Teaching from the climb

There is a particular kind of surgical teaching that only works from the summit. The attending who has done the operation a thousand times can compress a decade of judgment into a single sentence at the table. It is a gift. It is also, sometimes, illegible — because the thousand repetitions that earned that sentence have been quietly deleted from the telling.

I am not at the summit. I am a urology resident, somewhere on the steep middle of the climb, where the handholds are still cold and I can feel exactly how far it is to the next one. That position has a disadvantage and an advantage, and they are the same thing: I still remember not knowing.

I remember which step in the procedure I didn’t understand the first time. I remember the guideline I misread, the anatomy that only clicked on the third reading, the question on rounds that exposed a gap I’d been quietly stepping around for months. That memory has a short shelf life. Mastery erases it. So I want to write some of it down while it is still fresh enough to be useful to someone one step behind me.

What this is

Between Cases is a notebook. Not a textbook, not a journal, not a highlight reel. It lives in the gaps — the twenty minutes between a clinic and the OR, the night after a call shift, the slow turnover when you finally have a moment to ask why the thing you just did is the thing you just did.

There are three things you’ll find here.

Teaching topics.Structured walk-throughs of urology built the way I wish someone had built them for me — anatomy and reasoning first, the maneuver second, the “here is the part everyone gets wrong” said out loud instead of left to be discovered. Written from a trainee’s mental model, because that is the model the next trainee will arrive with.

Writing. Essays about the work itself — what it does to you, what it asks of you, and the small human things that get deleted somewhere around hour seventy of a call stretch. Some of it is reflective. Some of it is an argument.

Research.The papers, reviews, and projects I’m actually working on, collected in one place, in plain language. Not a CV — a working bench.

Why not video

The best surgical educators I follow teach with the camera — operative footage, the real tissue, the real plane. I can’t offer that here, and I won’t pretend to. What I can offer is the other half: the words around the operation. The decision before the incision. The reasoning that a video assumes you already have.

A trainee’s perspective is not a lesser perspective. It is a different vantage on the same mountain, and it expires the moment you reach the top. So I’m writing it down now, on the way up, while I can still see the route.

If you are one step behind me, I hope this saves you a cold reach or two. If you are far ahead, I hope it reminds you what the rock felt like.