They Can't Stop the Clock.

Abstract

They Can’t Stop the Clock Amy Stewart Starting surgical residency was a dream come true. I had a vision of residency where we would work as a team and learn from engaged senior residents and faculty. I would work hard but be rewarded with increasing responsibility, knowledge, and respect. My residency class was three women; 100% women! We met before orientation and became fast friends. Then reality hit for all of us. Day 1: ‘1 in 3 women drop out of surgery. Which one of you will drop out?’ was the welcome we received from a male senior resident, ‘You aren’t women here, you are surgeons,’ and ‘I better not see any pink around here,’ said others. I thought it was an initiation and laughed it off. This could not be real, but it was. From the very first week, most of the senior residents treated us like unwanted stepchildren who could do nothing right. Mistakes were not tolerated. I was on my own as soon as orientation was over. There was no constructive criticism or education, just berating and public embarrassment. One senior resident would anonymously textpage with a list of missing orders or other perceived missteps from call. Others would wait until rounds with the attending to ask about missing information, as to embarrass us directly in front of the faculty. This was counter to what I had seen in my medical school rotations, where senior residents would shield junior residents and give support should the intern falter. We were expected to know everything without instruction. Information only moved uphill, so as interns we were the last to know but the first to be blamed. It would have been more helpful to discuss why an order was needed or why a different decision would have been better. I quite clearly remember, as an intern, caring for a traumatic subdural patient on a blood thinning medication who needed rapid medication reversal. I was alone in the emergency room caring for this patient when the nurse said she could not run the blood product needed to reverse the medication as fast as I requested. In my inexperience, I believed her. When the patient decompensated a short time later, I called my senior for help. They were furious that I had not managed the patient properly. With some mentoring or a more welcoming environment, I may have had the knowledge needed to push the nurse for faster administration, or would have been able to reach out sooner to my senior for advice. Instead the patient died. “Call me if you need me, but you better need me if you call,” was a common refrain. The chief [End Page E5] residents were only seen if there was an operative case or if their favorite faculty were rounding. The mid-levels were only available if you needed to be supervised, which was accompanied with comments such as ‘I can’t believe you’re not signed off on this yet.’ Otherwise, you were on your own to cover; consults, floor patients, notes, orders, call faculty or consultants, and overnight coverage of four general surgical services, cardiothoracic surgery, trauma, vascular, and neurosurgery. Additionally, we were responsible for a full lineup of cases every day, even post call. Never mention duty hours—it made you look weak. We would regularly be called into the office to “correct” our duty hour sheet to get the numbers under the required 80 hours per week. This bothered me because, even though I only logged my hours from the public schedule and not what I actually worked, I was scheduled for more than 80 hours a week. I was already bending the rules by not logging my actual hours worked, now they wanted me to go even further and log less than I was scheduled. We stayed until the work was done, usually late, despite our duty-hour logs that said we left promptly on time. These heavy schedules and late nights caused issues for our home life. During our five years of training, there was one new baby, three weddings, and two divorces between the three of us. I had a school-aged child. There was...