensively mastered. This continuous growth leads to the large number of subspecialties required to adequately cover all the diagnostic and therapeutic angles of modern medicine, as well as the need for constant learning and teaching by one’s peers. To me, the prospect of continuous learning in a medical career is still exciting -- even more exciting than eating a potentially deadly piece of sashimi.