As A Doctor, What Harsh Truth Did You Learn From Your First Year Practicing Medicine?

This question was originally posted on Quora.com and was answered by Lacy Windham, studied at University of Tennessee Health Science Center



You are not as much of a badass as you thought you were.

The very first total laparoscopic hysterectomy ever performed at Sentara Norfolk General Hospital wasn’t performed by an attending. It was performed by me, a second-year resident along my fourth year chief.

He and I had just come from the Gyn Oncology service at the nearby Catholic hospital where we had assisted on this procedure along with our attending on a daily basis. We felt like we knew this procedure inside and out, and we convinced our attending to let us try it.

It was a success, and we replicated it multiple times.

That same year I was assigned to assist one of the private gynecologists at the Catholic hospital, and she was initially disappointed to realize she had been given a second-year resident instead of the chief. But it was a total laparoscopic hysterectomy, a procedure she herself was just learning, and the procedure I knew inside and out, and a few minutes into it she leaned over and whispered “you’re making me look bad”. She always welcomed me into her OR from that day forward.

By my third and fourth years I had made a name for myself at both hospitals with laparoscopy. In the middle of one night, while taking a patient with a ruptured ectopic to the OR, the anesthesiologist leaned over when I entered the operating room and said “I’m so glad you’re here.” She had been worried, because my attending that night was a maternal fetal medicine specialist who did not normally perform laparoscopy.

I had drifted past ‘confident’ and was working my way well into ‘cocky’. You want a confident surgeon. You do not want a cocky one.

Before I knew it, I was on my own in private practice.

On one of my first calls, I had to call a C-section. In residency, a typical C-section involves no fewer than three physicians. There’s an attending, and one or two residents. I work at a community hospital. We don’t have residents. I didn’t have a surgical assistant either. Standing across from me in the OR was a labor and delivery nurse. I hadn’t realized until just that moment, that the labor and delivery nurses helped with the C-sections at my hospital.

It hit me at that moment.

I was all alone.

I was the only person in my entire hospital (at that moment) with the ability to perform that C-section. I was the person most responsible for taking care of my patient and her baby.

On my operating days I again felt the weight of my responsibility toward the patient. I found myself at every point choosing the safest possible option. In residency, for laparoscopy, I mostly performed direct insertions of the first trocar. Now that I was in private practice, I found myself performing the Hassan technique, more annoying and time-consuming but least likely to result in a major vascular injury.

I asked my partners for help a handful of times that year.

One night, after a simple primary cesarean, I had to take my patient back to the operating room for abdominal bleeding. The bleeding was coming from the right side of the uterine incision from the uterine artery. She had been hemostatic when I closed her abdomen earlier that day. It was the kind of freak thing most likely to happen to you in your first year of practice, not necessarily the result of any poor technique, but it bothered me.

I was feeling a little bummed out about this new version of myself, to be honest.

One night around 3 o’clock in the morning, I was dealing with a preterm patient who was abrupting. I was worried about her and her baby, but I was working the problem.

As I walked out of her room, the older charge nurse that night laughed and said “Dr. Windham, does anything ever rattle you?”

I actually was rattled, but suddenly I realized that no one could tell. Maybe that was real confidence, the ability to feel the danger underlying the situation rather than being oblivious, and the ability to keep calmly working the problem anyway.

Eight years later, I am far more skilled and knowledgeable than I was in residency. 10 years from now, I hope to be even more so. I am confident, but it’s a confidence that comes from experience instead of a misplaced one.

But I’ll never be cocky again.

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