A Medical Student’s Perspective: Reflections and Lessons from Rural Surgery
By Kaylynn Purdy
I am, as far as anybody is aware, the first person from my small mining town in British Columbia to go to medical school. Growing up, my town was often in a state of physician shortage.We relied on a few long-term physicians who spent their entire careers there, but the rest seemed to come and go like the seasons. Whenever we lacked physicians, the suffering and frustrations in my community was evident.The rural doctor shortage in Canada is part of what motivated me to pursue a career in medicine. I wanted to serve the often-forgotten rural/remote communities, much like my hometown in Canada.
Early in my second year of medical school, I felt like I had won the medical student lottery. I had gotten my top choice for my first month-long “Integrated Community Experience” in a rural town in Northern Ontario with a population of about 10,000 people. I chose this town because it was one of the few rural Northern communities that had a fully functional operating room (OR) staffed by GP anesthetists, one general surgeon and another general surgeon with a specialization in vascular surgery. Students were expected to spend at least one day per week in the OR, and often, as first assistant. As a newly minted MS2, the prospect of being a first assist was both exciting and terrifying. It was during this month that I discovered my love for surgery. Yet, it wasn’t until well into my third year of medical school that I began to appreciate what it truly means to be a rural surgeon.
It was a Saturday night when I got a call for an emergency appendectomy that was to happen in about 20 minutes. My only regret that night was not eating dinner sooner. As I rushed out the door of the retirement apartment complex I was assigned to live in for the month, I stuffed a granola bar in my mouth and waved hello and goodbye to an elderly woman walking outside with her dog. It was Halloween weekend and I frantically scraped frost off my car, worried that I would be too late to scrub in.
I sprinted up the 4 flights of stairs to the OR, feeling the grooves worn into each step by the catholic nurses, who ran the hospital in a bygone era, under my feet. One of the scrub nurses was setting up- she let me know that the surgeon was waiting in the doctor’s lounge and that the patient would be coming up from the ER soon. Being an old hospital and modeled after a more male-dominated medical profession, the doctor’s lounge was also the men’s changing room. I cautiously opened the door, fearing I might see something I didn’t want to see, and saw the surgeon sitting on the couch eating baby carrots. He gestured for me to sit, and offered me a carrot. Given that he was known to rarely acknowledge the presence of medical students, I felt as though this gesture was a sign of appreciation for coming in when the rest of my colleagues had gone home for the weekend. We chatted about cycling, and doping in le Tour until the patient was in the OR. As we walked out of the lounge he looked at one of the scrub nurses and said “Kaylynn is going to drive the camera tonight.” I didn’t even know what that meant at the time as this was the first laparoscopic surgery that I had scrubbed in for.
In true rural medicine form, I also had the opportunity to learn how to administer anesthetic, put in the patient’s Foley catheter and then shave his abdomen before it was finally time to scrub. Since that day, I have come to see scrubbing as a moment of calm and meditation, a moment to collect myself before walking into the OR. It is my three minutes of tranquility to calm my nerves.
I focused on controlling the camera like it was the only thing that mattered in the world. Soon my nervousness dissolved and I was fully engrossed in what was unfolding on the screen before me. It was like being absorbed into a Netter’s textbook. Time stood still. As the appendix was removed, I was asked to take a “sweep” look at the rest of the abdomen. The gallbladder was massive, inflamed and angry looking. The patient was just a teenage boy and of course being Canadian, also a hockey player. That night he had both his gallbladder and appendix removed. I felt simultaneously devastated for him, but in awe of what I had just witnessed and had been a part of at 11pm on a Saturday night.
At the time, I was on a high from the surgery itself. As I reflect on that night more than a year later, however, the awe of the surgery is less, but a different kind of amazement has replaced it. To me, it is almost magical that a surgery team can be called in from home and ready to operate in 20 minutes.With one surgeon on holidays, the other was at the beck and call of the people of his community 24/7. During my month-long placement, this single surgeon was the keeper and protector of health for an entire community. The respect that that the community has for its surgeons was incredible, because without them they would have to travel to a regional centre hours away for a surgical consultation, to have a wound checked, or to take care of a sick child.
No matter the size or centre that a surgeon practices in, there are uniting features of surgeons across the world. These include being able to quickly gain the confidence of your patients, trusting your gut and your training, knowing when to push the boundaries in a “Hail Mary” situation and knowing your limits. In rural surgery, these characteristics seem to be even more important, as there is often no back-up, nobody to call in for help. In rural surgery and rural medicine, often it is just you, your small team of people who are also your friends, and your patient who just might be your neighbor or an old high school teacher. There is simultaneous isolation and profound intimacy in rural surgery.
Some people might consider rural surgeons the “Cowboys” (and Cowgirls) of medicine because of how they try to save a life with limited resources. These surgeons feel compelled to try to reduce the suffering and burden that is imposed when patients are forced to seek care far from home. After living and breathing rural surgery for a month, then spending eight months of my clerkship in a semi-remote city, I see these surgeons as the quiet heroes of medicine. Nobody tweets about them, they didn’t just publish the latest research about cancer or develop a new technique to improve healing after bowel resections. They don’t work at prestigious university hospitals, but they are on call often for weeks at a time, ready to operate and ready to serve. They are often the hearts of the hospital and the lifeblood of a community. They are what allows people to retire and grow old in their communities knowing that they will have reliable essential medical/surgical care at home when they need it.
I might not be a rural surgeon “when I grow up,” but I hope to one day be a pillar in my own hospital and community. I hope that my surgical team are also my friends and that I think of each patient like my neighbor and not just as a case. I still have the picture of the gallbladder from that Saturday night surgery. I kept it because it is a reminder of who and what I want to be one day: A surgeon who places her community before all else.
Kaylynn Purdy is now a 4th year medical student at the Northern Ontario School of Medicine in Thunder Bay, Canada. She hopes to pursue a career in Neurosurgery with a focus on timely access to surgical services. When not in the OR, she can be found skiing in the winter or out riding her bike in the warmer months.
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