It's hard to explain to someone who's never seen an operation what it means to be a resident in the OR. Many people think an operation as a gigantic, single breath-holding spell that requires mental discipline and sadistic love for asphyxiation. A lot of laypeople have given me a sort of half-scared, half-incredulous look when I tell them I'm a surgical resident.

"But you don't actually, uh, operate on people, do you? Don't you need training to do that?"

Well, um, yeah. That's sort of what I'm doing now. Training to be a surgeon.

"But like, you're training. So you just assist or watch the surgery, right? You don't actually do the operation...do you?"

In reality, an operation consists of many parts and multiple steps. When you first start out, you master the simple steps -- handling a scalpel, sewing up skin, etc. Then you progress to more advanced maneuvers -- tying vessels, dissecting tissue planes, anastomosing bowel -- until, eventually and theoretically, you've learned enough to go through an entire case by yourself.

At least, that's the way it's supposed to work. Sometimes (or perhaps many times) being a surgical resident involves about as much coordination and physical dexterity as a sea cucumber. For instance, last night I had the (ahem) privilege of being involved in a midnight emergency revascularization of a critically ischemic leg (popliteal-distal peroneal reversed interposition saphenous vein graft). Because of my position at the operating table, I could see nothing of the operating field. I did nothing during the case except stand awkwardly holding a suction cannula. Occasionally the surgeon would order me to "Suck! Suck!" at which point I would try to suck up some of the blood around his 7-0 Prolene vascular anastomosis. This would lead to "You're not sucking in the right place!" to which I wanted to respond "But I can't see where I'm supposed to be sucking!"

The correct response, however, is "Yes, sir. I'm sorry, sir. I'll suck better, sir." (Don't we all wish we could suck better...)

More than teaching me about the art of operating, I think surgery residency has given me a higher sense of humility and humiliation. There are so many times I wish I could talk back to my attendings, but the hierarchy of academics prevents me from doing so (though there's nothing that prevents any attending from getting verbally frustrated at me). In a sense, I suppose this has taught me something useful -- I've learned to bite my tongue, hold my opinions, and bury my anger. In return, I developed a generous inferiority complex and a bounteous reservoir of emotional rankling and stress.

I'm not sure how residents get over this sense of dourness. Some of them, I suppose, never do, and they become the frustrated, impatient, and ill-tempered surgical attendings that propagate this Halsteadian tradition. One day I hope not to become like that, but I don't really know how to get from here to there.