A memory of New York-doing what you say

from wilkipedia First World Trade Center Bombinh

As many of my readers may know I trained in New York City , Manhattan in fact, capital of cosmetic surgery for most of the century ( other then LA and even earlier Switzerland ) to some degree. I was in that town, for approximately 8 years. There before I did plastic surgery I completed a general surgery residency. What you may be surprised to hear was that I was actually the Chief Trauma Resident in general surgery at New York University Downtown Hospital the day that they attempted to blow up the world trade center the first time. I will never forget that day.

In those days the general surgery residents and interns were at the Hospital 36 hours at time. As chief I would come in at 6am and get off the next day typically at 6pm. then I would sleep till the next morning and then do it again in a never ending cycle. One thing you learned in New York  was how to get things done, sometimes in what appeared to be impossible circumstances. As example we would see 40 patients in less than in hour  because the trauma team would be so much like a finely tuned instrument that it was possible because each team member would do their job OR they would be kicked out of the program. It was called a pyramid program in general surgery there. The reason is there would be I think 12 interns starting and as each year of training progressed they would eliminate based on host of factors a few until the final 5th year and ou became chief resident there were only 3 as I recall. What happen to the others , well many never became surgeons. It was hard work and you had to have certain instincts to survive. Same when I was with 20th special forces group , US Army you learned how to survive or you were out.

Sorry about the side track but I was concentrating on “getting the job done”. So many times I see people who cannot seem to get the job done. They say this and that and live in a dream world. I am sure you have seen them. “I will go to gym and lose ten lbs” of course the next day they are Baskin Robins eating ice creme. Yet that only hurts themselves. What really gets me are those who make promises to others and never do what they say. In my surgery residency that was what usually why people were eliminated in the program and never advanced. It was usually nothing to do with being a “bad surgeon” it had to do with reliability. As example , if an intern told you he would have the lab result on certain patient when the team made rounds on the 40 patients the team better have those results when the team saw the patient.  So picture this, 20 doctors and medical students rapidly going from room to room and standing out side the door. The interns would read the results of the test to rest of the team. The chief resident would make some teaching point to the others about the patient and they would then enter the room. Once inside the Chief resident and others examine the patient. Then the Chief or senior resident would tell the team the plan—Get a Upper GI scope today and we will see the results by tomorrow and decide this or that. Understand this process would take less than a minute. Yet it all depended on the one intern who would tell the team what the results were of the test he was suppose to get. If he or she failed at that job the process stopped and the team become a fumbling side show. Instead of one minute, it became a distaster. The chief would not say “ok bring me that later”. He had no time for that. He needed the results then to make the plan for the day. The team had 39 patients more to see in an hour. So as you can see after a few times like that it became evident who should stay and go to top of the pyramid and who should leave the program.

So that is how a pyramid works for surgeons, its not the brightest or smartest or the best surgical hands who wins. Its the man or woman who is reliable because every one is smart , everyone can handle suturing and cutting. It boils down to one thing. The ones who do what they say are of value and the ones who do not are eliminated. Cruel but true. It also produces the best people to be your surgeon. After last weeks blog I started thinking about this. I met and had a great time with a Nobel Laureate. He was a down to earth guy, very smart, and educated but there are many people who are like him I know in terms of intelligence. In fact I can think of two people in my life that very well may be smarter than him and I know they are smarter than me. Yet they do not win a Noble prize. In fact they are both relatively unaccomplished individuals , and the reason is they do not do what they say they will do. So I think that must be the key more so than intelligence.

As for me, I really try to do what I say I am going to do. Sometimes it impossible but in general I really do my best and most of the time I am able. I hope I do not dissapoint to many people. Although it happens I am sure at least I was able to be a surgeon.

Until next time

doctor808