General Surgery: Conscious Uncertainty

This morning we had case presentations, and to my dismay Dr. B called on me to present. I was sure I'd suck since I had no visual aids (unlike Jedd's powerpoint presentation), so I basically pulled out my report and described what I saw in a femoral-femoral bypass that BB did in my first week of rotations. Dr. B then proceeded to pimp me on peripheral vascular diseases, indications for a fem-fem bypass, and more; sadly I didn't know the answers to most of them =( Then I was the only one who spoke up when Dr. B asked what a Swan-Ganz catheter was (I had JB's midnight pimping to thank for that one) and he ended up having me go to the blackboard to write out hemodynamic values and figures. I was up at that board for a good 30-45 min. *sigh*

After lecture I drove back to the hospital in time to see the end of a CEA (carotid endarterectomy). I wasn't too disappointed though; there was another one scheduled for later in the afternoon. At lunch I saw Kathy H and Dr. D from obgyn; funnily enough, we all had JB teach us surgery at some point or another. The second CEA was delayed b/c anesthesia had trouble starting an arterial line, so we rounded on patients in the meantime. Then when surgery began, JB started pimping me about structures in the neck (i.e. where does the recurrent laryngeal nerve lie on the right? On the left? What's this nerve here?), and I struggled on a lot of them. Now he must think I'm a total dumbass. The only question of his that I was able to answer with certainty was identifying which nerve ran beside the carotids to the organs (the vagus nerve).

"See, that's good, what I'm aiming for," he said. "When we first start out in medical school, we don't realize how much we don't know. That's called unconscious uncertainty. Then we become aware of how much we don't know, and that's called conscious uncertainty. We then study harder to increase our knowledge base but still need help sometimes, and that's called conscious certainty. Once you don't have to think about something to know you're right, then you've reached unconscious certainty, and you've got it made."

I know I'm stewing in conscious uncertainty, big-time, and I plan to read up on lap choles, hernia repairs, and hemorrhoids before tomorrow so that I won't be as stupid as I was this afternoon. I did spent a good part of the surgery holding the overhead lamp straight (it kept going crooked), which was a nice waste of time and left my arms sore. This was even more tedious scut than retracting. Luckily someone later came in to tape the lamp in place, since as JB pointed out, I spent too much money in med school to be a designated lamp holder. *sigh* This wasn't one of my better days.