REFLECTION

First impressions are everything. At least that’s what they say. As a fourth-year medical student, eager to earn a spot in an orthopedic residency program, I researched as many programs as I could. In my home town of Spokane, Washington, where I completed my final two years of medical school, there was not yet an established rotation with any of the orthopedic surgeons in town. Furthermore, there does not even exist an orthopedic surgery residency program. I did not have a lot of exposure to orthopedics, and I had zero exposure to an orthopedic residency program. Many reviews posted by past students on various websites and forums online continually drew me to look into programs in Michigan. Michigan? I couldn’t deny the fact that Michigan is an incredibly unique state in the sure volume of orthopedic training programs it has; many of which have well-established, rich histories and successful track records. At the pinnacle of my list of top-tier programs was always Genesys Regional Medical Center (now Ascension Genesys Hospital). What I read online became confirmed by word of mouth; it had a reputation as a well-rounded program with a strict, but rock-solid program director and an incredible group of attending surgeons. The case volume was tremendous, and the autonomy of the residents unmatched. But that was not necessarily the impressive part of the program. What made the program, many said, was the residents. Their work ethic and orthopedic knowledge was unmatched. The education was resident-driven and was second to none. Reduction and casting/splinting skills were superb. Every bit of the autonomy the residents had was hard-earned, and they were held to high standards by both the PD and attending surgeons as well as their fellow residents. It was not a place for someone looking for an easy rotation. It could be intimidating, and grueling. Some said that the residents were nice and taught well, but busy and it was hard to get personal with them because they never had a spare moment. Honestly, I was so terrified by a place with such a reputation… and that’s exactly the type of place I knew I wanted to be. 

I set out to expose myself to what I thought were the best programs “out there” for the next 5 months, rotating at 4 programs in Michigan and 1 program in Pennsylvania. My first month ever of being exposed to, and working with an orthopedic surgery residency program was going to be at Genesys. I was beyond nervous. The near-folklore of that place and it’s residents made me second guess what I was doing. I knew nothing about orthopedics, except that I was going to be “pimped”. Was I overreaching? Could I compete for the best of the residency programs? Yes. I decided that all I could do was work my tail off night and day, learn as much as I could, leave it all out on the field, and hope for the best.

Well, first impressions ARE everything. In fact, with no disrespect to all of the other programs, Genesys may have ruined my impression of every program that I encountered after them.

Fast forward to now. As a chief orthopedic resident at Genesys, all of this sounds a little over-the-top, even silly. However, I still vividly remember my thoughts and feelings as I went through the process. I am not embellishing now how I felt back then. I understood the incredible responsibility that I was about to take on if I was going to in fact pursue a career in orthopedics. Patients were going to trust me, and permit me to cut them open! It was the weight of that responsibility that drove me to find a place that would properly prepare me to bear that burden with confidence. I wanted to find a place that would push me to my limits for 5 years, a place that would get the most out of me and out of each moment spent in training. I wanted a place that proved that it could produce prepared, skilled, competent, fearless surgeons routinely. I found such a place in my first week of audition rotations. The stories were true. Genesys was the benchmark. Perhaps unfair to the other programs, I held every resident to the standard which I encountered at Genesys. Sure there were individual residents at other programs who were great, knowledgeable, kind, or fun; But each still fell short in some way compared to the complete package. I will forever be grateful to that group of residents and attendings who took the time to teach me, an eager medical student who initially had very little orthopedic knowledge. Those residents, many of whom became my co-residents, and attendings recognized instead, the progress made, work ethic, and passion for orthopedics, and decided to give me a chance.

Nobody coming out of Genesys “needs” a fellowship. Those skills that others might need a fellowship to acquire are almost certainly developed and even refined during our time in training. Yet, this only better prepares us, and better qualifies us to pursue the fellowships of our desires. With the support of our program and attendings, the Genesys residents have consistently been able to successfully match into many of the best fellowship programs in the country. The quality of our training at Genesys was reinforced to me a year ago as I was on the “interview trail” for a fellowship in adult reconstruction. The opportunity to mingle with residents from all over the country solidified my belief that the knowledge and surgical skills of our residents rival the best of the best.

Fast forward again to today. Never could I have imagined a scenario in which the peak months of my orthopedic training would be taken away from me. Many surgeons recall those last 6 months of their residency as a “golden time”. I was looking forward to prime opportunities to bang out a ton of surgeries, putting all of the pieces of nearly five years of intense training into place. Teaching other residents, and passing on any last tips or tricks that I had learned that may help them in their journey. Nobody could have predicted the way that the COVID19 pandemic changed, and impacted so many things so abruptly. At first, I was bothered, almost bitter. It wasn’t fair.

I felt robbed.

As a program, we took on the challenge well. We were effective as we collaborated, brainstormed and developed fair, thoughtful, safe plans and protocols together as a team. Our education didn’t miss a beat as we transitioned to all virtual meetings. One morning as a meeting ended, and we all signed off I sat there numb and deep in thought. Then out of the blue, my phone startled me as it chimed with a text. It came from one of our attendings. A surgeon who I admire and look up to. Someone who I consider to have played an intricate role in my progression and development as a resident. A mentor who must have known what I needed to hear at that moment. Make no mistake, I do not share part of his text to me in boasting. I share it to showcase the quality of character of my attending, and many of the attendings who have trained me; I also share it as insight into that moment which sent me back into a period of deep reflection.

The text, “…sorry this virus is taking over the last part of your training. You have done great! One of the best ever, and will be greatly missed.”

I sat back, almost in tears. I started to reflect on everything that I have done and been through over the last five years. I cannot speak for other programs, but orthopedic surgery residency at Genesys described in one word is relentless. The early mornings, the brutal hours daily, the brutal weeks, the morning reports, the lectures and presentations, the intense amount of reading and studying. So many call shifts, night shifts, late nights, endless amounts of surgery, case preparation, sleep deprivation, missed meals, and the list goes on and on. And I would not trade it for the world. Relentless is exactly what I wanted. And Genesys delivered. All of the grueling work of literal blood, sweat, and tears was also interwoven with comradery, fun, growth, knowledge, progress, mentorship, and endless opportunities. All of my collective experiences in training had led to both competence and confidence.

At that moment, I realized that I was willing to admit what I already knew. That Genesys had delivered. The fact is, for some time, I had already been banging out surgeries with incredible, yet appropriate (and hard-earned) autonomy. For some time, I was already living out that “golden time” of residency that so many others do not get to experience until the last few months of their training. For a while now, I was hitting my stride. I had been putting all of the pieces together, operating and teaching other residents, passing whatever pearls I had learned on to them. At that moment, I realized that it was all ok. I finally replied to my attending,

“That means a lot, I really appreciate that. It really hit me a few days ago that possibly the last elective cases I will ever get to do in residency very well could have been back in February. It’s kind of surreal. But I am at peace with that, if that is the case. Because of incredible attendings and mentors like you who have been so remarkable about teaching me and providing opportunities for me to learn and operate, and setting me up for success. Thank you for that.”

I sit here now, and reflect on the almost overwhelming burden of the responsibility I felt as a medical student, that I had only five short years to become the best surgeon that I could be. I think about my first impressions of Genesys as a medical student, and how I made the right choice. Everything has come full circle, and I no longer feel bitter or robbed. No, not even close. I feel blessed for the opportunity that I have had to train at a place that has developed me into a compassionate, humble, yet confident surgeon. I feel immense gratitude to all of those who have played a part in preparing me. Preparing me for this situation, of ending residency in a way that I didn’t anticipate; for preparing me, no doubt, to face future unexpected situations. As my last day as an orthopedic resident is nearly a month away, and the future is yet unknown, as I told my attending in that text: I am at peace.