Sunday, May 30, 2010

Playing The Game

I love surgery so much and I so badly want to match well, that I been pushing myself to do things outside my comfort zone .  Basically, I've been learning to play the game.

I've never been in any big corporate environment, in fact, I've never really been in any hierarchical system where I have to 'play the game' to get ahead.  But now I am.  And I'm getting better at it every day.   I'm not cut-throat, or anything, but I am starting to recognize the chain of events that will lead to my success and where I can intervene.  Let me explain.

     Goal: Get into an AWESOME residency for surgery
     To do that, I need to have great letters of recommendation from the top surgeons in our program
     To do that, I need to (1) spend time with them in the OR, (2) get them to talk with me, and (3) get them to see how brilliant I am.

(1) How To Get Into The OR-  I'm on surgery, so this should be easy, right?  Wrong.  There are one or two attendings that I need to spend time with and get letters from, and they are the same attendings that EVERY medical student going into surgery is vying for OR time with.  Here's how I've 'played the game'- I look ahead in the OR schedule and find out when these attendings are going to have big cases (2+ hours, more extensive surgeries= more time to talk and more interesting things to talk about).  Then I 'kindly' offer to  the other medical student that they can take the small really cool cases that the doc is doing this week.  And then the next week rolls around and, "O look at that, I guess it's only fair for me to go to the OR with that doctor, since you went last week".  O looky there- it's an awesome, huge case that I have been studying about for a whole week now.  This may seem a little cut-throat, but I figure that if any other med student wanted this as bad as I do, then they would be playing the game too.

(2) How To Get Them To Talk To Me-   Also should be easy, right? Wrong.  Most of the attendings aren't interested in talking about the surgery that they are doing while they are doing it.  They want to talk about sports and politics.  And if I can't keep up with those conversations, I fade into the background of the OR and no one notices me.  So I've learned which attendings follow which sports.  Dr. A cares a ton about the hockey playoffs.  Dr. B watches every Red Sox game.  So I know that I'm better off looking up the score from the night before than looking up the patient's hemoglobin if I have 10 minutes before the case.  Danny has been my personal savior for sports advice.  He'll give be a briefing any time of day on reasonable things to say.  My fallback is to make generic comments like,  "Well, look at what happened last year...."  because there's always something that happened last year that semi-relates to whatever they're talking about and normally someone else can fill in all the details.  I'm sure this will bite me in the butt sometime soon, but for now it has worked just fine.

(3) How To Get Them To See How Brilliant I Am- The hardest task of all.  I can't just start rambling off the details of GI track physiology in the middle of a case.  And it's harder than you would think to ask good questions that show how smart I am.  Very rarely, an attending will ask me questions that give me a chance to show off a little; but this is a rare occurrence.  The best trick that I've come up with, is to get the resident in the case on my side beforehand.  The residents on my team really do like me and want me to do well, so I've let them know which attendings I am trying to impress.  Then, when we are in the OR with that attending, they will set me up to show off a little.  They'll just casually ask me about a patient that I saw that morning, "Laura, did you see that Ms. C's creatinine was up this morning?"  And then I'll be like, "I did see that.  I'm thinking that it's secondary to her dehydration because her BUN/Cr ratio is up too, and increasing her IV fluids to 200cc/hr should resolve it.  But I can't rule out ATN, so I ordered a urine electrolye study so that I can calculate her FeNa."  And we keep that up for an hour or so, and suddenly I'm looking brilliant.  Sweet.

I think that 'playing the game' is one of the most important skills that I have learned on my Sub-I.  It's outside my comfort zone to be so calculated in my actions, but it's good to go outside my comfort zone every so often.  And I think I'm going to get some awesome letters of recommendation.


  1. I FREAKING LOVE YOU. I'm just in high school, but i know exactly what I want, and now you have shown me how to get there.

  2. You will use these skills for the rest of your life. There is always someone standing in your path that can help/hurt your cause. Worthwhile investment to turn them into your fans.

    Regarding #2 - why do you think I took up golf? :-)