New Falls

Fall is finally in the air. After a brutally hot summer that seemed to last forever, the calendar has been flipped and the weather seems to be slowly complying. The mornings are cool and clear, as are the evenings, and every once in a while I spy a tree with some fading leaves. I even had to kick a few dead ones out of my way leaving work last evening.

And as is the case at this time of year, the dying trees signify the start of so many things. The academic cycle starts anew, and with it come new crops of medical students and interns to the hospital - full of knowledge, and needing experience.

It's hard not to get a sense of the cycle of things at this time of year. Seasons come and go, as do the interns, but all that seems so much more obvious at the transitions. I guess it's when we're just more aware of that change.

The other day, in the operating room, while removing a patient's gallbladder, it became abundantly clear that there were four individuals working on the case, each of whom had a predictable level of knowledge and technical ability. There was the attending surgeon at the helm, following by the chief resident, followed by me (a "mid-level" resident), and of course followed by the medical student. Knowledge, skills experience -- it all flowed downstream. And it was so obvious that I couldn't help but think that I was simply just part of a system - a grueling system that took young, helpless interns and put them through five years of exams, sleepless nights, oral presentations, clinical rounds, computer simulations, difficult patients and their families, central lines on obese patients, trauma activations, massive blood loss…five years, to produce a surgeon. And as predictable as the seasons, so too are the abilities of the resident.

On the one hand that's comforting. After a couple more years, I tell myself, I'll be that good, and that smart. But then I begin to wonder - am I just a product of a system? As sure as I'll progress, so too will fall fade to winter, and winter blossom into spring. It's automatic.

I like fall. It's beautiful, and it's a fresh start for so many phases of our lives. And it's a time for progress.