Anyone else want to kick the snot out of me?

I've decided that being a medical student is all about having the snot kicked out of you repeatedly. Today I was at the hospital in the operating room, and thanks to a harsh lesson learned last week, I was wearing running shoes instead of high heels. I had also come prepared with lunch and plenty of water and a vow to take a pee break when I needed it, not when my bladder exploded.
I wasn't prepared for the fact that most of the surgeries of the day involved live X-rays used to guide wires into the heart, and that meant I would have to wear a 30-lb lead skirt and shirt for the whole day. But that wasn't the worst of it. Oh, no. I didn't realize that as a first year medical student I was indeed the lowest man on the totem pole and that my life wasn't worth crap.
It started in the morning with the fourth year medical student. He put an ECG in front of me. "I'm going to pimp you." He said matter-of-factly. "What can you tell me about this man's cardiac function from his ECG?"
"Well, the rate and rhythm." I began.
"What is the rate?" He covered the numbers at the top of the page.
I suddenly realized then that I had no idea how to count the rate on an ECG strip- I had always just looked at the automatic printout at the top of the page.
"You're going to have to help me with this one." I said.
He kindly explained an easy trick for counting the rate.
"Now what about the axis of injury?"
Axis of injury? Vague recollections from my textbook readings swirled around in my mind, but I couldn't make any sense of them. I think he sensed I had no clue, so he explained it to me again. I followed him dumbly to the patient's bed and stood there like a smiling idiot while he questioned the patient.
Back in the operating room the anesthetist was hurriedly working through some unusual lab values.
"What do you give for hyperkalemia?" He demanded of me, seeing me standing there.
"Magnesium?" I said. (Why I said that, I really have no idea.)
"Bicarb!" He snapped back at me. "Don't you remember the Henderson-Hasselbach equation?"
Oh, right. The Henderson-Hasselbach equation, just like the Schroedinger equation, just like the Fibonacci sequence and the square root of 6,543. How could I have forgotten? He didn't give me a chance to collect my dignity.
"Why is hypokalemia a problem?"
I started to break out into a cold sweat. "Potassium stimulates the depolarization of the ventricles. Without adequate potassium there is no depolarization and it leads to cardiac failure. Hyperkalemia leads to over-stimulation of the ventricles...."
I glanced at the nurse next to me to see if she would give me an encouraging nod meaning I was right. The anesthetist gave a little grunt and walked away, and with a huge flood of relief I realized I'd answered the question correctly.
In the afternoon I begged the surgeon to let me scrub in and assist.
"You're the low man on the totem pole." He told me. "The other student is ahead of you so he has first dibs. Good luck."
Later between patients I ran to catch up with the surgeon as he strode down the hall.
"Please, Dr. K." I said. "I'd really like to scrub in and assist. I just want to help suture. I've sutured before."
"You can scrub in on the last case." He said without looking at me.
I actually skipped down the hall and clapped my hands. Outside the OR I waited until he had started to scrub and just copied his technique, to make sure I was doing it right. The nurses helped me into my sterile gown and gloves and I took my place at the operating table.
"Hold this." Dr. K ordered, handing me a retractor.
I pulled the skin of the incision back and held it faithfully until my arm began to cramp. He turned to me after several long minutes and I was still holding it. The anesthetist started to laugh.
"Good job."
"Why are you putting that stitch there?" I asked about a silk thread he was looping around a vein.
"To stop the bleeding, of course." He shot back. "That's the second time you've asked me that. Isn't that what all stitches are for, to stop the bleeding?"
"Yes sir." I said. A bit of my energizer-bunny mood had evaporated.
"Cut this thread." He ordered.
I grabbed the scissors and went for the knot.
"Not like that!" He shouted. "You can't hold the scissors like that! You have no control. Don't wave the tip around."
He smirked at the anesthetist. "Only guys are allowed to wave their tips around."
I could feel myself turning red under my mask as they laughed. This time when I went in with the scissors I held them properly, but I had to work to keep my hand from shaking.
A few minutes later the anesthetist pointed to the X-ray screen. "What are those two round circles?" He asked me.
I stared blankly at the screen and saw the two symmetrical dark circles over the chest. It took me a long pause but then I realized what they were.
"Those are the snaps on her gown." I answered.
Everybody laughed, but the anesthetist sounded disappointed that I'd got it right.
Towards the end of the surgery Dr. K handed me a needle clamped between a pair of snaps (scissors that grip things, basically).
"All right, put two stitches here and then follow the line down." He ordered.
I moved towards the skin, trying to untwist the needle held awkwardly between my snaps and pickups (tweezers).
"Don't hold them like chopsticks!" He said sharply. "There, you've got your needle in the wrong position. Where have you sutured before?"
"In Africa." I said honestly. "I stitched someone's head closed that was gashed open."
"That's completely different." Dr. K said, sounding a little annoyed. "No, you're going through the wrong layer of tissue there. Take out the stitch and start again."
"Yes sir."
"You need to practice this first. Maybe in the ER when it doesn't matter so much. Here, you have to hold the needle at a 2/3-1/3 angle. Not like that. Closer to the surface. Not like that."
I tried a different angle.
"Not like that."
I tried again.
"No, not like that."
I tried again.
"No. Here, let me do it."
Well, I put in 6 stitches but 2 didn't count because he took them out and redid them himself. By the time I got around to finishing up the incision with steri-strips and uncovering the patient and de-gowning, I felt completely deflated. Dr. K just glared at me when I cheerily said goodbye.
I wound my way through the semi-deserted hallways to the change room and sat down on a bench, still in my scrubs and shoe covers. The room was empty and outside I could see it was raining and I felt my eyes welling up with tears. I couldn't even get a couple of stitches in properly. I couldn't read an ECG. I didn't know what to give for hyperkalemia. And a hundred other questions I'd been asked today and a hundred other rude or sexist jokes that were at my expense. I felt out of place in this world of tall, intelligent, male doctors who didn't have to stand on their toes to see what was going on. I'm sort of embarrassed to admit I cried.
The other day I read this quote of Winston Churchill, that I hadn't paid much attention to at the time but now as I stared out the window at the rain it came back to me.
Success consists of going from one failure to another failure without a loss of enthusiasm.
I'm home from work now and everything smells like latex and rubbing alcohol. My shoulders ache from that lead apron and I have a bag full of suture kits that one of the nurses sent home for me to practice with. I'm trying to decide which is more like human tissue- raw chicken or grapefruit peel? I've got about four hundred pages to memorize this week and somehow I have to learn how to interpret a chest X-ray and memorize what the pathways for alcohol metabolism in the liver look like.
I'd like to give up. But I can't. Winston Churchill gives me hope. He went from failure to failure, and one day he overcame. All I can say is, does anyone else want to kick the snot out of me? Now's your chance. I'm a medical student, after all. But I'm also an overcomer. And I'm not going to lose my enthusiasm. I'll stay up all night with my sutures, if I have to, but next time I'm in the OR with Dr. K again I'm going to ask him to let me scrub in again. And I'm going to make darn sure I keep my scissor tips from waving around.