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Academic Medicine:
doi: 10.1097/ACM.0b013e3181e5ec1c
Other Features: Teaching and Learning Moments

Monkey See, Monkey Don't

De Cotiis, Dan MD, PhD

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Dr. De Cotiis will be a radiology resident at Temple University Hospital, Philadelphia, Pennsylvania.

On my very first trip to the OR, I passed out. As a 12-year-old, I was overwhelmed by the open cholecystectomy. The attending surgeon was wise enough to recognize my symptoms and hurriedly had the circulator nurse take me outside. I spent the rest of the day with a pathologist grossing in surgical specimens. The juxtaposition of the living person in the OR with the dead tissue on a disposable specimen tray affected me deeply. The surgeon directly cared for his patient; the interventions guided by his hands healed. The experience, which I perceived as the dichotomy between purely therapeutic medicine and diagnostic medicine, convinced me to become a surgeon.

Johnny was one of my first complicated patients during my pediatric surgery rotation. A Wilms tumor protruded from his left kidney. On rounds, the surgical team and I discussed what we saw in the films and the more esoteric points of pediatric solid tumors. The attending outlined various concerns he had with Johnny's management and follow-up. I wasn't really paying attention to what was said. My primary concerns were staying awake and not looking stupid. After all, the patient didn't appear to be too sick, and, in a few hours, I'd be in the OR.

The surgical details of the case were complicated. The attending complimented my understanding of vascular anatomy and oncology. The movements of my hands with the weight of instruments began to feel natural. At hour nine, I started to sweat. Suddenly, I was 12 years old again. I had to leave the case. As quickly as possible, I removed my gown and gloves and ran for the cafeteria. After a healthy dose of sugary soda, I returned to the OR and delivered the tumor through Johnny's abdomen.

Congratulations were given all around; the case was successful. My personal pride in finishing despite a bout of hypoglycemia was palpable. To be the first assistant on a Wilms tumor case with a world-renowned pediatric surgeon was no small accomplishment to me. I had removed Johnny's cancer with my own two hands, and my own sense of future seemed without bounds. The shock was equally palpable when the attending later told me that I'd never be a good surgeon.

My disinterest in patient management and follow-up that morning had not escaped notice. I was told that surgeons manage patients, not procedures. While I clearly loved the technical aspects of surgery, I didn't love managing the nonoperative care of surgery patients. I was crushed by the negative weight of my attending's comments. It was the most disappointing day of my life. My own considerable estimation of my surgical dexterity was destroyed with his next comment, “I could train a monkey with the hand skills.”

Several weeks later, I saw Johnny in the pediatric hematology-oncology clinic for a follow-up appointment. I entered the clinic room and was struck by the two-year-old blowing spit bubbles. At that moment, Johnny became a person and not just a specimen to be manipulated and processed. He was a little boy, and, most important, he was my patient. None of what I saw that day in clinic was familiar from my early morning visits to his room in the children's hospital.

The attending was right. My interest in management, follow-up, and outpatient clinic never did surpass the appeal of the OR. The ability to diagnose and heal patients, and not only aptitude for procedures, makes a surgeon. That day in the clinic, I recognized the truth in the previously disappointing negative comments from the attending. My concern should have been our patient, Johnny. A mastery of the molecular biology of tumors, venous drainages, and surgical approaches is not what defines the physician. These things are underpinning components; they are not the patient.

Instead of disappointment, the surgeon's comments gave me a reason to explore other areas of medicine. I was dangerously close to becoming a well-trained monkey with occasional spells of hypoglycemia. The truth, while disappointing, was liberating. In the end, I decided to become something other than a surgeon.

Dan De Cotiis, MD, PhD

© 2010 Association of American Medical Colleges

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