Q1) It is your Chief year! Did you ever believe this year would come? How would you reflect on the journey overall thus far?
To be honest when I started, I couldn’t actually envision myself ever becoming a chief resident. The knowledge and skill that I saw in our chiefs seemed unachievable for me. Maybe that’s why it took me 7 years to get here instead of the traditional 4. Just joking, that was my research break. Looking back, it’s incredible to see how far I have come, but I still feel like there is so much more to learn and just not enough time to take it all in. Residency training in General Surgery has been the most challenging and yet rewarding endeavors of my life. A part of me will be sad that it’s over, but I am incredibly excited for whatever comes next.
Q2) So what is next? Where are you off to in July? Have you already lined up a job or a fellowship or are you still keeping your options open?
Life after residency is still a bit of question mark for me as I am still figuring out my next steps. I have always loved working across the entire breadth of general surgery and find great reward in caring for acutely ill patients. With that in mind, I still plan on completing an acute care surgery fellowship at some point. I am also extremely passionate about medical education and I am looking forward to becoming more involved in teaching at the medical school level. While I am still on the hunt for opportunities to further my skills in these areas, I am also learning to find contentment in this time of uncertainty. At this point, step 1 is passing that final quiz and we’ll see what comes next.
Q3) What are you going to miss the most about residency?
Without a doubt, it’s the people I have been privileged to work with each and every day of this journey that I will miss the most after residency. Whether it’s in the operating room or on the hospital wards I am so grateful to have learned so much from everyone that I have worked with. When I am finally out on my own, I will miss seeing new ways of approaching old problems and learning a new operative technique on a daily basis. I am fortunate to have received so much support from all of the staff and continue to be inspired by the hard work and dedication of my co-residents. I will truly miss you all.
Q4) Where did you go to medical school and how did you come about the decision to specialize in General Surgery? Was it something you gradually got into or is there an “aha” moment from your background or training?
I completed medical school at the University of Calgary. Despite thinking that I would go into Public Health when I applied, I quickly realized that I wanted to take a more hands-on approach to caring for sick patients. I spend my early electives in critical care and emergency medicine before having the opportunity to work with a General Surgeon in a resource poor community. The surgeon’s ability to diagnose a patient in the emergency department, remedy the problem in the operating room and then see the patient get back to their life was entirely captivating. After that experience I just couldn’t see myself doing anything else and not much has changed in the years that came since.
Q5) What is the most memorable thing that you have done outside of surgery in the last five years?
It can be hard to travel during residency, but I somehow managed to carve out two weeks between rotations to travel to Peru in my second year with my now fiancé. We had an incredible time hiking the Inca Trail, travelling to Machu Picchu and the Colca Canyon and suffering hypoxia together at the top of a volcano after we climbed to an altitude of over 6000 m. It was a much-needed break in the middle of my hectic junior years and a life-changing adventure that neither one of us will ever forget.
Q6) What was your most memorable night on call?
It was a night that was ultimately punctuated by three iPhone alarms simultaneously going off in the middle of what must have been our fourth emergency surgery of the night. It seems that the staff surgeon, senior resident and me, the junior resident, had all planned on getting up at the same time before ending up in the operating room all night. As funny as that moment was, its everything that happened before this moment that makes it so memorable. After a slow start, we were suddenly inundated with pages for new consults, sick patients on the ward and eventually multiple emergency operations. I will never forget that night partly because of how hard I worked, but mostly because of how well we worked together as a team and what we could accomplish together.
Q7) What was the absolute funniest moment during your residency?
It was the beginning of a new rotation and the attending surgeon was kindly introducing me to our patients on the ward but struggling greatly with my last name. Every room it was a new creative reinterpretation. After keeping my composure for the first few, I laughed quite loudly after my introduction as “Dr. Van… Zander… Thorn.” The subsequent look the patient gave me, as if to say, “How dare you laugh during this serious moment?” made it even more memorable. I apologized, explained and we all laughed together, but obviously to those in the room, I will forever be Dr. Van Zanderthorn.
Q8) How about the scariest moment during your residency?
Rotating through the intensive care unit presents residents a steep learning curve but is absolutely necessary to feel confident caring for sick patients in the middle of the night. It was my last night on call and I was on my own on the unit when suddenly one of our patients who had been intubated during the day developed a tension pneumothorax. Earlier that night I had placed a central line seemingly without issue, but now the patient was coding, and I felt responsible. Immediately I called for help as I struggled to decompress the chest and place a chest tube. Fortunately, we were able to stabilize the patient, but I must have been white as a ghost by the end. I never would have made it through that moment without the support of the nurses and other the rest of the critical care team. For that patient and every other one, I am endlessly grateful.
Q9) Do you have any call superstitions or routines?
I am not a superstitious person, but someone early in residency told me, “Nathan, you don’t have to believe in something for it to have an effect.” As years have moved along, I have found myself acting increasingly superstitious when I am on call overnight. Reinforced by one or two challenging shifts, you will never hear me say the Q-word or tell the nursing staff that I am going to try and get some sleep. It’s not that I believe that it makes a difference, I am just not willing to take the chance that it does.
Q10) If you could give some words of wisdom to new Residents starting General Surgery (or to your past self on the first day of residency) in the light of everything we’re facing these days across Canada (limited jobs, duty hour restrictions, more and more specialization), what would it be?
I wish that I had realized earlier in my training that despite how it feels, you don’t have to be perfect every day. The truth is most of the people you work with don’t expect you to be perfect, they just want you to work hard and take good care of their patients. Atul Gawande’s book, Better, was one of the most influential books I read during my residency and in it he writes, “Better is possible. It does not take genius. It takes diligence. It takes moral clarity. It takes ingenuity. And above all, it takes a willingness to try.” Becoming a surgeon doesn’t require perfection, it only requires that we give our patients our best effort each and every day. The more we do that, the better surgeon we become.
Q11) What would your juniors say is the best thing about you?
It doesn’t feel right to answer on their behalf, but I hope they would say that I care deeply about their success in residency and am fully invested in their education. Whenever I interact with one of our amazing juniors, I try to value their growth and learning as much as I value my own. General surgery juniors are some of the hardest working residents in the hospital and it can be tempting to focus on the operating room and let them do a lot of the heavy lifting on the wards. We must always remember that residents are still learners too and it’s imperative that we invest as much time and effort into their education as they spend taking care of patients.
Q12) Rapid fire:
What do you listen to in the OR? Whatever pop music I can get away with
What is the operation you dislike the most? Babysitting the big toe
What is the operation you like the most? Exploratory Laparotomy
What is your favourite medical TV show? Scrubs, no question
What is your go-to surgery textbook? Cameron’s Current Surgical Therapy
What is your post-call ritual? Sleep as soon as possible and try to have a productive evening
What is your favourite “go-to” food on call? Vietnamese from Touch of Ginger
White coat or hoodie? White coat during the day, hoodie at night
Single or double glove? Double Glove
Dry scrub or wet scrub? Dry Scrub
Trauma laparotomy or elective Whipple? Trauma Laparotomy
Open inguinal hernia repair or laparoscopic? Laparoscopic Hernia Repair
Monocryl or skin staples? Skin Staples
Perianal abscess I+D or ingrown toenail? ???? Perianal Abscess, feet are gross