SOL: Stanzas of Life

There is a particular kind of tired that only exists at hour fourteen of a surgical call shift. Your feet stopped hurting around hour twelve. Your brain is somewhere between hyper-focused and fundamentally disconnected from your body. The OR is still humming, with the bovie crackling, the pulse ox singing its steady tone, the attending’s voice cutting through the ambient noise to ask you, casually, as if it were the most natural thing in the world, “which artery runs along the medial border of the psoas major?” You answer. Or you don’t. Either way, you learn something.

This past month, rotating through general surgery, orthopedics, and anesthesia at a Level I trauma center has been the most demanding stretch of medical school so far.

Walking into an operating room for the first time, you quickly realize it is its own world, with its own hierarchy, its own rituals, and its own dialect. The scrub tech controls the instrument field with quiet authority. The circulating nurse is the room’s connective tissue, tracking every sponge and needle count, fielding requests, bridging the sterile and non-sterile worlds. The anesthesiologist runs a parallel universe at the head of the bed with lines, gases, drips, occasionally surfacing to comment on blood pressure or quietly flag something the surgical team hasn’t noticed yet. And then there is the attending. Some of them teach relentlessly, narrating every move, asking questions not to embarrass but to genuinely transfer knowledge. Others operate in near-silence, communicating through gesture and glance, and you learn a different way: by watching, by reading the room, by understanding that competence can exist without explanation. Your role in the room shifts depending on the case, the attending, and honestly, your own momentum that day. Some mornings you scrub in early, get positioned at the table, and find yourself actually retracting. Other days you stand at the periphery, observing, learning the choreography of a procedure you’ll eventually need to understand.

That duality – engaged one moment, observer the next – is one of the most honest thing about third year that nobody really prepares you for. It’s not failure. It’s the nature of the apprenticeship. Being a medical student in the OR sometimes feels like being a background actor who has memorized the script; you know the steps of the procedure, but you’re not the one making it happen. The key is staying ready so that when the attending looks up and asks if you want to close, you can say yes without hesitation, and actually mean it.

General surgery is deceptively broad. Each case demanded different anatomy, different instrumentation, different emotional register from everyone in the room. Suturing was one of the things I was most eager to practice, and the attendings found moments to let me close skin, throw interrupted sutures, and get comfortable with the driver in hand. The long shifts are real. Twelve-hour days slide into sixteen. You eat when the case allows. You hydrate in the locker room between cases. You get very comfortable with the particular exhaustion that comes from standing still for long periods, especially when your role is active retraction.

Nothing quite prepares you for orthopaedic surgery until you’re in it. The physicality of the specialty is unlike anything else in medicine, with surgeons hammering, sawing, drilling, torquing with a kind of controlled mechanical force. Fluoroscopy, the real-time X-ray guidance used throughout fracture fixations, joint replacements, and hardware placements means radiation exposure. A standard lead apron weighs roughly fifteen pounds. You wear it for hours. By mid-rotation your lower back has opinions it never had before, and you understand viscerally why orthopaedic surgeons develop specific musculoskeletal issues over long careers. The cases themselves were among the most visually striking of the month with acetabular fracture fixations, tibial nail placements, total knee arthroplasties.

Anesthesia was, in some ways, the rotation I understood least before I started. At first glance it seems like the anesthesiologist disappears behind the drape and monitors numbers. In practice, the depth of physiologic knowledge required with pharmacology, airway anatomy, hemodynamic management, regional nerve blocks, and the intricate math of gases. I stood at the head of the bed and learned to read a patient’s status through their monitors, their color, their response to stimulus. It reframes what surgery is: two teams working in parallel, one opening and repairing, one maintaining the biology that makes repair possible. In twenty minutes, a good anesthesiologist builds a complete physiologic portrait of a stranger and formulates a plan. It is clinical reasoning at speed, and watching it is one of the best teaching experiences of the rotation.

Being at a Level I center means the trauma activations are real, frequent, and often severe. You stand in the trauma bay as a team moves with practiced urgency. You watch, help where you can, stay out of the way when staying out of the way is the right thing to do. And somewhere in the middle of it, you feel the full ethical weight of what this work actually is. There are cases where the surgical team does everything right and the outcome is still devastating. There are conversations with families that happen in hallways and waiting rooms that no simulation can replicate. There are moments where you wonder about the social determinants that brought this person to this bay and feel the inadequacy of a scalpel as a response to a social wound. Trauma surgery forces a reckoning: we are treating the consequence, but the cause is almost always something medicine alone cannot fix. The surgeons navigate these cases with a compartmentalization that I used to read as detachment and now recognize as a learned, intentional form of presence. You have to be fully in the operative field during the case. The processing happens later, and everyone has their own way of doing it. Finding mine is ongoing.

Third year clinical rotations exist in a peculiar middle zone. You are not a pre-clinical student anymore; you are in the hospital, in real rooms, with real patients, doing real things. But you are not a resident. You are not the doctor. You are something genuinely in-between, and that in-between feeling is sometimes uncomfortable and always instructive. There are cases where you are actively engaged like retracting, irrigating, suturing, being pimped on anatomy you’ve studied carefully, feeling useful and present. And there are cases where your primary contribution is standing at a certain angle and not contaminating the sterile field. Both are real. Both matter. The willingness to engage fully in the second type of case is what earns you the first. The exam pressure runs underneath all of it. The shelf exam looms. There are question banks to get through, First Aid chapters to review, operative reports to read and connect to pathophysiology. You are studying while sleep-deprived, reading about surgical complications while standing in a locker room between cases quizzing yourself on the branches of the celiac trunk because the attending might ask and you want to be ready. Performance on evaluations feels high-stakes as you want to be seen not for self-promotion, but because you want the people supervising you to know that you’re trying, that you’re engaged, that you are becoming something.

A month is both too short and exactly long enough. Too short to master anything, but long enough to internalize things that will shape you as a clinician. I am carrying forward a deep respect for the people who do this every day: the surgeons, the nurses, the techs, the residents who teach between their own exhaustion, the patients who put themselves entirely in other people’s hands.

#3rdyear #medical school #rotations