“The Choice” – Annie Wang (1T8)
Author’s Note: When I first submitted this piece to ArtBeat, I asked the ArtBeat Team to feature it anonymously. As a first-year student entering this new world of medicine — a world that perhaps had unwritten rules and unspoken codes I didn’t yet know about — I was afraid a piece like this would haunt me later down my career. However, I changed my mind after speaking to a wise friend of mine. She told me she believes that for a piece of writing to have accountability and integrity, the writer should be named. There could be no credence if the writer can’t even stand behind their own stance. So, here I am, standing behind my stance.
As I walked through the double sliding doors, I tried to inconspicuously smooth out my scrubs for the last time. The nurse at the front desk eyed my bright-orange “Observer” badge and smiled at me, the cool, professional smile of a veteran. “You need a mask,” she pointed to a box in the corner, “You must wear it at all times while you’re in the OR.” I nodded, and quickly grabbed one from the pile.
She led me down the hallway, her steps quick and silent as her black clogs grazed the floor. We arrived at OR 11, where the surgeon I was shadowing for the afternoon, Dr. X, was operating. The surgery started three hours ago, she told me, it’s a major surgery and will probably go well into the night. My stomach did a little flip at my luck – a major surgery! I thanked her and tried not to look too ecstatic as I donned on my mask.
I walked into the OR and introduced myself as a first year medical student. The patient was lying at the centre of the room, his body draped in sterile blue. In the harsh surgical light, I could see his chest slowly rising and falling. Dr. X, his fellow Dr. Y, and his resident were all huddled around the patient, their eyes focused and alert. The scrub nurse stood close by, her hands hovering over the instrument table like hawks ready to swoop down onto a prey. The anesthesiologist, surrounded by beeping machines, and circulating nurse, situated by the supply cabinets, both nodded at me from across the room. I took a position by the foot of the patient, and tried to stand still.
This was not my first time in the OR, yet I could not contain my marvel as I watched the surgery proceed. An hour went by; Dr. X passed the scalpel over to his fellow Dr. Y and told him to continue. At first, everything went on as before. While Dr. X watched, Dr. Y delicately moved some tissue out of the way to gain access underneath. The resident held a protractor steadily in each hand, his body perfectly still. Light tapping rang from the instrument table as the scrub nurse switched one clamp for another. Overhead, faint music played from the radio.
“What the hell do you think you’re doing?” Dr. X demanded suddenly. His voice was barely audible behind his surgical mask, yet his words sliced through the room like a hot knife.
“I’m isolating the tissue sir.” Replied Dr. Y, his hands were frozen in space.
“No, you’re destroying it!” Said Dr. X sharply. I heard him swear. I could feel the entire OR tense up – I tensed up.
“I don’t care if you’re sorry. I want you to stop destroying my tissue!”
The surgery continued, but Dr. X’s reprimands didn’t stop. For the next four hours, he not only berated Dr. Y’s surgical competence, but also questioned whether Dr. Y was deserving of his spot in the fellowship program. I stood there, my feet rooted to the ground and my jaw clenched. I didn’t dare to move. Dr. Y either quietly apologized or was silent entirely. I was silent too. The resident, the scrub nurse, the circulating nurse, and the anaesthesiologist: we were all silent. At one point, the resident caught my eye, and raised his eyebrows at me. I raised my eyebrows back at him. Still, I did nothing.
That night, with my scrubs stowed away in my backpack, I walked home in the dark. I thought of just a week earlier, we were asked in class to reflect on our biggest fears for clerkship. I wrote down that I was afraid of feeling powerless within the hierarchical nature of the hospital. I was afraid that I will see a superior’s actions cause lapses in patient care, and not be able to speak up. I was afraid that under an environment of learned helplessness, I will become a cynic and forget the reasons that led me to choose to become a doctor in the first place.
I don’t know if Dr. X’s actions resulted in sub-optimal patient care; maybe you can even argue his actions led to better outcomes for this patient. But I do know that I saw one human being treat another malignantly, and I froze. There I was, choosing to succumb to the hospital hierarchy, and I was not even yet a member. As a first year medical student, I undoubtedly had many shadowing and observership experiences before me. If I were faced with this choice again, would I choose different? Do I dare to choose differently?
I hear from my classmates and my teachers, things are changing. Conflict resolution and teamwork courses are now part of our curriculum. Medical schools are choosing applicants that demonstrate willingness to listen to others. The speeches we hear during orientation week are infused with words like cooperation and humility. Still I wonder, because I believe actions of individuals build the shift in culture. Because in that OR, when faced with such a choice, I chose to do nothing.
One day, I will be a resident, and then a fellow. One day, I will be Dr. Y. Should I just trust that by then, things will be different? Should I just trust that in this future, doctors will treat their healthcare colleagues with respect?
And in the meantime, will I keep holding onto my silence?