My Vantage Point

I spend a great deal of time looking into people's faces. No, I mean really looking into their faces. My job gives me the opportunity to assist in cancer surgery which requires opening the face to reach back into the base of the skull to remove tumors. When I first started my odyssey of learning head and neck surgery, I felt lost within the cavernous depths of the human face. Once the skin is pulled back to expose what lies beneath, there is an incredible amount of intricacy. Happily, I was able to reinforce the anatomy lessons I'd previously committed to memory and I've become familiar with the muscles, nerves and vessels. I rarely feel lost within the tissues, and if I do, there are landmarks that quickly point me to certainty.

The interesting thing about my daily work is that I spend most of my surgical day looking at my patients upside down. We rotate the bed a hundred and eighty degrees so that the feet are away from us. This allows us full access to our surgical field. I stand at the crown of the head and look down and over the face. I get used to up being down and down being up. It's become second nature to me. When I was in surgical training, I can remember how I struggled with this concept when learning to guide endoscopic instruments. It seemed counterintuitive to move left to see right and vice-versa. I never thought I'd be able to run a camera properly.

Similarly, when looking at radiologic studies, right is left and left is right. I don't even think twice about it. I realize now that when I'm standing face to face with someone that I'm examining clinically, I transpose their MRI or CT scan onto their face, switching the study to fit their actual, physical presence without even considering the steps I've taken in my mind to do so.

Lately I've questioned my decision to remain in clinical medicine. The hours are getting longer, the pay certainly won't get much higher, and the rewards are becoming more and more difficult to define in my own mind. I've considered moving back into Psychiatry or hospice care. The thing I need to consider is that it's taken me several years to develop this sense of knowing, this being able to look into the face of my patients and grasp my place. This is a comfort level that I don't want to take for granted, but neither do I want to throw it away because I am aware that it has taken me so very long to get here.