Toads-in-the-Hole

My classmates and I are like big game hunters: a great deal of our time is spent questing for the rare, the beautiful, and the dangerous things beyond the friendly confines of civilization. Rather than track, kill, and mount elephants and cape buffalo, however, we pursue "procedures."

Allow me to drain the metaphor of all of its power via plodding explanation. A big whack of our grade (and thus, our worth as future doctors and, indeed, our intrinsic value as human beings) is extrapolated from our entries into the Student Patient Experiences Database (SPED), a clumsy and user-nasty computer program into which we log everything we do with patients. We accumulate most of our patient experiences in the clinic, taking history of their various illnesses and complaints, jotting down notes, and going out into the clinic hallway to Present the Case to our attending doctor.

But SPED also gathers our entries on procedures, which means everything that we actually do to patients other than take their histories. Suturing a laceration, delivering a baby, interpreting an X-ray, or performing abdominal surgery are all procedures. But not all procedures are equal. We are expected to gather a wide variety of procedures, and it is assumed (though no one has told us this) that some procedures carry more weight than others. With this in mind, I made my metaphor.

Obtaining a Pap smear is like catching a medium-sized fish. Suturing up a laceration is like bagging a duck. A surgery to remove the gall bladder or appendix (which around here seems like the first step in the therapy for any patient with abdominal pain) equates to getting a deer, and taking out a thyroid is like taking out a tiger. There are some surgeries which are almost never done in Yankton, SD. Patients tend to drive to Sioux Falls or even Omaha to have them done. But, once or twice a year, a patient will have heart surgery or an abdominal aneurysm repaired, which, if we were to assist on the procedure, would be something like capturing a live Sasquatch.

If all of this seems like a mental game, then you're getting the point. There is a great deal about the third year of medical school that is unpleasant (60-70 hours per week spent away from my family), terrifying (doing something for the first, second, or sometimes third time), or just aggravating (not having convenient multiple-choice options to choose from), so it helps to have a little game to play.

The metaphor deepens and becomes more satisfying when I think more about big game hunters. They aren't hunting animals for food, and while the animals are frequently dangerous, they're not trying to make the Serengeti plain a safer place. Similarly, the actions of medical students are usually pointless. We are the least important people in the hospital/clinic. On the rare occasions that I actually help in patient care, I like to slowly raise both of my fists in the air while declaiming "I… am useful!" The rest of the time I'm trying to see and do as much as possible without getting in anyone's way.

Largely, big game hunters are out in the wilderness gathering experiences. Then, they go back to civilization and tell stories about their experiences. So we students regail each other with stories about the Pap Smear of the Patient With Two Cervixes. Or the Twin Delivery that Took a Long Time. And we'll listen to each other with rapt expressions, "Man, they let you put in a chest tube?! You've got all the luck!" while in our secret inner self we know that if we were the ones staring down the barrel of a chest tube, if it was us taking careful aim at a White Rhino, our hands would shake and our hearts would pound.