In which I squander my right to bear arms.

In elementary school, I was told that if I try hard enough at anything, I could do anything I put my mind to. But inspirational as that might be, it’s still a load of codswallop. My best effort isn’t good enough, and it probably will never be good enough for surgery. I understand the gut-wrenching despair of feeling swamped with information, with getting back an abysmal test score. But I could always study harder, or study more. And in a sense, I have. I’ve practiced my knots; I’m the fastest in my cohort, one-handed, left-handed, right-handed. I’ve practiced my subcutaneous suturing (two attendings said my work was “not bad.” They didn’t rip it out and redo it, so…). But brute strength? But what if this mortal husk I call mine is just not tough enough? It’s time to admit the cold hard truth. It’s too late for me to suddenly muscle up enough to make a difference.

I had missed my alarm the morning of a total vaginal hysterectomy case, and I hadn’t been given the case the night before to look up. I managed to rush there on time, but I hadn’t eaten or drank anything, and an hour into the surgery, I was retracting stiff tissue and my hands were shaking with the effort. My muscles were screaming, but the attending kept telling me I needed to retract more, that I was putting the patient’s bladder at risk if I didn’t properly retract the anterior wall. I knew she was right, but wishing I could put more effort into my arms didn’t actually change my force output. After what felt like a few minutes (honestly, probably seconds), I told her that I couldn’t hold the position much longer. She told me to hold on. I suddenly noticed that I was sweating. It was hard for my eyes to focus, and the tension in my back and abs started turning into burning nausea. I told the surgeon again, “I don’t think I can do this.” She was already frustrated and told me to just keep holding; the procedure was harder than we had expected, because the patient was obese and the vaginal opening was so narrow. My terrible retracting job probably only made it worse. She had had to adjust my hands what seemed like every few seconds as she worked, even though every time she adjusted me, I tried to pull the flesh back harder. At my third complaint, she asked me, “What do you want? Do you want to take a break?” The words were meant to be kind. They came out angry. I wish she had said instead, “You don’t look so good. You should take a break.” At this point I could barely hear anything over the blood pounding in my ears, a few traitorous tears were leaking into my mask, and I had to admit defeat. “Yes, I need a break. I feel like I’m going to throw up.” Emesis must have been the magic word, because in seconds the circulating nurse whisked me into a chair and I hunched there, sweating, breathing hard, hearing just pounding, as my arms and legs shook. Both arms were numb up to the elbows. The scrub nurse took over where I left off, manning both his job and my job for ten minutes as I broke scrub and drank water in the break room. I never felt like so much of a failure.

When I scrubbed back in, the scrub nurse and circulator were making jokes to help me feel better. They reassured me that this kind of thing happens to everyone. But when I resumed my former retracting position, the attending didn’t acknowledge me at all. She didn’t look away from her work, didn’t make any sort of comment about my almost passing out, or my return. I know she had more important things to concentrate on, but I couldn’t help but think she wished I could just do my one simple job right, so she could do her terribly complex and difficult job better.

I don’t know how I made it through the next seven hours. Luckily the nausea did not return. I was perpetually hunched beneath the patient’s left leg, almost always with the foot right up against my eyeshield. At that angle with my arms and my back, even if I were well-muscled, I wouldn’t be able to hold the retractors at my full strength. And I was still in the way. Every so often, the attending’s elbow would lightly hit my face as she pulled at sutures. I don’t blame her. There was so little space. There was no acknowledgement of our little face-five. I bet she wished my head weren’t there. The whole situation would be comical if my back weren’t screaming. My arms were screaming, too. My hands, well, if I opened my grip every so often I could feel the pins and needles returning to them. I talked to God. I recited verses in my head. I thanked the Lord for the moments the surgeon turned to grab another instrument, where I could relax the retracted flesh a few millimeters. Or when my retractor wasn’t necessary for a certain spot, and I could return the abused hand to my chest. I tried to have an out-of-body experience. I imagined an awards ceremony in which I was given a medal for being the world’s best retractor (I wasn’t by a long shot). I imagined one of my classmates, also on OBGYN, who had huge muscular arms rippling out of his scrubs. I bet the attending would have loved if he were here. He probably could hold this flesh open with one hand and bench a house with the other. I imagined if I had those arms. I’d have to buy a lot of new clothes. But outwardly, I tried not to make any more sound for the rest of the surgery. I didn’t feel it was safe to mention if I were feeling uncomfortable. Doubtless everyone else was feeling the strain, too, as the surgery dragged on from the predicted four hours to eight. But if we all broke scrub and put our instruments down to coddle them every time they had a boo-boo, where would the patient be? Why couldn’t I stop being so selfish, weak, and useless, forcing everyone else to work extra hard for my sake?

I was in high school the first time someone laughed at me for wanting to be a surgeon. I was there in his palatial catalogue-worthy three-story apartment in Taiwan, asking him for advice about medical school. He asked, “What do you want to do?” I said, “I want to be a surgeon.” He laughed in my face. “You? A surgeon? You can’t even lift a man’s leg if you wanted to. Do you know what surgery is?” I remember leaving red-faced and humiliated. Like many things in my life, I wish I could, as a representative of my gender, prove him wrong. But I continue to learn that, thankfully, the female demographic does not champion me as their hero. They have plenty of able-bodied female surgeons to do that. And that in my individual case, I cannot prove him wrong at all. But I can’t help but feel I let down people who look like me.

If I could just study harder and be of more help in surgery, I’d do it. But to be stronger? To be less weak and useless? I thought I had left behind my life of being the last pick for sports at recess behind. What a shock to find a dim echo here, waiting for me.

I spent most of the rest of the day after the procedure studiously not thinking about what had happened, what it meant. I had a decently nice afternoon and evening. But when I pulled up to my house, 9:55 PM, it resurfaced. When my dad asked me about my day, I couldn’t stop sobbing, these huge alien staggered gasps so protracted that made me feel like I could choke and die right there on my living room couch, drowning in my own tears. I guess deep down I had always believed that studying harder, eating right, losing weight, taking the stairs, parking farther, would be the bare minimum to keep me swimming well enough to at least round out the rear of my medical school cohort. Yeah, if I just try hard enough, I can do it just like everyone else! But med school finally pulled it off for me, the well-orchestrated moment that almost all of my classmates have described to me before, whether it happens in sophomore orgo or junior physics or first-year anatomy: the moment of realizing that in this matter, no effort, method, or willpower will make me even adequate for this demand. Nothing I do will make a difference. This is what it is. I’m just not made for wresting a vagina open for 8 hours. I probably fairly earned my attending’s contempt, and I will never be able to fix that impression, because it’s accurate. Breathe. It’s ok to fail. Breathe. Everyone does, sometime, somewhere. Breathe. This is my turn to fail.