The Casting Room

I’ve been reflecting on how easily past training experiences (or any experience for that matter) can be oversimplified by those who didn’t live them.

It took me a minute to understand why that bothered me. It's because those oversimplified accounts tell a very narrow story of some of the very experiences that shaped me.

Realizing that made me want to write about one specific moment.

Not to glorify what was hard or dismiss our progress in GME, but to name the moments of humanity that stayed and their enduring impact.

In the culture of a Level 1 trauma center, with multiple training programs and far less oversight than now, many residents were, by today’s standards, mistreated. General surgeons, like all of us, developed coping mechanisms. Most at our institution at that time earned a reputation for being fierce. You didn’t want to mess with them.

There were a few outliers whose hardened personas could be breached, moments where you could see that their kindness and desire to serve. The culture didn’t really make room for that, though. So more often than not, I couldn’t tell whether someone was a jerk to their core, worn down by what they’d been through, or simply determined not to let anyone at work see their humanity.

By some fluke, I ended up as the only intern on the trauma surgery service that month. Normally there was a surgical co-intern. There wasn’t this time. (Did I mention it was a busy Level 1 trauma center?)

The junior was tough, the way you had to be to survive those conditions. The senior was more level-headed than most, but all business. And if you thought other rotations’ call schedules were intense, trauma took it further. Each surgery team covered trauma call for the entire weekend. You went in Friday morning, call started, and you stayed through Monday. Call technically ended Monday morning, but the cleanup lasted all day.

Layer on my mal-adaptive perfectionism, my overreliance on external validation, and my then-unexamined “hero of family medicine” complex, and I was determined not to let the trauma team see family medicine as weak based on my performance.

I was at the hospital before 4am. Every day. I worked fast. I did the work without being asked. We had two medical students who followed the newly instituted rule not to arrive before 5:30am, which felt astonishing at the time. I carried baby Sebastian and baby Schwartz in my pockets and referenced them often. I proactively knocked out H&Ps, discharge summaries, and admit orders. I ran everything by my junior without disturbing the senior. I pulled chest tubes when output was down. I stayed ahead of things as best I could.

It must have been viewed favorably. I was rewarded with an invitation to the OR to perform a muscle biopsy.

And then came our call weekend. I don’t remember how many patients we started with. I do remember where we ended. By Monday afternoon, after the attending accepted two transfers after our call had officially ended, we were carrying 36 patients, including 14 of the 16 SICU beds. There was little sleep. Near constant traumas. Endless details. Not enough nourishment. Just one foot in front of the other.

By Monday rounds, I couldn’t keep up despite my all out effort. I wasn’t adequately prepared, and it showed. I felt humiliated. It took everything I had not to cry outright during rounds. The junior looked like she was barely holding it together too, under the very routine and typical, harsh pimping and the relentless focus on every missed detail.

When rounds finally ended and the attending walked away, I was looking for where to run, hide, and bawl. Before I could, the senior grabbed my arm, along with the junior’s, and pulled us into the casting room nearby. He made us sit down. (How long had it been since we’d sat?!) He opened the fridge and handed each of us an orange juice, peeling back the foil so we didn’t have to.

And he let us cry.

No one said anything. He didn’t criticize the attending. He didn’t try to make us feel better. He just let us cry.

When we’d pulled ourselves together, he gave us a gift. Specific instructions so we didn’t have to think. Then a clear directive to go home once those were done and to get some sleep.

He saw us. He understood. He gave us the basics: rest, fluids, glucose. Short, doable orders. Then he told us to get out of there.

Under pressure, he showed grace. And kindness. And professionalism.

In times like many of us are facing, with so much stress and suffering around, I keep coming back to how much connection matters. Being seen and heard is one small but foundational part of what we can offer each other in the middle of it all...

Who noticed you when you didn’t have words left? What stayed with you from that moment?

Who around you might need to be seen more than solved right now? What could simple presence look like?

As always, I'd love to hear.