Ilana Birnbaum is a medical student in the Class of 2020 at the University of Toronto.
This work represents some of my reflections during my 6 week Surgery rotation as a third year medical student. While I enjoyed this rotation and learned a great deal about surgery, and clinical care more broadly, I largely felt anonymous. I felt hidden away behind my surgical mask, cap, gown, and gloves.
Even when I was not physically wearing this personal protective gear, I felt as though there was a distance of sorts between myself and the patient. This lack of identity seemed reciprocal. As I felt anonymous to my patients, they too had an element of anonymity in my eyes. My consults in the emergency department were focused, follow-up appointments in clinics were concise, and rounding on inpatients in the mornings was reduced to a few yes or no questions. The majority of my time spent with a given patient was when the patient was under anesthetic.
This perceived distance between myself and patient was increased by the surgical and medical jargon I tried to avoid but found myself spewing none the less. These feelings of depersonalization – of both myself and the patient – are not something I contended with on previous clinical rotations.
Is surgery unique in the need for depersonalization of provider and patient? Is this level of anonymity necessary to be able to do the work of a surgeon? Is there a role for protective gear beyond maintaining a sterile field? What is the patient perception of a surgeon? How is the role of healer hindered or enhanced as a result of these necessities of surgery?
I had no answers, or at least, no one could hear me under the mask.
I’m a general surgeon since 27 years now and I’m as passionated as at the beginning of my practice by the human side of Medicine.
Surgery gives us the privilege to get in touch with the most intimate and vulnerable part of the patient.
The surgical act becomes then an extension of that link of confidence and trust established with the patient.
In the OR depersonalization seems necessary. Operating on a small defined spot seems required, to avoid thinking about the devastating consequences of cutting a nerve or vessel in a real human. But this behavior must change once a real one to one human interaction occurs.