Grand Rounds: How war shaped my surgical training and career pursuits

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This month, I had the honor of delivering a Grand Rounds presentation to my hospital’s Department of Surgery as part of an annual tradition to display the passions, accomplishments, and career goals of the graduating resident class.

Below is the presentation I delivered but in a slightly elongated form as there is no time constraint here. Each paragraph represents a slide in the presentation. I have included relevant images and photographs directly referred to during the presentation.

The title of my presentation is War: Perspectives of a Surgical Trainee.

Here, I will share the circumstances that propelled me toward a career in medicine and then, more specifically, the circumstances that shaped my trajectory toward trauma surgery and surgical critical care. I will also share what I imagine my future will look like as well as the lessons I carry with me every day as I continue my surgical training. Continue reading “Grand Rounds: How war shaped my surgical training and career pursuits” →

Twenty-Nine

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I kept a running tally, and when everything settled down, I confirmed my count: my surgical attending, an emergency medicine attending, two triage nurses, multiple EMTs, other junior surgical residents, two physician assistants, a recorder, more bedside nurses, an emergency medicine resident at the head of the bed, a medical student, the X-ray technologist, and others, including myself, a senior surgical resident to the patient’s left.

A young man had been shot in the leg. The headline might have read something to the effect of Another Victim of Gun Violence in Cleveland. He was bleeding but not catastrophically. His vitals were normal, his pulses intact, but his thigh was swollen and slightly deformed. He was anxious, naturally, and sweating profusely. The pain must have been unbearable judging by the creative strings of profanity he shouted through gritted teeth. Scout films confirmed a broken femur. Our orthopedic surgery colleagues joined us in the trauma bay and soon after booked him for surgery.

In the moments leading up to this trauma activation, I was glued to my phone, my main source of news from the front and sometimes the quickest way for me to learn about relatives and familiar neighborhoods. Fourteen killed in an airstrike, I’ll read. An entire building demolished. Two children missing, still buried in the rubble, presumed dead. And now another Israeli airstrike. This time the courtyard of a hospital. The casualty count can’t be confirmed; bodies are strewn everywhere. Are they dead or dying? Were they already here for medical care, only to become victims again? Who does this limb belong to? Continue reading “Twenty-Nine” →

Politics in the workplace

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Part of the standard doctrine we are taught, in parallel with doing no harm, is that the service of providing care to another is and must remain entirely apolitical. I have always thought this to be wrong.

There is nothing apolitical or politically neutral in providing care to the ill, the injured, the scared, or the underserved;

in establishing a free clinic for the uninsured;

in watching a patient die but having to sanitize your hands and immediately visit another patient without letting them see the cracks in your shield;

in reviewing radiographs to weigh your suspicion of elderly abuse;

in demanding the prison guard leave the room to provide the county inmate even a modicum of privacy;

in risking your license by subverting elected officials who wish to outlaw or restrict maternal health services;

in referring a drug-dependent patient to a methadone clinic or two;

in rapidly transfusing blood into a pregnant woman hit by an intoxicated driver who, by the way, happens to be recovering rapidly in the adjacent trauma bay; Continue reading “Politics in the workplace” →

On family and all that is left at 7 pm

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His kidneys failed, I’m told. The both of them. Tubes crisscross over and under his bed in a room crowded with empty seats, fuzzy television screens, useless nightstands, and a whiteboard that reads: “Goal: Increase activity”.

The lights are turned off and it’s 7 pm. Flash back to the days when we were young and restless.

With muddied hands (mama told us to stay away from the puddles but we never listened) we run to the kitchen sink without making eye contact. Because once we make eye contact, mama gives us that look that means we’d better be in bed in less than five. She asks whether we’re tired. “No,” we say, but we are. We are just too young and too proud to admit it. And at 7 pm, the lights go off.

Flash forward to the days when we outgrow ourselves.

I don’t know what to say. Five of us are in the room now—four standing, none sitting. I’m the last to shake his hand, to give him that squeeze that, when I was a teen, all the married Arab men would advise me about. Continue reading “On family and all that is left at 7 pm” →

On your own terms

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How would you like to die?

Peacefully? On your own terms? Is there dignity in early retirement, so to speak? Or does the dignity lie in the struggle, the fight to the very last gasp?

“Look at me.” I knew not to look. “How would you like to die?”

I doubled back without realizing. Sensing my surprise, my attending broke eye contact with the patient and returned my stare. Three seconds felt like an eternity.

“How,” there was a brief pause in his cadence, “would you,” another one, “like to die?”

He enunciated every syllable. There would be no doubt in his words, no question in his intent. He was soft, understanding, and at once cold, so cold, and calculated, and firm. Continue reading “On your own terms” →

Big Day

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Something like No Problem by the Chet Baker Quartet was playing in the ICU. It was one o’clock in the dark of the night. The barbershop was open for business.

Having been assigned to the Trauma ICU for the past week, I was comfortably familiar with the patients and their stories. I rounded on the unit at the start of my shift, making small adjustments here and there and hoping for a quiet night.

I began by saying my hellos to the family in bed 2, each relative clutching a hand and praying that the young woman, many years my junior, whose brain had swollen as a result of her injuries, would win the fight for her life. Visiting hours had ended but they were allowed to stay late given the circumstances. I drew the curtain behind me.

At the other end of the unit, the woman in bed 13 was no longer calling out or squirming restlessly. She had learned earlier in the day that she was the sole survivor of the crash. Her eyes remained fixed on the wall clock when I entered the room as though she was counting down the minutes until she could join her husband again. I stepped out just as silently as I had come in. To do this job, you learn to compartmentalize. I take walks. Continue reading “Big Day” →

Mother Tongue

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On the way, echoing softly around the corner and down the hallway, I hear it. Maybe I’m imagining it – I’ve only slept four hours in the last two days – but I swear I heard a soft K and delicate L wrap around a guttural H. I could recognize these sounds anywhere.

I have to see someone. Nothing urgent, just a quick check. For the anxious or tired patients, especially those so soon out of surgery, I like to tuck them in at night. It’s a miracle move, probably the greatest secret in medicine, more tangibly impactful than the flowcharts and electronic doctoring that dominate much of my training.

I am a building away. I can take the second floor shortcut and be there in a few, but I can’t escape the sound of my mother tongue. I take a right instead, my focus now at odds with my curiosity. I realize I have been homesick this whole time and I wonder what or who I will see.

For years I have lived far from home, away from family and community. Short of a phone call, my connection to home is distant and tired. My patients are my best friends, I am afraid, and my thorough notes a reflection of our time together, fleeting conversations I am known to take too seriously. Continue reading “Mother Tongue” →

Hospital Omelet

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Ms. B gently asked me if I could cut her omelet into bite-size pieces. I gingerly handled the plastic knife and sliced into the delicate hospital-made omelet. I made three expert pieces, straight-walled and contained. Bacon bits spilled out of the first one, but it was an edge piece. It’s not my fault. The other two pieces held up nicely, the glossy spinach densely packed in between the warm folds of egg. I admired my handiwork. The J.D. in me began to romanticize: maybe I was meant to be a surgeon after all. But the Dr. Cox in my mind interrupted. “Bite-size, Sami.” I looked at the plate. People don’t eat this way. Ms. B laughed as I cut the continent-sized pieces into thirds and turned her omelet into scrambled eggs, which she explicitly did not order.

The next day, she was set for discharge. Her transportation was due at 4 pm. It was 2 pm now. We had rounded earlier in the morning and finalized her paperwork, prescriptions, and orders. I wanted to catch her one more time.

Ms. B lives with amyotrophic lateral sclerosis, or ALS, a disease process I know little about and had not expected to encounter. Our conversations were always so pendulous. One minute she’d laugh at her circumstances. The very next, she’d abruptly start to cry. I had to remember to place the tissue box near her left hand, the only one she could move to her face. Her strength was nearly gone. Continue reading “Hospital Omelet” →

Hallway Dinner

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I leave the hospital most days around seven o’clock and reach home by the time dinner preparations are in full swing. I can make out the sweet symphony of kitchen sounds through the old wooden doors if I listen closely enough. Occasionally, if I’m lucky, the neighbor across from me has her door propped open ever so slightly, enough for me to appreciate faint sizzles and the thud of wooden spoons, music to my ears.

As I walk down the hall to collect my mail, I am reminded of the value of our sense of smell. I arrive to fish – salmon, I think – on Saturday. Sunday is pizza day for the family living to the left, Szechuan stir-fry for the family to the right. Broccoli and cornbread on Monday. Someone left something in the oven for too long on Tuesday but the char complements the notes of chile de árbol I pick up from further down the way. Wednesday is an amalgamation of garlic, sweet potato, and something peppery. I imagine the spread of a potluck right now. Thursday smells like bread and, two doors down, fish again. I feel connected and international. Continue reading “Hallway Dinner” →