The answer, at least the expectation of the commanding officer, was fairly simple, if not obvious. And a good ice-breaker to start the discussion. But the young pilot’s response caught his CO completely off guard. The pilot reacted, as pilots often do, with a simple and emphatic word: no.  At that moment, the tone of the conversation changed rather dramatically, and the officer looked quizzically at his inexperienced student and asked why. His answer was both factual and based on science versus speculation or military optimism. “With our current engine specifications of lift and drag, higher speeds would require the engines to be too big. And, at that size, the resulting aerodynamics would not allow a significant increase in airspeed.” Of course, the answer didn’t incorporate the jet engine which was the real game-changer and not yet available to either the military or commercial aviation.  But that innovation was just around the corner.

Years later, a young medical student was called into his attending’s office.  This time, the discussion was regarding his application for a residency program at a prestigious medical center. The conversation followed a similar path as the young pilot, as they both chatted about the evolution and transformation of medicine today and into the future.  The discussion turned from the clinical to the philosophical, as the student spoke of his father’s dissatisfaction with his current job as a primary care physician. The future seemed a bit uncertain for both father and son.

Then the question from the attending came.  “Do you feel that the physician of today, you and me, will become obsolete?”

The medical student was on guard, as this was an important interview.  So, it’s no surprise that he heard zebra hoofbeats in the distance. But still his response was swift, resolute, and almost pilot-like—he said yes. But there was more to come. He spoke eloquently of his father and how the joy of medical practice had deteriorated into a system where pre-authorization became a misplaced journey of hope for both the clinician and patient. He explained how holding a hand was replaced by holding a mouse and peering at a keyboard and screen. And he opined on how his father would come home late at night, exhausted and burned out from a system that seemed to priortize dollars over heartbeats.

His point was clear.  That physician of today is obsolete.  The role is inconsistent with the human needs and desires expressed by patients, caregivers, clinicians and all those who provide that simple four-letter word: care. But he continued about his personal expectations for tomorrow. He clearly didn’t want to become that type of physician and suffer the consequences of an oppressive system. It had little place for him or his father. 

His voice became elevated and optimistic as he presented his generation’s future and reclaiming the joy of medicine.  His vision wasn’t a compromise, but a perspective on how technology can redefine roles, share the cognitive burden, and even enhance his human capabilities such as hearing, touch, and sight. 

Just like the jet engine, advances in technology that he grew up with, can help define his humanity and redefine medical practice.  He tempered his perspective with the reality that this is no simple task or path.  And in many instances, it’s already been declared DOA by those types who still flew in the old “prop jobs” of yesterday.  He concluded with the simple observation that change, and change for the better, is at hand.  And his job, as a new intern, would certainly be to hold the hand of his patient. But sometimes, he concluded, technology might be holding his other hand.

Author’s note:  The young pilot in this story is my father, John T. Nosta who was a Naval Aviator in World War II. He later went on to become a successful electrical engineer.  His vision was both practical and forward-thinking.  And sometimes, he liked to fly very fast.  The year 2022 is the 100^th anniversary of his birth.

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Scalpel, please!

I’ve never been ‘on the table’ in surgery. I can’t empathize, but I’m endlessly curious about it. As a doctor in training in Romania, I consider it only from a professional perspective. As much as I would like first-hand knowledge, I fear the loss of control over myself.

What is more, I’ve seen the movie ‘Awake’. Certain visuals are so hard to erase from one’s mind!

Despite all the movies featuring surgery, I never imagined that anyone could be brought up to such a fragile state of being.

TV screens don’t do humanity justice. They make us seem too ‘fixable’, and downplay our risk of death. It’s almost a systematic desensitization, seeing your fellow humans bleeding out while you’re on the couch, your eyes glued onto the display. With the movies nowadays engaging in such explicit (yet unrealistic) content, it’s hard not to be fooled by the idea that sucker punches and knife-stabbings are easy from which to recover.

But is it, really, the same in real life? Has the ‘scalpel please’ line become so commonplace that we no longer associate it with the incision that can make the difference between life and death?

Itwas 7 a.m. on a summer morning. I was already at the hospital, attending my internship in the ENT (Otolaryngology) department. I’ve chosen this specialty because it offers both the clinical and surgical experience, which is great for someone trying to explore their options. At that moment, I wasn’t sure if ENT would be something I wanted to pursue in the future, but I was trying to keep an open mind and wait for something interesting to happen and spark my curiosity.

As an intern, what I can or cannot do depends on the doctor supervising me. If there’s enough time in their schedule, I can even talk with the patients and work on my history-taking and clinical examination skills. If not, I would usually attend consultations and surgeries.

All the surgeries were being scheduled early, which was so painful due to the lack of sleep I was suffering from. That morning I was talking about, I’ve felt like I could really fall asleep while standing up.

What can you do, though? A padawan never complains!

A patient was already waiting for us in the operating room. The case was a classic ENT procedure: nasal septum deviation. I’ve watched enough of these cases. However, I never imagined how awfully different the perspective could become.

Usually, this type of surgery is pretty basic. Doctors in this department call it ‘the bread and butter of the surgeon’ since there isn’t a day that passes by without squeezing a quick septoplasty into the already busy schedule. These cases last about an hour, and the recovery is also pretty smooth. Not that big of a deal if you think.

The procedure doesn’t require more than two people: the primary attending surgeon and the assistant surgeon (in this case, a resident). That morning, the resident was out of the office. When this happens, a nurse can take their place. Even though there was a nurse available at the moment, still I heard:

‘Scrub in and come help me!’

DO WHAT???

My eyes, struggling to stay open at that excruciating painful hour, suddenly were wide open. My ears couldn’t guide the sound any faster to my brain for it to process those few words that weren’t making any sense.

Me? To play the role of an assistant surgeon? How is that even possible?

Interns are usually allowed to come close to the operating table if they want to. What shocked me was that I wasn’t coming close to the table. I was being asked to take part in the whole process!

This thing rarely happens, because there’s a huge amount of responsibility that falls on doctors’ shoulders if students fail. Given that, one has to be really good in order to receive such a great opportunity. At the time, I didn’t think I was worthy.

I didn’t have a lot of time to reflect on the situation. Actually, I didn’t have any at all. The next moment, I was washing my hands, putting on my mask, cap, gloves, and gown. You could say I was ready to enter the O.R.

And I did. With both fear and curiosity pounding in my chest, I’ve positioned myself strategically opposite the surgeon. She was that fearless woman, so good at her job that she made me forget there was still a world outside of the room we were in. For the moment, nothing else mattered.

It was us against a deviated septum.

I never knew that an hour could last more than 60 minutes. Or at least, that it can feel like a whole day of hard work. For me, this hour felt as though it would never end.

The level of adrenaline that was pumping through my body must have been through the roof. I constantly thought that I might do something wrong, putting the patient’s life at risk.

There were moments when I had to use a hammer in order to help the doctor shape the nasal cartilage. Those were the scariest memories since I had to use both force and precision. We didn’t want to leave the poor man without a nose.

I also helped with the sutures, aspiration, and other chores I could manage to perform with the little knowledge I possessed. Although I felt utterly overwhelmed, somehow, I managed to get myself together and take it to an end.

At the end of the surgery, my hands, and a great part of my gown were covered in blood. Another human being’s blood.

As I was changing clothes and throwing out the surgical equipment, still trying to process the entire event I took part in, the surgeon came next to me. She confessed she forgot during the surgery that I wasn’t a resident. She expected from me what she would’ve expected from them. She apologized and asked me if I will give up surgery for good because of this incident.

I told her that it had been the most real thing I’ve ever managed to experience. And I truly meant it. What is more, I’ve learned something new.

I could see what’s it like to be on the other side of fear: there’s fear there, too, until you turn it into strength.

Since that day, ENT has become a solid option for my future as a doctor. The confidence that day has offered me pushed me into constantly challenging myself and never thinking I’m not worthy of something until experiencing it first.

We can never know what we’re capable of until we give it a try!

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