The Eternal Fellow

by Tayyab S. Diwan, MD

How many fellowships is too many? Really now. Can any of us ever have too much training? And we all
know the answer to that is yes. We all need to stop somewhere and start our lives as attending surgeons.
But not me, oh no. I want to be in a fellowship for the rest of my life.
Well, Im sure thats what it may seem to people looking at my career
choices from the outside. I have just finished a minimally invasive
surgery (MIS) fellowship and have just recently started a transplant
fellowship. Now, before you turn the page or throw this newspaper on
the ground in disgust, let me explain. And the best way to explain is to
start at the beginning.
My career started as a preliminary intern in general surgery, after not
matching in ortho. I spent two years attempting to break into the field
that I thought at the time would make me happy, get me girls, and
lets face it, at that time it was just to get me girls. And after being denied again, well, twice over, I took a
hard look at my options and decided that I would go into general surgery. I transferred to a categorical
position at another institution, where I finished out my training, all the while dreaming of becoming a private
practice general surgeon. Nice life, nice car, and by that time I already had the great girl. But something
changed in me. To say it better, someone changed something in me.
Ive learned that changes happen when no one is looking. Most of the time they go unnoticed, until someone
looks back and tries to figure out what happened. When I started residency, I worked well over 100 hours
per week and never knew when I would go home, and knew it wouldnt be long before I had to be back at
the hospital. My life revolved around call, food and sleep (when I had time for it). Then, like a revolution, I
was working less than 80 hours per week. I had full weekends off. My life had changed. Before the 80-hour
workweek, I had already decided to go into private practice. Why was there a need to subject myself to more
training than the minimum five years of surgery residency? Even after the change, I still thought, enough
was enough. I need to move on with my life and start my real job. The master plan was to finish residency,
go into private practice and live my life with my wife and kids.
And then
My fourth year of training I spent three months with Drs. Lee Swanstrom, Paul Hansen and Mark Whiteford,
in Portland, Ore. I was there to learn advanced laparoscopy. And did I ever. The cases were amazing, and

second only to the technical prowess of the attending surgeons. I was literally in amazement at what could
be done laparoscopically. I decided that I wanted to do what they did. Their enthusiasm didnt stop in the
OR. They carried it over into research. They drew me into a world I never planned on being a part of. A world
full of grant submissions, papers, pig labs and research protocols. This experience changed my mind about
becoming a nonfellowship-trained general surgeon. So much so, that I applied and luckily got accepted to
Dr. Swanstroms MIS fellowship.
But this is only half of the story. Well, two-thirds, anyway. During that same year, my fourth year of residency,
I also did my transplantation rotation with Drs. David Mulligan, Adyr Moss and Subramaniam Reddy at Mayo
Scottsdale. These, again, were three phenomenal surgeons, who had great skill in the OR. But they also
had such a sense of teamwork. I enjoyed every moment I spent in their presence. They had an undying love
for transplant, and all its intricacies. Each was interested in their own specific aspects, but they all loved
what they did. And that rubbed off on me, too. With their passion and skill, they changed peoples lives
forever. With a few anastomoses, they gave patients another chance at a life that was sure to end
prematurely without their help. Their passion and enthusiasm infected me, and, as Dr. Mulligan always likes
to say, I got the transplant bug. So I applied for transplant fellowships and landed one at Mayo Clinic, in
Rochester, Minn.
Now, you are probably thinking that Ive gone overboard. I might be a little off my rocker, or slightly loco in
the cabesa. You arent the only ones. While I interviewed for my transplant fellowship, I was inevitably asked
why I was doing an MIS fellowship. I wont go into my answers, as I wouldnt want to bore you with the
never-ending discussion of how transplant and MIS might fit together. But in my head, it made perfect sense,
and still does. These are two fields that I am drawn to, both for their technical skill and their effect on
patients. And I have a plan in my head how these will both serve me well in the future.
With more than 60% of surgery residents deciding to further their training in a fellowship, there is no doubt
where the field of surgery is heading: to a better place for patients and a happier place for surgeons. It
means that more surgeons will be doing what they like, and doing it better. Not only because of their
fellowship training, but because people tend to be more involved in things that excite them. This, in turn,
should improve patient care. Everyones happy, right? Well, maybe not our spouses. But luckily my wife is
completely behind me. (Love you, honey.)
All of us went into surgery because we love it. When I was a medical student, a surgery chief resident I had
said, Before you decide to go into surgery, be sure. Not 100% sure, but 110% sure. Do it because you think
you will love it. Otherwise, its just not going to work. I still remember her name: Dr. Claudia Goettler. I dont
think I will ever forget what she said. It has turned out to be absolutely true. Between you and me, there are

days I dont love it. Please dont tell my patients. But I think this is true for all of us. But be sure that there
has never been a day that I wasnt proud of what I was doing. I love surgery. I love what I do.
So it stands to reason, that after my residency, I wanted to do a fellowship. We all learn what we like, and
dont like, in residency. I learned I didnt like to perform perirectal abscess incision and drainage (no
surprise), I really didnt like lazy interns, and especially hated my cafeterias hamburgers. But I also learned
what I loved. I loved the OR, I really loved certain cases and truly loved my cafeterias gyros. My love of both
MIS and transplant led me to fellowships in both. (It wasnt the gyros, no matter what my junior residents
might tell you.) I knew that I would be happy doing laparoscopic hepatobiliary surgery; laparoscopic donor
nephrectomies; and kidney, pancreas and liver transplants. Is that too much to love? No way. Are four years
of fellowship too much to do to accomplish my goals? Absolutely not. After investing six years in residency, a
few more years in fellowship in order to do what I love is not a lot to ask of myself.
I now realize that this isnt just a job. It is a lifestyle. And you know what, its not bad. Sure, there are long
hours. Sure, there are frustrations. And sure, it can be stressful. But tell me what other job affords you the
opportunity to change peoples lives so dramatically on a daily basis. There isnt one. There just isnt.
Dr. Diwan is from the Division of Transplantation Surgery,
Mayo Clinic, Rochester, Minn.