Tuesday, March 10, 2009

After Reading Chapters 1 and 2:


Respond via the BLOG (for periods 3/4) to the following:

1.) Would you have chosen a hospital similar to Bellevue or a “white-tower” hospital in the suburbs?

2.) Do you think Dr. Nolen should have asked the Attending Physician for more help during his first appendectomy operation? Why? Why not?

31 comments:

  1. 1. While I admire Dr. Nolen's desire to challenge himself as well as conquer a public city hospital with worse conditions and supplies, I may have chosen a "white-tower" hospital instead. Being an intern and resident appears difficult and demanding enough, so if I made that choice a big part of it would have to do with trying to make my training the least bit easier than it would be if I decided to train at a Bellevue-like hospital instead. Then again if the residencies at the "white-tower" hospitals were similarly demanding, I may have been drawn to the Bellevue Hospital.

    2. I thought that by not asking the Attending Physician for more help, Nolen was learning to make better judgments independently as a doctor. While I was nervous that he was going to injure the patient, I trusted that he would ask for more help if he felt that he was unable to handle the situation.

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  2. 1. Honestly, I don't think that I can say that I wouldn't choose a "white-tower" hospital over Bellevue. I think it might be a little presumptuous for me to assume that I would choose Bellevue over a fully-equipped, efficient hospital. So I suppose that I don't have that I have a really satisfactory answer, but I think that going to Bellevue would require an extremely solid work ethic and somewhat of a tough skin. But at the same time, even though the hospital is clearly understaffed and undersupplied, I think that it forces the employees streamline their work; and I'm 100% sure that nothing goes wasted at that hospital. I don't know if it's the ideal place for a new intern, but I think that places like Bellevue need talented surgeons and doctors to make up for the lack of supplies.

    2. There is such a huge difference in doing surgery on whatever inanimate object they use in surgery school and actually cutting someone open and doing the same procedure on a real human. So, because of htat I think that it's really important the new surgeons be allowed to do the surgery themselves, unless, of course, it is extremely clear that they are going to injure the patient. But I think that the only way Dr. Nolen was going to get over his fear of even cutting the skin was to actually do it himself; even if it meant that by the end, the doctor had to literally hold his hand and do it. Even that is educational- he at least is "doing something."

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  3. 1) Personally, I probably wouldn't be up to the challenge of beginning a medical career in an environment like the Bellevue Hospital. I would be intimidated enough starting out in a nice clean work environment with helpful colleagues, let alone working in a run-down, confusing place like Bellevue. Dr. Nolen's choice is admirable, but I can't really say that I would be able to have that kind of courage.
    2) No, I think it's good that Dr. Nolen had to learn to perform a surgery on his own. Advice and help from superiors is only helpful up to a certain point. After that point, it becomes a hindrance, and you can never become an expert independent from your mentor if you always rely on them. The only way for Dr. Nolen to truly conquer his fear was for him to have the confidence to perform surgery on his own, so he would know just how much he was capable of.

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  4. 1. Personally, I feel that a doctor will be helping people anywhere he or she works. However, there is the notion of working environment to consider. Lack of supplies will lead to whole new types of stress for everyone working in that environment. Bellevue will certainly teach a new surgeon how to function in the most efficient non wasteful way; however, it will defiantly make the new surgeon feel a little nervous. Lacking anything makes anybody nervous. I think I would have picked a hospital like Bellevue over a "white tower" hospital because it would teach me how to not be wasteful and how to make do with whatever is available. I think these would be extremely valuable skills for a surgeon and would lead a surgeon to feel more comfortable knowing that they can make do with whatever they have. I think working at a hospital like Bellevue would make me a more creative and calm surgeon. Also, I think it would be better to work in an environment that will teach you about all sorts of people. I think it would overall be a more rewarding experience to do my residency at a hospital like Bellevue.

    2. There are two types of knowledge, practical and book knowledge. It is important to have both types of knowledge about any career you are planning to enter. I think Dr. Nolan probably learned more practical knowledge from that first unaided surgery than he ever did from medical school simulations. However, he wouldn't have been able to gain that practical knowledge if he didn't have the background he had because of his book knowledge. I think that by doing it himself, Dr. Nolan took full advantage of that learning opportunity and gained all he could from it.

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  5. 1. As an intern and an aspiring doctor, I would have probably chosen a hospital similar to the Bellevue hospital, because succeeding there would result in a larger feeling of self-accomplishment and more respect from others. Becoming a successful doctor at one of the "white-tower" hospitals would lead to some respect, but not as much as if I were to succeed at a "Bellevuesque" hospital, one where I would have to work much harder and be more efficient in order to succeed.
    2. I think Dr. Nolen should have probably asked for more help, even though it might have jeopardized his credibility. But, preserving someone's life is more important than one's credibility as a doctor, and so he should have asked for more help if he did not know what to do as opposed to possibly making a mistake that might take someone's life.

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  7. 1. Were I an aspiring medical student who more than anything wished to learn of the technicalities and in's and out's of practicing medicine in an unforgiving habitat, I would have chosen Bellevue. Picking a hospital as grueling and under resourced as Bellevue is certainly noble, but I imagine that if I myself were truly a medical student, I would have picked a white-tower hospital. If I myself went into the medical career, it would be to help people and to practice medicine, not to learn the art of reusing old syringes. While there are probably a few kids who would have gone to, say Oakland High over CPS in order to gain the 'real world' experience of surviving (and excelling) in a generally hostile environment, this takes a special breed. I have enough trouble getting sufficient sleep as it as at CPS; there's no way I could handle an internship and Bellevue.

    2. I do think that Dr. Nolen should have asked for more help. Self reliance is a great thing, but when it's your first surgery, the expectations probably aren't astronomical to begin with, and choosing between your own pride and the life and wellbeing of a patient is a no-brainer. They most likely assigned Nolen with the experienced Attending Physician for just this reason; it was silly and irresponsible for Nolen not to take advantage of his experience.

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  8. 1.I'm not really sure...Bellevue seems like it would be really effective in teaching people how to become surgeons/doctors under harder conditions to work in, how to get things done efficiently, and how to not waste any materials. Someone who succeeds at a place like Bellevue could probably succeed at so many other places, which would make it a good place to intern because by the time the intern has finished they would probably be really competent. At the same time, I probably wouldn't choose Bellevue because I don't think I would handle the stress of working there very well, especially because a job like a surgeon would be enough stress on its own (since just one wrong surgery could really hurt someone).

    2. I think he should have asked for more help. It may have benefited him personally not to, because after that he knew that he could do the operation, and because after an experience like that, he probably knew how to do that operation really well. However, I think it was more important for him to ask for help because as it was, the patient ended up being injured from the surgery, and even though he recovered in a few weeks, it could have been worse. The point of the operation was to help the patient, so I think that should have been the priority over gaining confidence in surgery.

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  9. 1. If I were in Dr. Nolen's position, I probably would not have picked a hospital similar to Bellevue and would have opted for a "white-tower" hospital. I think I would rather start off in a good and comfortable environment because being new to something is hard to adjust to, and having to deal with less than ideal conditions can be stressful and discouraging. After becoming more experienced, I would feel more comfortable at a hospital similar to Bellevue because I would have a strong foundation of training. With this good foundation, it would probably be easier to know what to do in stressful and pressure situations. However, I definitely admire Dr. Nolen's courage for challenging himself and picking Bellevue, but personally, I probably would have picked a "white-tower" hospital.

    2. I would have asked for more help, especially since a person's life can depend on the outcome of an operation. Although I think it was courageous of him to work through the problem and rely on only himself, I think it would have been safer to at least ask someone to guide him. This experience probably helped him gain more confidence in his abilities, but the patient did suffer because of his mistake. Also, it was his first surgery, so it would have been acceptable to ask for help and to learn the correct way to perform the procedure. Usually, I think it is good for people to learn through their experiences, but when someone else's life could be severely affected, I think it is best to play it safe and ask for help.

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  10. 1. I would certainly have chosen a "white tower" hospital for my first job. While I understand that the most meaningful work can be done in Bellevue-type places where everyone is working hard and making due to best serve the patients, I also strongly believe that the most important work can really only be accomplished by experienced doctors and surgeons. As a way to learn quickly and handle stress, Bellevue is a great opportunity and definitely a jumpstart to a surgical career, but at the same time I feel that in those more hectic and often unorthodox scenarios it is essential to have some practical knowledge. I think the unsuccessful "cutdown" that Nolen performs is a perfect example of this. Initiative, confidence, resourcefulness and hard work are all great as long as there is experience and knowledge behind it. Nolen rushed blindly ahead, largely unaware of the consequences his actions may have had, and in a poorly equipped hospital this is even more dangerous. Had he gained more experience he could have been even more efficient and helpful when he arrived at Bellevue.

    2. I don't think that Nolen should have let George (the Attending) perform the operation himself, because hands-on experience is definitely the best way to learn. I do feel, though, that he should have been coached through the process verbally, and if George was not going to offer that from the start I think should have asked for that kind of assistance. I feel this way because practice does not make perfect, perfect practice makes perfect. Performing the surgery incorrectly, while he can learn from his mistakes later, never gave him the opportunity to successfully and correctly perform the actions so that he could know what it should be like. I feel that George should have talked Nolen through the process very carefully but let him handle it himself unless he completely botched it up.

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  11. 1) If I were Dr. Nolen, I feel that I would probably have chosen a "white-tower" hospital in the suburbs instead of Bellevue. Because Dr. Nolen was still an intern and new to many things, going to Bellevue seems like skipping a crucial middle step. If he had had more experience before going to Bellevue, it would make more sense as he could improve on his previous experiences instead of blindly going forward with all of the additional challenges of having a lack of supplies. It isn't really necessary to try everything at once.
    2)I feel like Dr. Nolen should have asked the attending physician for more assistance during his first appendectomy operation because of all of the serious consequences that could have occured because of a mistake. Although I can see how it would be useful for him to go full out the first time to conquer fears or something, a gradual increase in participation of operations to make him more and more used to it would end up with the same result but with safer means. Because they are dealing with actual human beings and not test dummies, extra caution should be required.

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  12. 1) If I were in the position of Dr. Nolen, I would have chosen an internship at a white tower hospital, instead of one like Bellevue. From his relatively dismal descriptions of the the Bellevue hospital, it seems to me that it does not offer an environment that is conducive to learning the practice of being a surgeon. Despite Bellevue presenting more a a challenge, I do not believe that working as an intern there would lead to being the best possible surgeon.

    2) I think that Dr. Nolen should have asked the attending physician to be more active in the appendectomy. I understand that by doing it by himself as much as he could allowed him to learn by making mistakes, I do not believe surgery is an occupation where learning through mistakes is an acceptable method. Due to the serious consequences of making a large mistake, Dr Nolen put the patient at risk, and ended up making the recovery for the patient particularly difficult.

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  13. 1.) I would have chosen a hospital similar to "white-tower" over a hospital like Bellevue. I do respect Dr. Nolen's decision to work at Bellevue, but as a starting intern it seems more beneficial to start at a "white-tower" hospital. With better supplies, and better and more experienced doctors to learn from, I feel like I would learn much more from Bellevue. Although it would be a great opportunity to help the less privileged patients at Bellevue, I don't think it would be worth it with such a quality hospital in "white-tower". Lastly, I don't think I would work at Bellevue even if I was a skilled surgeon. Even though it would be very rewarding I would rather leave the job to those like Dr. Nolen. I think I would thrive in a higher class hospital, and no matter what class is in a hospital, all the patients need help. There will always be the noble people like Dr. Nolen who choose to work at Bellevue like hospitals, and that is just not me.

    2.) I think that Dr. Nolen should have asked for help if he needed it even the slightest bit. Surgery is such a serious engagement that a small mistake could be life-threatening, and that would be unacceptable. I think hands on experience is the best way to learn, but so is asking for help. If Dr. Nolen was unsure even the littlest bit then he should ask for help. Learning from mistakes is a great way to learn, but when one can learn without making a mistake (like asking for help), then it seems like that is the obvious way to do it. Even if he could not do the surgery alone the next time, he could gradually learn more and more from the more experienced doctors until he could perform it himself.

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  14. 1. Personally, I would want to work at the "white- tower" hospital because it has better supplies and it is better equipped. I would be stressed out just being at a new place and being an intern and everything and working at Bellevue would exacerbate the stress. It would be much harder for me to learn well at Bellevue than in a nice clean hospital. Maybe after I was a skilled surgeon then i could work at a place like Bellevue.
    2. Dr. Nolen was very brave for not asking for help and I think it helped him learn a lot but I think that it would be safer for the patient is he did have help. By doing it on his own he put the patient at serious risk. There are pros and cons to what he did.

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  15. 1. I would like to think that I would choose Bellevue over a “white-tower” hospital, but then again I would like to think that I would have the ability to become a doctor at all. I can’t even imagine what it would be like as an intern at Bellevue. I agree with Carol, being an intern alone has to be hard enough. And maybe I would have the courage to move to Bellevue after a while, but still such a challenging job in such an unsure environment has to be really taxing. I admire those who have the ability to do such things.

    2. I do think that Dr. Nolen did need to learn by doing to an extent, but I also believe that maybe the first time he was at the operating table was not the right place for it. Maybe I’m too timid, but I think that he should have at least had more help the first time through. It is a human being after all. The second time though is a totally different story, I think that is a better opportunity to learn in a hands on way, because then he would have at least been at the operating table once before, and maybe it would remove a little bit of the overall shock of his first surgery on his own.

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  16. 1.) Actually, this question occurred to me while reading the book. Although a hospital similar to Bellevue seems so much more rewarding, I’m not sure if I could say I would be confident or capable enough to put myself into such a situation. Of course I intend to help people, but I am also, sadly to say, quite likely to base my choice on “first-impressions”. The description given by Dr. Nolen made the Bellevue Hospital sound really unorganized and hectic. However, I agree with his point about his colleagues. I would also want to be in an environment filled with people who work hard to help others. I feel like a “white-tower” hospital is more likely to have interns, doctors, etc. who are likely to put themselves before their patients… Obviously, I think this is wrong (you should too :P) Anyway, my point is that I may be reluctant to choose either or, but I hope I would/will choose the Bellevue-like hospital.

    2.) Hmmm… I think in Dr. Nolen’s situation, he did not want to ask for help because it was an opportunity for him to present himself capable of doing the operation on his own. However, although it seemed as though the attending physician, George, did not step in because he was being polite and wanted Bill to do it on his own, I do not think that this was a good move… sorta. :/ I felt that at times Bill seemed totally lost and helpless during the operation. As attending physician, George should have been more helpful in talking him through parts he did not know how to do completely. As Bill said, once he is able to do something correctly, he would go ahead and do it without supervision or help. Bill should have received more help in his first appendectomy operation. The way things worked out during the operation weren’t that bad though. While reading Dr. Nolen’s statements and opinions about the whole scene, everything seemed to work out or make sense.

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  17. 1. If I were a new intern, I would have chosen someplace more like a “white tower” hospital. I completely respect Dr Nolen’s reasons for working at Bellevue, but I don’t think I could handle it. I wish I could say I would work at a hospital like Bellevue, because it obviously needs all the help it can get, but I don’t think I could handle all the pressure. I am a perfectionist when it comes to labs, procedure, and the like and I don’t think I would last long at Bellevue. I would waste too much time, and time was not something to be wasted at a hospital like Bellevue. Although there are some perks about starting as an intern at Bellevue: you get actually work with patients and start procedures, whereas if you were at a “white tower” hospital you would probably be following around a doctor all day and not really participating in any procedures. I feel like one would learn faster working in a hospital like Bellevue, but part of one’s leaning would be by making mistakes. Personally, I would be too intimidated to start do actual procedures as an intern. Overall, I feel like I would be better suited to work in a “white tower” hospital.

    2. I defiantly think that Dr Nolen should have asked for more help on his first appendectomy operation. Surgery is such a delicate and serious procedure, and I think that Dr Nolen should have had more experience before actually doing the procedure. He could have seriously hurt the patient, maybe even killed him. I think it was irresponsible to Dr Nolen, and the Attending Physician to let Dr Nolen continue with the surgery even after several mishaps. Dr Nolen should have realized that he was not ready to complete the surgery, and he should have asked for help from the Attending Physician.

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  19. 1. As a amateur surgeon, I would have chosen a "white tower" hospital over a place like Bellevue. Because of how Dr. Nolen describes Bellevue, it seems significantly more challenging than a "white tower" hospital. I would definately be up to such a challenge if I had had experience in a hospital before and was looking for an ambitious opportunity. If Dr. Nolen had had more experience, he would have had less stress at Bellevue and probably have had more success in his surgical procedures. However, because he chose such a difficult situation as his first experience, he was thrown into a stressful situation that could have been avoided had he had experience in a calmer environment. I, for one, need to have a pretty decent understanding of something before I begin to do it on my own. While I understand that a difficult experience (like Dr. Nolen's) could be ultimately quite useful, I would prefer to begin learning in a "white tower" hospital.

    2. I think that Dr. Nolen should have had more guidance from the Attending Physician. It was important for him to have this experience (because he expects to do it frequently) but at the same time, he put the patient in danger because he lacked the knowledge and experience, and was improvising when he should not have been. I think he and the Attending should have worked together so that Dr. Nolen was learning and performing the procedure correctly, instead of just making mistakes and trying over again.

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  20. 1. For my first medical internship and aspirations to be a surgeon, i would have gone with a "white tower" hospital first. I would have chosen this hospital over Bellevue for the simple fact of an easier integration into hospital work and life. The lack of proper equipment and supplies at Bellevue would make an integration from medical school rather difficult and nerve racking. Along with proper supplies, a "white tower" hospital might offer a bit more opportunity to slowly integrate into surgical processes as well as basic primary procedures, which a first time intern hasn't performed. As a first time intern, i think working at a "white tower" hospital would be an easier and more enjoyable integration into hospital life and the surgical field.

    2. I think that Dr. Nolen was right to try the procedure on his own, but i believe that he should not have been so cavalier. Just as he complicated the vein procedure with Mrs. Rogers, Dr. Nolen complicated this procedure by entering the operation with a false sense of confidence and failure to understand the nerves brought to a real operation. I do believe that nolen should have taken a less primary role in this procedure in order to preserve a bit of his confidence as well as prevent complications. If Nolen had chosen to recieve more aid, he would have seen first hand how intense a real operation is without destroying his self-confidence and possibly damaging his reputation as a compitent intern/doctor.

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  21. 1. To be honest, I would have chosen a white-tower” hospital in the suburbs. I would want to be a part of an enthusiastic, and efficiently working team of doctors. However, a hospital like Bellevue would not have been forgotten. After getting established in the medical profession, and getting on my feet financially, I would strive to improve the standards of hospitals like Bellvue. Hospitals like Bellvue are understaffed and do not function efficientlty. The hospital also fails to provide their patents with a sense of comfort or privacy. This is a shame. *I wonder why there do not seem to be any hospitals like Bellvue in the subhurbs.* To me, from experience, it seems that poorer neighborhoods recieve poorer service than richer neighborhoods do. This is an atrocity and it needs to be changed. Therefore, I would do everything in my power to uplift the standards of hospitals like Bellvue to those of "white-tower” hospitals in the suburbs. This way, in spirit, I join the team of hospitals like Bellvue.

    2. I believe Dr. Nolen did exactly what he was supposed to do. He is a beginner, therefore he is going to make mistakes. I strongly believe that you learn best from your mistakes. He wouldn't have learned anything if he was constantly asking the attending physisian to help him do it. He will not always have an attending physician around him in the future, therfore he should atleast get a taste of what it would be like to work as the primary surgeon. The attending physician did his job well as well. He was patient with Dr. Nolen, but he also made sure to ensure that the patent was not in danger. The physician stepped in when he was supposed to, but other than that, he allowed Dr. Nolen to make important mistakes and complete the opporation.

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  22. 1. As a intern, it may have been a better idea to sign on with a more affluent and well-funded hospital, a proverbial "white tower", because while the atmosphere if a more affluent hospital may not be the most demanding atmosphere in which to learn medical practice, it is certainly a safer one, wherein Dr. Nolen could have learned his trade at a safe, less demanding pace, and then moved to the other hospital, in order to demand more of himself and improve faster.

    2. Dr. Nolen may have been right to not to ask for the extra assistance in the actual procedure, I think it would have been a very good idea to ask for supervision, to prevent possibly harmful mistakes, while still allowing Dr. Nolen to learn and grow in confidence.

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  23. 1. While I think it was great for Dr. Nolen to volunteer in a hospital like Bellvue, I could never ever see myself in a setting like that. The biggest reason is because when I'm sleep deprived, I can't learn. Things just don't stick. I would need a calmer environment to learn anything. Secondly, I learn things better in calmer situations. So in a hospital where there is more money and more supplied, my learning curve would be faster.

    2. I believe he should have asked for more help. I think this is obvious because he almost killed the guy. While it is admirable that he wanted to try to do it by himself, it is clear that he wasn't ready yet. If he had had more directions, he would have made fewer mistakes and yet still get the same amount of experience without almost killing the guy

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  24. 1) I think Dr. Nolen had noble reasons for choosing to work at Bellevue. Although he was depressed and even repulsed by some of the things he saw, he was drawn to the qualities of Jerry, the chief resident and the nurse, Sharon. I would admire these people for the same reasons he does; they are professional and they go right about their business. Although the Bellevue hospital is under-funded and does not have as much support staff as a "white tower hospital", as a competent physician I would appreciate working with such people. I think the challenging environment of Bellevue would enrich my medical career, however, I would not work there as a resident. I would choose to work there for a period of time only after I had some experience in a less hectic environment.

    2) I don’t think asking for more help would have necessarily helped Dr. Nolen in his appendectomy operation because nerves were his primary obstacle. He made his first mistake, cutting the fascia, because he didn’t want to appear hesitant while making his incision. He also wanted to appear decisive when he cut the appendix, but his cut was too close to the tie which slipped off. George maintained his composure throughout the entire operation, however Dr. Nolen quickly lost most of his initial confidence. If Dr. Nolen had not been concerned with how confident he appeared, then I don’t think he would have had the same problems. I think it was partly George’s fault for making Dr. Nolen feel pressure to move more quickly.

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  25. 1) Personally, I would have chosen a "white tower" hospital over Bellevue, though Mr. Nolen Made the right decision for himself. By choosing Bellevue, he was meeting the ultimate challenge, and working his way up through the system. For Nolen, with an incredible amount of ambition and an impressive work ethic, Bellevue was the right place for him to work and achieve success. Personally, I would rather work in a more organized, better run "white tower" Hospital. I would prefer to learn to be a surgeon in better run hospitals with more access to materials, instead of a run-down old hospital such as Bellevue.

    2. Nolen, though his first Appendectomy was almost a failure definitely needed the experience. His problem was overcoming his fear of cutting through the skin, something that will not go away with simply watching another surgeon work. However, Nolen also stepped almost blindly into it, and should have asked for a bit more help for the sake of the patient. Though the patient eventually recovered, if Nolen had had a more gradual process of learning to do surgery, it would have been better for both him and the patient. He should have asked for a bit more help, yet he should have also done as much as he could have by himself without
    help to further his experience.

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  26. Personally, for me there would be no choice. I would rather start of in the “white-tower” hospital that was well supplied, sanitary, and overall more accommodating. I would rather be able to learn more and understand the field of medicine better in a “safer” environment/hospital. His choice to work at Bellevue, the less well-equipped hospital is very respectable and honorable; however, personally I would not have made the same choice. Medicine and treating people is a complicated enough of a field as is and there is no obvious reason to me to make it more complicated. Furthermore, once I was more comfortable with the profession I could then choose to transfer to a different hospital like Bellevue.

    Regarding whether or not he should have consulted and found the resident before trying the surgery, I think he made the wrong decision. Although it was important to learn to be able to do the procedure on his own, and to learn to be self-confident and responsible, I think there is an imperative to preserve life first and foremost. On any potentially dangerous operation I think it would be better to be sure by getting the residents help, because any mistake could mean the patient’s life or death, which I personally feel is more important than gaining experience.

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  27. 1. By answering a hypothetical question such as this one, one assumes that they have the necessary knowledge and experience to successfully and accurately answer the question. But I do not believe I have these faculties, and so, I am incapable of offering a response. I am not in the same situation as Dr. Nolen, nor have I had the same experiences as he had. I could conceivably give a response, but because of the aforementioned reasons, I would find any response to be a completely fruitless endeavor.

    2. While one could say that Dr. Nolen was risking a human life by not asking for more help, and that the risk of a human life is completely unacceptable, he would not have learned as much by doing so, and so likely would not have successfully learned how to undertake the operation, which could save further lives. Of course, by doing this I am assuming that all human lives have the same merit and that saving one is just as good as saving another. Do I have the right to do this, to decide that one person is the same as someone else? Or is this basically the same as saying that everyone should be valued differently? Frankly, I don't really think I do, although I have done it here.

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  28. 1) I would have chosen a “white tower” hospital over Bellevue if I had the option. To me, one of the key rewards of being a doctor, aside from the paycheck, is getting to help your patients and save lives, so I agree with Nolen in that sense. However I wouldn’t view a rather run-down facility such as Bellevue as a challenge, I would just see it a yet another obstacle getting in my way of being able to efficiently treat and help patients. His comparison of working at Bellevue to of conquering Mt. Everest illustrates my point. Being able to conquer everest (or Bellevue) would be a point of pride for Nolen, but its not about pride; its about the patients.

    2) I think Dr. Nolen should’ve certainly asked for more help. I get that it’d be embarrassing to ask your AR for a lot of help, but he could at least have asked questions about the procedure or asked for advice. That way he could at least come across to his AR as a guy who knows when he needs help as opposed to someone too proud to ask for any, but ends up hurting his patient by not doing so. As for help in the actual procedural help, I think he maybe should’ve asked his AR with help tying up the apendiceal stump, because his errors with the knots ended up contaminating the area on which they were operating.

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  29. 1. I completely agree with Nick, arrogant as I am. I think that by becoming experienced at a "white tower" hospital, as Michael said, I could better help people and to practice medicine, not to learn the art of reusing old syringes. However, I see the value of working in the Bellevue hospital for it's real-life-experience type work. Still, to further my personal interests in medical science, a proper white tower hospital is what I'd go for.

    2. As the majority of the people above said, I think in a real-life situation, it is indescribably important to get it right. Experience through mistakes is important, but only at one's own expense. Bravery is irrelevant in this context.

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  30. Uh, here's the original response I wrote on my other computer:

    1. I can understand the appeal of the challenge of working at a hospital at Bellevue, but I would personally prefer working at a "white-tower" hospital in the suburbs. To me, the difference in challenge of the two is, to build off of Dr. Nolen's comparison, comparable to the difference between Mount Everest and K2. Each mountain poses its own, very different challenges. The agenda of a Bellevue surgeon certainly seems grueling, but I suppose a "white-tower hospital's" would be almost as tough. To get the most of the internship-residency program, I would go for the "white tower" hospitals for the best education, even if the exposure to difficult cases is less.

    2. When a life is on the line, by any and all means, GET IT RIGHT. Something as important as surgery should never be attempted without sufficient experience, or without someone experienced helping. I understand that messing up is part of the path to getting better, but still, messing up is unacceptable.

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  31. 1. I am a coward! But then, I am also not a surgeon-in-training, so I really do not know what kind of hospital I would apply to. After reading this book I think that I would feel pampered at a 'white-tower' place, but I would probably be having a nervous breakdown at a more gritty place. On the other hand, I would be providing help where help is more urgently needed, and that would be nice.

    2. Of course he should have asked for help! As he himself goes on to say, pride is an unacceptable indulgence when a patient's life is at stake. That is all there is to it, from my perspective ... though, being human, I can empathise with and forgive the mistakes of others.

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