Tuesday, March 23, 2010

Making of a Surgeon--Intro & chapter 1

From "Making of a Surgeon" - You need at least 1 response to receive credit for blogging - ideally you can respond to other posts and create a dialog with your classmates.

Would you have chosen a hospital similar to Bellevue or a “white-tower” hospital in the suburbs?


  1. Hmmmm...This is a difficult question that poses a sort of moral dilemma, at least for me. I love to challenge myself (like the protagonist of our story), and a hospital like Bellevue would certainly provide a sufficient challenge. However, the lax sanitary methods that seem to be employed at Bellevue (like using the syringe/needle multiple times) seems like it would be a hazard to the patient. I know that Bellevue does not have the same resources as a “white tower” hospital in the suburbs, but they also seem to no care as much about the patients (a sentiment illustrated by the doctors (whose name escapes me at the moment) who was completely disenchanted with his work). The staff seemed at bit detached, and I think it is unwise for interns to be performing medical procedures (without the guiding presence of someone more experienced) that they have never executed before. Whereas, at a “white tower” hospital, I still believe there are challenges. It is not as if brain surgery is all of a sudden “easy” at a nice hospital and difficult only at a place like Bellevue. The procedures are just as challenging at any “white tower” hospital, and yet the resources exist so that you can feel you did everything you could for every patient, rather than feeling like you could have saved someone’s life, had you only been given the time and resources. So, I truly believe that being a surgeon is a challenge wherever you go, and if I had a choice, my preference would be for a “white tower” hospital, because then I would know that I gave as much as I possibly could to the patient.

  2. The problem is that if you go to a "white tower" hospital, you're considered a pansy or a spoiled person because you took the cleaner and easier way, where there would be challange, sure, but not nearly as much. Personally, I think I'd end up going to a white tower simply because I'd be scared of Bellevue and it's lack of resources. I'd be worried that if I botched something up, it could definitely lead to BAD (aka death). So even though the white-towers are spoiled, I'd probably head there, much for the same reason Brett says.

  3. I believe that the answer to this question lies with some perspective. If I knew that all my life I would want to serve the rich and be a doctor with no lack of materials, I would go over to a white tower hospital. But, if I were a graduating med student, I would need to think realistically about exactly how I can contribute to the world. Spending $10,000 on an MRI scan only to find out the source of Joey's tummyache was that he swallowed his pet goldfish is not my idea of contributing to the world. If I were a doctor, I would want to learn how to work with as little as possible to achieve the best possible care for patients that really need it. There is a reason why Cuba lacks many modern innovations in medicine found in America, yet still has one of the best healthcare systems in the world. Their doctors learn by improvising, by creating their own solutions. Furthermore, doctors volunteering in organizations like Doctors Without Borders need to carry as little as possible with them to treat medical cases far worse than even we can imagine in an ordinary American hospital. A small Sudanian boy with 3 gunshot wounds and signs of traumatic stress disorder does not need MRI scans. With that dose of perspective, I would join the Bellevue hospital, because learning to work well with limited resources is the greatest and often most effective tool modern doctors can use.

  4. I would definitely work at a “white tower” hospital and not one like Bellevue. I completely disagree with the idea that succeeding at a hospital like Bellevue would be like climbing Mount Everest. The challenges at a white tower hospital are just as difficult, if not more challenging. The white tower hospitals have standards that they have to uphold and they are hard to get into for a reason. Working there, you know you would be working alongside the best and that means that succeeding there would truly be impressive. If you wanted to have a break form all of the equipment and the wealth then you could join Doctors Without Borders for a few years. The resources that are available at the white tower hospitals are obviously there because they are helping. Another thing is that the staff at Bellevue didn’t really seem to care about the patients and the tricks that Dr. Nolan started to pick up were things like stealing clean needles when he found them which I don’t think makes him any better of a doctor. As Brett said, there might be a situation in which the proper resources could save a life, and not having those resources would in no way make you a better doctor.

  5. Daniel Eager said:
    If I had to choose between going to a ”white tower” hospital and one similar to Bellevue, I would choose to go to a hospital similar to
    Bellevue because I would be able to help more people. Although my work would be less personal and maybe less effective (for a single patient) at a hospital like Bellevue, I would be able to reach out to more people who, if they are coming to a place like Bellevue, need my help. This exemplifies one of my beliefs about life that although doing something on a small scale is meaningful and important to those whom it directly affects; it is much more practical and effective to contribute to a larger cause. Another reason I would choose to work at a place like Bellevue is because I like to take on challenges (like going to CPS or working at a less well-off hospital), rather than taking the easy way off. Again, there is nothing wrong with
    working at a “white tower” hospital; it is just not the option for me.


  6. Choosing between these two hospitals, I would probably pick the Bellevue hospital. The work at this hospital seems to me much more challenging than the one at the "white tower" hospital because of the enormous challenges that one faces at a Bellevue-like hospital. In order to make the world a better place, I believe that one person (in this case a doctor) can start making a change in a single place, such as a hospital. When one doctor is able to promote change in such a lax atmosphere, his attitude and perseverance for change can rub off on the others doctors. More importantly, the opportunity to successfully change a bad workforce to an efficient, well-run workforce is much more personally rewarding than doing well at a "white tower" hospital.

    I do not agree with Valerie in joining Doctors Without Borders. How can a country that is so lacking in quality healthcare send their best doctors to other parts of the world? It may sound like narcissism, but I believe that before a doctor can work other parts of the world, a doctor should consider re-vamping his/her own country's healthcare system before attempting to help another country's.

    Although you cannot discredit the hard work that the doctors may put in at the "white tower" hospitals, it is not as important as the doctors that work at the Bellevue hospitals. The Bellevue hospital is accessible to more people because it is not as expensive, and the challenges presented there provide an opportunity for a doctor to prove himself.

  7. "Ah, for I have lived without health, and without harmony do I now part" Such are the words of a poor man at the end of a Chekhov short story. This peasant, this hero, did not receive adequate care and perished because of a mild illness that morphed into a dangerous disease. It is because of men like this that I would choose to work at the Bellevue hospital rather than the "white-tower" health center. The poor and needy of the world need the immediate help that a hospital can provide, and despite its shoddy sanitary conditions, the hospital would save lives and make the world a better place.
    There will always be those who choose to work in the white tower hospital. It is a simple choice, the easy choice, to leave the "dirty" work to someone else. The truth is our society is based on a capatilism that even promotes working at a white tower establishment. But through history there have been great men such as FDR, and Huey Long who advocated for the poor and made it their business to help them. They built hospitals to save the people who really matter in our society. Today, I join the great ranks of these early twentieth century legends. May their souls rest in peace, for they have changed the world and so will I.

  8. Truly a horrible detriment to posting late (besides the lost points) is that much of the things you would like said has already been said.

    So my answer to the question of Bellevue or White Tower is White Tower.

    For slightly different reasons than most people have written (if only to be original.)

    It's true what people have said before, that there are less patients in the White Tower and that you can get more intensive care there, but I would like to add something more. Death Happens. And, in every profession, I'd think especially doctors, you need a win sometimes. In the Bellevue Hospital, there's going to be a lot less of those, with some lax cleanliness conditions, and much less funding and equipment, and inevitably, more people will die.

    Human beings can only take so much failure before they get discouraged. With the equipment in Bellevue, it is inevitable that some times you don't save anyone. It's been proven by several rather inhumane tests on mice that eventually, if you've tried as hard as you can and nothing seems to work, you just stop trying. (The affliction is called Learned Helplessness) But in a white tower hospital, even if you do end up pampering the rich sometimes, there are going to inevitably be some cases that could have been painful or fatal that YOU managed to fix.

  9. Whoops, made a mistake. The tests were NOT actually on mice, but on dogs (using electric shocks) and on human babies (NOT using electric shocks.)

  10. Both Bellevue, and White tower offer many different pros and cons. Bellevue offers an environment in which resources are limited, and this is not good because it makes the handling of patients more difficult, but good because it teaches you how to work in high stress, low resource situations. White Tower however, offers an established environment in which you can focus on one patient at a time and therefore perfect your craft.

    If placed in the position, I would most likely choose White tower. I feel like f i'd just graduated from medical school and was trying to get my footing in the medical field, it would be difficult for me to deal with the high stress of the job AND the lack of resources. I know that working in a situation that is limited can be a learning experience but it is also extremely nerve wracking. As Mitchell Stated, people die in all hospitals, that is inevitable, but I would hate to have on my conscious the idea that someone died under my care because I literally couldn't do anything for them, I didn't have the resources to help. Working at White tower may be seen as taking the easy way out, and in a way it is, I would be just as dedicated I would just be in a more controlled environment. If a young, new doctor, was set to work at a place such as Bellevue they would not know how to handle themselves. I feel like in order to work at a place like Bellevue you would need to be confident in your skill, and know exactly what your strengths and weaknesses were. After a few years of working at a well situated hospital, Bellevue may be a smarter choice but not before you know what you're doing.

  11. Thank you all for your posts; I found them quite interesting, as you each had different perspectives.

    Aside from the grimy work conditions at Bellevue, my impression was that the main difference between training a White Tower hospital and training at Bellevue was one of "face-time." And I mean that in several different ways.

    1. Because Bellevue is short-handed, there will be many more opportunities to jump in and get your hands dirty, working with all sorts of patients, and you will get lots of practice in the different techniques you are learning because there are more patients to practice on.

    2. At Bellevue, the residence are expected to pick up skills quickly and be able to operate independently as soon as possible. I imagine that at a White Tower hospital where there are more specialists and doctors that residents would crawl before they walk, and walk before they run. Watching and getting extra guidance is a luxury, but for those itching to get in there and do it themselves, a White-Tower hospital might prove limiting or frustrating.

    My impression of residency thus far reminds me of teaching someone how to swim. You can show them all the techniques, have them practice lots of things on dry land, but until they get in the water and get a chance to practice the real thing, it is very difficult to know if they're any good, and impossible to tell if they're improving.
    I think Bellevue favors the "push them in after one quick demo and see what they can do" approach, expecting the residents to learn new techniques while in the water. While the White Tower hospitals spend weeks on dry-land exercises with only brief dips into the pool to check for understanding.

    Given that, although I was pretty grossed-out by the conditions described at Bellevue, and like Valerie said, a bit horrified that they had to resort to hiding resources like clean needles, I think I would personally choose to jump in and swim.

  12. Although Ms.Doering gives a compelling argument for choosing Bellevue, if I had to choose between the two I would undoubtedly choose White Tower. Interns are the next generations of doctors, and they need to be trained with the best possible practicing. An intern must learn good medical practices. If a generation of interns is raised to follow such horrifically unsanitary medical practices like at Bellevue, than what will become of the people's health. Even if a doctor while not always be working in the best possible conditions, he or she must always strive to create the best possible conditions. By having White Tower as a standard for further medical practices I would have a strong ideal to live up to, and strive to improve those conditions.Of the two, I would definitely choose White Tower

  13. Well, since I am not sure what this post should be about, and since I know that we should probably not continue the white tower vs. Bellevue debate on forever, I guess I will just talk about the reading. These last few chapters (2,3,4) have been extremely interesting, and a few topics have seemed especially striking to me. One of these topics is the lifestyle of the interns; it seems unbearable. Perhaps it is just the way he describes it, but the intern lifestyle seems really terrible. He gets almost no sleep, he is ridiculously overworked, and he must deal with some really obnoxious people. Once again, this could be just because he is in Bellevue, not a white tower hospital. However, his dedication is impressive. I knew that the lives of surgeons were not exactly relaxing, but I had no idea that their lives were so stressful. I guess that this intern process weeds out those people who will not be truly committed to the cause of helping others. The entire process certainly inspires a sense of admiration in me for these people.
    Another interesting topic I observed was the author's description of the people who were admitted to Bellevue. Most times, when I think of staying at a hospital, I cringe. A hospital stay (to me) represents illness and pain, not to mention bad food and a lack of privacy. However, the people that the author is treating are truly desperate people, and, to quote Dr. Nolen, Bellevue (which is not even close to being a white tower hospital) Bellevue represents the "height of luxury" to these people. That thought is really depressing. Most people want to avoid the hospital at all costs, and yet these people want to be admitted, even if it means that they are injured (or that they must injure themselves, as in the case of the man who reopened his own wounds). The patients at Bellevue are a sad symbol of desperation.
    And, it greatly saddened me to read that some wealthy, healthy people (like Sidney Carlton) would exploit the medical staff at Bellevue when there are truly people in need of those resources. However, it is a difficult situation, because many of the "patients" that Dr. Nolen treats are addicts who frequent the hospital for a nice dose of morphine, and take away resources from those who are really sick. Once again, the question becomes a moral issue: Who really deserves the medical resources? and When should overworked, under-staffed hospitals like Bellevue stop admitting people who really do not need the help?
    Anyway, feel free to comment, and enjoy the rest of your break!!!!!!! :)

  14. Better late than never...

    I most likely would have taken the easy way out, so to speak, by choosing a "white-tower" hospital. I have noticed that when given the choice between an easier task and a harder task that is more rewarding, I invariably choose the former. I have never had what you might call a good work ethic and it takes a heck of a lot of motivation in order to make me do something that I do not want to.

    Sure, choosing Bellevue might have been better for me in terms of building character but again, I really could not care less. Even if Bellevue would grant me a greater understanding of the medical field, I would stick with the "white-tower" hospital for the more apparent benefits like a break room or general cleanliness. Furthermore, is it really that beneficial to work at a crummy place like Bellevue? Sure, you might have to figure things out for yourself but what is wrong with getting a little help every once in a while? I am sure that doctors at the "white-tower" hospitals have to do things on their own sometimes without the guidance of an experienced teacher and though it might not happen as often as it does at Bellevue, it does still happen. It is not fair to say that all doctors at Bellevue are better and more knowledgeable or independent than all doctors at "white-tower" hospitals.

    - Collin Styles