Culture of Medicine & Rethinking Residency

Join Dr. Frances Mei Hardin on her mission to dissect the complexities of the medical profession in her debut episode of “Promising Young Surgeon.” As an ENT specialist with a passion for reform, Dr. Hardin peels back the drapes to reveal the raw truths of a surgeon’s life and the cultural issues within medical education. This isn’t your typical medical hero’s journey; it’s an honest exploration of the challenges faced by doctors and the need for systemic change.

In this episode, we navigate the turbulent waters of residency, the emotional toll of patient care, and the daunting task of starting a solo practice in a rural community. Dr. Hardin doesn’t just operate on patients; she operates on the very fabric of the medical establishment, stitching together a narrative of resilience and reform.

Published on
March 14, 2024

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Hi there, and welcome to promising young surgeon. I’m Dr. Frances Mei Hardin, a tri organ healing mercenary or what the nerds call an ENT. But I’m not here to talk ears or noses or throats. I’m here to talk about the struggles and healing that come with the journey to becoming a physician. There’s something fundamentally wrong with the culture of medicine and how we educate doctors in this country, and I want to fix it. So join me as I dive deep into the minds of some of the craziest people on the planet, doctors. There’s this pervasive notion that surgeons aren’t real people, with their unique idiosyncrasies, charms, and interests. And part of this conversation is that I refuse to be limited to the very small box that people want to put female doctors, and certainly female surgeons, into. It’s such a pleasure to be here in the time honored surgeon podcaster tradition, and I’d love to talk a little bit about what you can expect if you join us on this podcast journey. Promising Young Surgeon is about the culture of medicine and medical training, which does include, of course, surgeons and how we’re brought up within the system. This podcast is for young physicians, pre med students, medical students, anyone who really has an interest in physician stories, which certainly includes people outside of the healthcare field. For instance, do you like Grey’s Anatomy or house or the resident? Any of those blockbuster shows about life in the hospital? Part of what I’d like to do is draw back the curtain on what really happens. For those of you who wonder what working in a hospital is really like, imagine if all the people were 80% less hot and you were terrified most of the time, sleep deprived all of the time, and people’s lives were at stake. So look, you have probably heard a lot from doctors about their heroes journeys or different Q and A’s with doctors, this podcast is not really about that. It’s about the ways in which the culture of medicine needs to change, how to overcome setbacks during training or early career as a physician. And it’s about performing well and being able to learn in a dysfunctional work environment. So we’re really here to talk about effective and positive ways to best situate yourself or even play the game as a physician. And you can expect candid conversations with a host of people, including physicians and surgeons, as well as healthcare adjacent people who give us this very valuable and unique perspective from outside.

Frances Mei was born and raised in Chicago as an only child

A little bit about me I was born and raised in Chicago as an only child. I receive a lot of feedback that people can tell that I’m an only child, which take know with a grain of salt. I do have a double first name. I go by Frances Mei to answer that question before it comes up. It’s a double first name. I know it’s high maintenance. I get a lot of feedback about the double first name, so don’t worry. I’m aware it’s a lot to ask of people, but I do go by the full Frances Mei. And I was actually named after my two grandmothers, Frances Ann and Yu Mei. In terms of what early childhood was like, if we’re going down the Wikipedia page here, I spent my early years in catholic school during the week, Chinese school every Saturday. I fenced foil. I played piano later on, eventually picked up the harp as well. But, you’re probably starting to get the, gestalt that I was quite a nerd, and that would be absolutely correct. We’ll keep going and see if things change for me at all. They don’t really change, but we’ll look at this together. I moved out at 13 years old to go to a boarding high school. And in terms of what was necessary to do that application and to be able to successfully make that transition and be accepted into the boarding school, I had to take the SAT in 7th grade. I had to take multiple courses at the community college in various sciences, like including biology, psychology, just to meet the 9th grade equivalent teaching level. And that was part of the application process, because essentially you skip 9th grade by going straight in from middle school to sophomore year. again, you’re probably trying to picture me as a middle schooler. Pretty weird cat. I was fencing. I was very involved in the catholic mass. I was like president of Bell choir. I was an altar server when I wasn’t at community college and things like that. So, again, feel free to roast me in the comments. Probably not much that I haven’t heard before, but go crazy. I then attended the Illinois math and Science Academy in Aurora, Illinois. My first foray into academic publications was in an astrophysics journal when I was 16 years old. And that was from my contributions to the dark energy survey, just as a rotating student who was going to fermilab one workday per week at, 16 years old. I went to Notre Dame, where I graduated at 20 with a biochemistry degree, with an honors in research distinction. I really only say any of this stuff because doctors love to hear it. they’re so obsessed with the accolades and also maybe how legitimate or not of a thinker you are, how legit or not an academician, you are. And so I just say all this because I will really want people mostly off my back. I’ve been in the academics game for a very long time. I’ve been prepping for the SAT when I was single digit years old. So I really like to joke that my parents wanted me to be a doctor and I wanted to be a graphic designer. So we compromised and I became a surgeon.

I think we should support surgeons who want honest work, to serve society

I do think that this touches on something, though, which is an important point I’d like to bring up, which is just that we should be able to train and support surgeons who want honest work, to serve their community, and to just really contribute to society. It’s not all people who picked up their first scalpel at, ah, three years old and have always thought, you’re going to pry this out of my dead, cold hands. So I’m definitely somebody who always loved stem from an early age. The math and sciences, absolutely. But in order to attract people like that into medicine and into surgery, I have a lot of thoughts about how we can make surgery a little less daunting. or unappealing. Anyway, I graduated college. I ended up taking a gap year living in the central west end in St. Louis. I did outcomes research full time for that year, and that was a wonderful experience, and that was, of course, my introduction into Ent. I then went on to case western in Cleveland for medical school, which was such like a wonderful experience. They have a really diverse program. It is small group based. I found it super supportive, open to discourse, and it was just, a, wonderful learning environment. And then I went on to do a five year Ent residency in the midwest, and I completed that successfully. Graduated back in 2022. And six months after graduating from residency, I created the brand rethinking residency. This is a platform, including a site, social media, different content that we put out. really involves resources that support resident and physician well being and mental health. The fastest way that I can explain this resource to you is just to say that it is what didn’t exist when I was a resident. When I was a resident and I was googling things like resident physician suicide and resident physician depression on my phone, like late at night, unable to sleep on call. Very little came up at the time. And yes, that was years ago, and yes, we’re always making strides in the right direction. But I did want to create one single spot where a lot of these topics and resources and emergent helpline numbers could all live. I’m currently in my second year of full time practice as an odor laryngologist. I live outside Nashville, Tennessee. I’m in solo practice at a rural community hospital, and I actually started the practice where the hospital had never had, their own employed ENT before. So that was a wonderful learning experience and really, great opportunity to build the practice from the ground, you know, as almost a safety net practice, where I’m the only ent that takes all insurances. In middle Tennessee, some of my patients are driving, like, several hours to see us in clinic. You’re probably wondering, especially if you’re healthcare adjacent or interested in becoming a physician, what is odolaryngology, and why would somebody choose ent? So, odolaryngology is another term for ent or an ear, nose, and throat doctor. General ent, which is what I do, involves the practice of all three pretty broadly. But there are many subspecialties within ENT. They include, for instance, laryngology, reconstructive surgery, facial plastics. In my practice. Personally, I do a lot of sinus and allergy, as well as endocrine and laryngology. Some of the best advice that I ever took to heart about this was when I was 20 years old and working in ENT outcomes research. Well, of course, I was surrounded by ents, number one. So there was a pretty strong bias as to why ents were the best surgeons and things like that. But I was told, essentially, to choose the bodily fluids that you can tolerate. That kind of holds up after all this time. I got to tell you, like, when I was in medical school and doing rotations and things like that, I kind of grew weary of the gangrenous feet, and I didn’t want to see a ton more groins. And so you can imagine that starts to rule a few things out. As an ent, I had to really ask myself and figure out if I could tolerate earwax, snot, trach secretions. And the answer is that I can. Those are not that bothersome to me. But I do meet people, or I meet young students who are just like, man. Anything that comes out of the nose or doing these serumin removals, I just cannot get behind it. And, of course, that can help them make their decision in terms of what kind of doctor they are trying to be. It’s more common than you’d think that a patient tries to take off their shirt in clinic to show me a strange new mole on their lower back. And I just respectfully say, I’m an ent. I only do clavicles up. This season, I have a great lineup of guests who also want to engage in these honest conversations about how we train physicians in the US. And together we kick around ideas on how to build a softer world.

There’s already a substantial doctor shortage in the US

There’s a couple points I just want to make about the culture of medicine and understanding the current situation. In today’s episode number one is the doctor shortage. So there’s already a, ah, substantial doctor shortage in the US. Projections over the next decade are like pretty unfavorable. And so this is a topic that we are starting to hear and see more about, particularly in rural areas of the country. But there are a lot of underserved communities from a healthcare standpoint. And I do think that part of changing the culture of medicine to be more inclusive and to draw in more brilliant young people who might have multiple options in terms of what they want to do with their career. But the reality is that our healthcare system does need dedicated physicians to join the workforce. So one resource that is really helpful is that the AMA president or American Medical association president, back in October 2023, gave a national address that highlights the physician shortage, as well as the different ways in which physician burnout interplays with and contributes to that issue. And so the numbers that I’ll cite are from that address in AMA publications and things like that. But one in five physicians surveyed during the pandemic said that they plan to leave medicine within the next two years. One in three surveyed said that they would cut back hours. This next point, this one’s huge. And if you work in healthcare now, it will probably ring true to you. But nearly half of all practicing physicians in the US today are over the age of 55. The American association of Medical Colleges projects national physician shortage of at least 37,000, possibly over 100,000 in m the next decade. And so I loved the AMA president had this extremely thorough, I thought great five step plan on combating this. They’ve identified the problem, a multi pronged approach to addressing it. The fifth item is not punishing physicians for taking care of their mental health needs. And I really love that. Know I went to the AMA broadcasts on this topic, but basically what I’m proposing is this like 6th prong, which addresses how we train people, usually over the course of a decade of their lives, for their career in medicine. That’s kind of interlinked with making it more accessible and more destigmatized to seek mental health care. Part of it is that we need to not have our trainees incur mental health damage inherently by the way that training is set up or by the situations that they’re exposed to in training. And so, certainly, like I said, we know that there are tons of contributors to physician burnout. Again, really beautifully addressed by a lot of associations, including AMA, but there’s EMR stressors, there’s insurance roadblocks and prior auth. There’s decreased reimbursements. And so, like I said, the last thing that we need to do is imbue medical training with various traumas, especially if they are toxic, workplace environment related and not related to, the trauma that we all inevitably are going to have when we care for patients and see poor outcomes or mortalities and things like that, because we’re not even getting into that piece of it, which is that as caregivers, it can be very emotional, and it can be very taxing to care for sick people, especially, if they get sicker or anything like that. So, like I said, there are all these brilliant young people who are deterred from careers in medicine because of various things like horror stories that they hear. I certainly heard horror stories about residency since, like, maybe age ten. And I was like, man, that doesn’t sound right. That doesn’t sound good. And obviously, I still got on this conveyor belt anyway. But I cannot say that I wasn’t warned. The, healthcare industry overall will benefit from a paradigm shift like this to improve the culture of medicine. Really, when we do have to examine the institution, have to examine ourselves and everything that we’ve done to even contribute to or perpetuate the institution of medicine and the culture of medical and surgical training, the question is, why are we creating a culture that almost forces young people to leave medicine for their own well being? In some situations, we have to educate and train them in a way that isn’t soul crushing, that can keep longevity and retention in their careers. and there’s so many other things that they already have to put up with. Like I mentioned, contributors to burnout before. And then again, this younger generation kind of has their eyes wide open about the wildly rising costs of medical training and debt that us pre meds take on, in addition to everything we just talked about, kind of setting the scene on culture of medicine.

Patient mortality after surgery on surgeon’s birthday higher than other days

I have this one specific study that I want to share with you. I love this study. I love the conclusions. I don’t know why we don’t talk about this more often. The title is patient mortality after surgery on the surgeon’s birthday. Observational study. This is a retrospective observational study. It was published in 2020. I know how much physicians like the numbers you’ll want to know the numbers. So, participants selected for this study, it was us acute care and critical access hospitals. Participants were 100% fee for service Medicare beneficiaries, 65 to 99 years old. they underwent one of 17 common emergency surgical procedures between 2011 and 2014, and the main outcomes were postop 30 day mortality, which is defined as death within 30 days after surgery. and they did adjust for patient characteristics and surgeon fixed effects. So let’s talk about the power of this study. There were 980,000 procedures performed by 47,000 surgeons in this analysis. For this study. 2000 of those, which is 0.2% of the whole set of those procedures were performed on surgeons birthdays. Okay, and now we’ll cut to the good part. So the overall unadjusted 30 day mortality on the operating surgeon’s birthday was 7%. And on other days, as in not the surgeon’s birthday, 5.6%. The 95% confidence interval of zero one to 2.5%. had a p value of zero three. And here’s what I really. I got to chuckle out of this, but these are the conclusions to the study, quote unquote. Among Medicare beneficiaries who underwent common emergency surgeries, those who received surgery on the surgeon’s birthday experienced higher mortality compared with patients who underwent surgery on other days. These findings suggest that surgeons might be distracted by life events that are not directly related to work. And I love this. This just screams academia to me, because they had to do this fancy study, analyze a million numbers to come to the conclusion that surgeons might be people, too. And we are people. And I’m not surprised by this interesting study about outcomes based on the surgeon’s birthday for the last several years, and certainly in perpetuity, I take off the week of my birthday. That’s just one of my vacation weeks, and that has always been part of one way where I can protect my time. I’m still a person who likes to celebrate their birthday this way. There has never been any crossover in terms of work life and home life during that period. And not only that, but I also got married during my birthday week, and that was not really an accident. This way, there is one protected week that has, like, the wedding anniversary, my birthday, everything like that. And I can protect it by just booking it out ahead of time with one week of vacation from the hospital.

I was in my second year of residency and working on endocrine cases

So we’ve set the scene a bit here with the culture of medicine, things like that. Surgeons are human beings underneath their scaly surgeon skin. But I now want to kind of just give, like, an introduction to my residency experience, because, of course, a lot of my work, my brand, rethinking residency, this podcast, promising young surgeon, they are all born out of, a need that I saw when I was a surgical resident, going through my training experience. So what I would love to do is just talk about, I will take you to one Thursday in my second year of residency, and again, ent is five years. So this is year two of five. And by this point, interns do a lot of clerical work, a lot of clinic. We did get to operate a bit, definitely spend some time in the operating room, whether it was for a bigger case and we were just retracting, or other times we got to do like, directular angoscopies with biopsy. That’s a good intern case, like ear tubes, things like that, maybe some tonsils, but, primarily your retractors. And then you’re also inpatient and clinically oriented. As a second year resident, you do start to definitely enter the OR, and you’re starting to enter the or as the first assist to the surgeon. Like you would now be maybe the only resident working with an attending on a bigger case. So this Thursday, I had a thyroid lobe. Interestingly, on Wednesday, the day before, I had my first two thyroid lobes with this attending, and I was assigned to work with him again on Thursday for one thyroid lobe. I will tell you that the preceding Friday, when the schedule came out with our assignments for the next week on there, like, which clinic you’d be in, which surgeries you were assigned to, and I saw these cases, it’s like, you could have knocked me over with a feather. I was like, oh, no, this is going to be scary, right? Because this guy had a reputation. and this was also really my first time getting into these real endocrine cases and being, like I said, the only resident with the attending on these case, as opposed to being the secondary resident. Okay. You’re kind of standing at the head of the bed, and you’re assigned to retracting, which. That’s still a good learning experience, though, upside down. So it’s a more limited learning experience than if you were right side up oriented to the field. But, that person’s not really in the line of fire. The way that a solo resident covering a case could, for instance, be in the line of fire. That’s a little bit of foreshadowing. But on Wednesday, the cases actually went really smoothly. I had spent the past, several days reading the textbooks, studying the steps, definitely, like, memorizing them backwards and forwards. That only gets you so far. And then I had gone to a senior resident and kind of consulted with him and got all of his notes about how this specific attending liked the, or setup. Just little idiosyncrasies about what they like to grab strap muscles with, things like that. So I’d studied the notes Wednesday, honestly, really went very smoothly. And, I mean, to the point that on my way out of the outpatient operating center, people were, like, high fiving me. They were like, wow, that was not bad. There was not that much screaming from any party, like, great. And so I went into Thursday not cocky, but I was cautiously optimistic. I was like, wow, okay, maybe we really can do this. And I was definitely loving endocrine surgery, and I was really able to see the fascial layers as we went through them and things like that. I wasn’t a person where you point out the anatomy or point out now that we’ve transitioned the next layer deeper, and I am confused or can’t see that or anything. So on Thursday, from the get go, I show up at about noon, I’m getting the or ready, doing everything like that, and a medical student shows up who was assigned to this case. That’s kind of strike number one, because I would learn later on from one of my scrub tech’s friends who, worked with him, this attending, for ten years. She was like, oh, he’s always much meaner with an audience. I don’t know why that’s a thing, but would have been great to have that heads up ahead of time, because no one had really warned me about that. But regardless, the three of us, the attending, myself, and the medical student, we scrub into the case, and we’re working, and this is a, ah, goiter with some substernal extension and everything. So it’s a challenging case. Like, even physically, like, pretty challenging. But, we’re doing great. We have good hemostasis the whole time, and basically it goes by fine. Sure, there’s little snps here and there. Like, at one point, he had dissected some tissue to show to me, for me to bipolar and cut, and I did it. And his response was, well, that’s one way to do it. But if you actually wanted the medical student to respect you, you would have done it the way I taught you. And of course, I was like, oh, yeah, absolutely, I want to do it the way that you are teaching me. Like, you are a very established head and neck surgeon, and I am definitely a newbie. I didn’t say anything because I don’t think it needed or merited a reply or anything. So, anyway, we keep working, and then the thyroid comes out. Beautiful. And that’s, like, such a hurrah. Moment of the case. That’s awesome. And again, the dissection had been really clean and excellent. We’re just feeling good at this point of the case, and it’s the part where we start to turn around into the closure. So the thyroid is out. We’ve irrigated the wound, we’ve confirmed really good hemostasis, and we are closing.

This attending has a very particular technique for closing the straps back together

This attending has a very particular technique or style for closing the straps back together at midline, and it involves a pop off vicro suture. For the listeners who have not seen this, it’s just basically a type of suture, but the needle will pop off, quote unquote, from the suture itself. It definitely, in certain situations, especially in head and neck, it can be, like, a lot easier to do all your throws with that pop off all the needles, tie them down. of course, stylistically, there are other surgeons who like to either run a stitch or they just like to save more suture, kind of be less wasteful of suture, and then they won’t use the pop off feature or they won’t use a pop off type. But regardless, this attending likes to get the straps closed with a horizontal mattress, and then you pull the needle straight up, and you pop it off. And he had shown me this just the day before, and it’s very unique to him. I’ve never seen it anywhere else, like, before or after this, but he likes to popped off. I was thinking to myself, okay, do this right. I was, like, the meme of that lady with the trigonometry floating around her face, and she’s, like, trying to reorient herself and thinking, okay, is this good? Is this right? And I thought I had it as I was taught the day before, and I pop it off immediately, I see that I did not do it right, and I’m like, oh, no. Oh, my gosh. So I’m starting to get pretty terrified. I see that I did it wrong just by his immediate reaction, and he goes, I wish we lived in a world where I only had to teach you how to do something five or six times, but I guess we don’t live in that world. And I’m starting to become pre scared at this point. And I was like, oh, yeah. And so he shows me again really fast, and he says, this is the way to do it. Okay. And I paused before I said, okay, and this is the part of the horror movie where you’d be screaming at the girl, like, just get out. Just, like, sprint right out of the operating room, keep walking. Start over as a graphic designer. Like, start a new life under a new name. Because basically, the reason that I paused was twofold. Number one, scared the wits out of me. I was, like, petrified. Number two, I could not tell what was different between how I’d done it wrong and what he had just demonstrated as being correct. So I just paused, and then I said, okay. And that was perceived as insubordination, I was later told. But basically, it led to him putting everything down, all instruments down, raising his voice to say, you think you’re so smart. You think you know how to do this stuff, but it’s my way or the highway. Like, I don’t even need you in here. I can do all this without you. I am actively fighting tears. And he leaves. He actually storms out of the operating room. And so then I just start crying. So I’m crying tears into my mask. I’m just very shocked and afraid. And I was left. Now that he’s gone, I’m in charge of finishing this closure. So I get the platisma closed. I get the subcue and the skin closed through tears. Not a person in the room says a word. There’s just, like, yacht rock playing, because that’s his station. So it’s just very haunting because there’s the yacht rock going. Nobody’s saying a word. Me crying, which people can see and hear, and I just get the case done. I do the closure. Not only did nobody say a word, but actually, then when we were rolling to the Pacu together, I had a hand on the front of the bed, and we’re all rolling together. I’m still crying. In fact, more. I would say, like, once we left the oR, then the situation was safe, and we’re moving to pack you, so crying more. And the crna looked over at me, and he laughed at me, and he was like, oh, yeah, he makes every resident cry, like, at least once. And it wasn’t said in this way. That was like, wow, that was kind of messed up. I’m sorry that happened. That is tough. I’m sorry it happened to you. Nothing like that. He actually seemed very entertained, by the way, that this attending makes every resident cry. And so I just like this story because I think it’s really ubiquitous. I don’t think that that’s specific to one attending or even one program. I think that a lot of other surgical residents could at least relate or have seen something like this. But what’s even crazier is this culture around it, because nobody in the workplace, nobody in the operating room was like, are you okay to close this by yourself? Like, you’re only a second year, and you do seem awfully upset based, on the tears that we see. There was just nothing like that. And not only that, but there are, like, instances where ancillary staff, I mean, are just outright entertained by this internal hierarchy and system of, bullying that can exist. So what are the takeaways from this? This happened my third time ever doing a thyroid with this person. Three is still a very low number of rodeos to have done. And like I said, I just think that this is such a good example of what a regular Thursday in residency can be like, because this was not isolated to even this month. This is something that is going on, and it’s what I would argue that we need to talk about, in order to even start to address or change it.

Adam Kay writes about how unsatisfying it can be as a resident physician

There’s another point about being a resident that I have seen, elsewhere in a book. This is going to hurt by Adam Kay. I really loved his storytelling, and I definitely could relate to this one aspect of it that he brings up in his writing. And that is how unsatisfying it can be as a resident physician. Specifically, how unsatisfying it can be to not see the conclusion of care that you’re providing. And that’s very real, because we don’t get to see the whole story. Like, we’re pretty much just run ragged coming in at discrete moments in time in people’s care. Of course, sometimes we get to follow somebody as an inpatient, and then you get to know them during that inpatient stay. But in terms of man, what’s the likelihood that you’re going to be there at their surveillance clinic visits afterwards, say, for a head and neck cancer, it’s a low likelihood. And so residents just typically do put their heart and soul into the work that they’re doing. Definitely care a lot about the patients, the outcomes that the patients have, everything like that. And we often don’t get to see any of the longitudinal piece of it. So I just thought that this was a great point, and it also just illustrates this other aspect of being a resident that can put a little bit of wear and tear on you. So my story that I want to use to just highlight this is that when I was a third year resident, I was on junior call consult. Still, our second and third year residents took junior call and then as a fourth and a fifth year resident, you took senior call, which meant that you were the second call, and that sometimes you could just answer questions from home or things like that. A second or a third year resident, like on junior call. All right, you’re the first call that can be quite busy, just in terms of phone calls about giving medications overnight. All new consults from either other services in the hospital or through the emergency department, those all come to you. And so again, when I was a third year, I got called one evening, like, about 06:00 p.m. And it was a facial trauma that we were being consulted for, and it was a degloving injury. And anyone who’s ever taken facial trauma call, you’re probably just thinking, phew, okay, glad that that wasn’t me, because deglovings are not fun. This injury is essentially where typically something sharp will catch someone, like, in this case, at the front of the forehead, something like that. And that sharp object with force will just shear off a giant piece of soft tissue, and they can be quite deep, like, in this case. And I think this is pretty representative of a common type of degloving we’d see in mvcs and things like that. It involved everything down to the bone. Like, even the periosteum was in all that tissue that had sheared off. So there’s this open flap hanging back here. And then our job is to irrigate it really thoroughly, make sure it’s clean, make sure we take out any foreign bodies, like sometimes dirt clods or glass, things like that, get it really nice, and then repair it. But this repair is not just, like, lay it back on and glue it shut. This is a multilayered, much more intensive type of repair. So, you know, it’s going to be time consuming. Again, anyone who’s taken facial trauma has probably been up all night doing and deep, loving. And so shout out to my senior resident that night because he actually came in and helped me close it for a few hours because it was 06:00 p.m. So we were all at the hospital. Anyway, we went down, took, a medical student with us to kind of help cut sutures and things like that, and we started closing this. And again, like I said, shout out to the senior resident because I made it home before midnight that night instead of after midnight. That was pretty much the difference that it made for him to stay and help out and just get it closed, like, a little faster for the first few hours. but we got it all shut pro tip. Don’t forget to put a Penrose in these, especially when they’re in the temporal area, because very high risk of hematoma, after you’ve closed them up. So we close it up beautifully with a Penrose. The patient was in the emergency room the whole time, but of course, he was on very good pain meds. Of course he was in a lot of pain. We were actively, yes, we inject, but we were actively, at any given time, closing him up with multiple sharp objects. he was snoring and asleep for most of it. And the part that he was awake for, he was just zonked out. Good pain meds. Three months later, I just happened to be in the attending clinic, who was on call that evening. So, of course, there’s no crossover. Like, they would have never met before. This is something that we just got really, well, closed up. He was admitted to trauma for, like, a few days, and then he was sent home. This was just a routine follow up for the soft tissue and make sure everything healed okay. Make sure they don’t need scar revision, that they’re happy with it. Plus, the frontal branch of the facial nerve had been re approximated as part of this as well. So it was so wild, because I saw that he was in clinic. Like, that was the next patient up. I had to go and see him first to present him to the attending. And it was so great to see him. Of course. I was like, how are you doing since your injury? And this guy, he looked awesome. He looked great. He had healed very well. He was on the younger side, so, I mean, the skin was looking, like, really excellent for the degree of injury that he had suffered. And he was just so happy. He was like, I’m feeling so good that I thought about canceling this visit, but I had to come in and thank Dr. P myself. He did the most incredible job. Dr. P is a fake pseudonym. That’s nobody, but that’s the attending in this scenario. And he was just like, I had to shake Dr. P’s hand myself. Like, what he did, this was big deal. They showed me pictures of the injury before it was repaired. I’m just so grateful to him. And so, like I said, when I repaired it, he was zonked out of his mind. I totally understand why he wouldn’t remember us. And of course, I was like, yeah, he is the best. Like, no problem. So then I had to go tell the attending, he just wants to shake your hand for the job that you did that evening. He went in, they did the visit. but I just like to highlight how at times being a resident does feel like being a cog in a wheel and that is part of the wear and tear that a resident physician can experience. Thank you for bearing with me through my kind of resident stories. I’m just trying to set the stage for some things that are pretty universal that I think can be improved upon. And by talking about them and setting the stage a little bit, we can start that conversation and like I said, kick around some ideas. I’m so excited to be joining the influent network, which is a platform specifically aimed at amplifying physician voices. And this is the dream. I get to bring these stories to a community of people who may be in need of them or have been looking to find them. I started a podcast to build the community of people with shared values and a willingness to explore the necessary culture change in medicine and medical training in the US. And I wanted a creative outlet to connect with people who are interested in physicians and surgeons’lives, tune in every week to hear more physician stories that expand our understanding of medical training and kick around ideas on how to change the culture of medicine and build a softer world. Next week, we will have Dr. Lauren umsted on the podcast to discuss abuse and residency training, as well as the lack of support and importantly, protections for residents and fellows throughout their training years. Dr. Omsted is an exceptional and successful facial plastic surgeon who owns and operates face Leewood in Kansas City. She will share her own stories from residency and fellowship training and will discuss how institutions have a vested interest in protecting themselves when allegations of abuse or misbehavior arise. Follow me on Instagram at at Francesmay, MD and at rethinkingresidency visit my website rethinkingresidency to learn more about resident physician stories and ways that residents can most effectively navigate the game of residency. I can’t wait to connect with you on the next episode of Promising young Surgeon.