The painful truth behind the playful quip

infertilitywoman

People don’t mean to be hurtful, they don’t mean to be unkind. People are just generally nosey and volunteer unsolicited well-meaning advice. Sometimes I just smile and nod, other days I grit my teeth and try not to scream.

This is the typical conversation which frustrates me because it leads to one of the darkest corners of my life, something that I don’t want to talk about. With anyone.

Well Meaning Person: Do you have any children?

Me: No (insert polite laughter), My husband wouldn’t even allow me to have a goldfish until my pot-plant survives for more than 3 months.

WMP: Oh, but babies are different, they are special and they are so much a part of you that you won’t forget to water and feed them! You will learn to love them more than life itself.

Me: Ah huh.

WMP: You should really think about having children, they are so rewarding. You and your husband would make such good-looking babies. You are still young enough, and time slips away, I wouldn’t leave it too long….

It is at this stage which I often try to remind myself that he/she isn’t being deliberately malicious, they are just curious and maybe, interested in my life. Yet I am filled with the urge to yell, Shut up, leave me alone. We can’t have children.

I tried that once. Well, maybe not quite that rude, but the response I got was, ‘Why can’t you have children?’

Aaaaaaargh. What part of ‘Shut up, leave me alone’ did you NOT understand?

I don’t like talking about our infertility, to anyone. I resent anyone prying into my personal pain. I have problems finding the right words, and I find it agonising to even think about it. I am slowly coming to terms with the decisions we have made, and yet I shudder at how others would judge me for them. Everyday, I carry on with my life, my job and my responsibilities as if there’s nothing amiss, but not a single day goes by, do I go without that deep yearning I have for a child, and the profound ache in my heart that comes with it.

Maybe it is time I share our story. Maybe if I tell it, it will help me to move beyond that excruciating pain every time I think of it. It may stop my constant fear of being found out and being judged for our decisions.  Oh dear, I haven’t even started telling you our story, and my face is already wet with tears as I am thinking of my next sentence.

Sometime this month, would have been Michaela’s 7th birthday.

I have had IVF treatment since I was 23 years old. I still remember my first appointment with my fertility specialist. I was sitting in the waiting room, for my number to be called, so my bloods could be taken for tests. Next to me sat a woman in her early 40’s. She was elegantly dressed in what looked to be a very expensive designer clothes. Her ears, neck and wrists dripped with pearls and she wore  a beautiful stack of diamond rings on her ring finger. She turned and caught my eyes. She smiled as I fidgeted under her gaze.

‘Is this your first time?’ she asked me. I distinctly remembered the kindness in her voice.

I nodded nervously. ‘Yeah.’

She patted my hand. ‘Don’t worry. You are young. You will have no trouble.’

I thanked her for her reassurance. In an awkward attempt to make conversation, I asked her, ‘so how many times…. ‘

She smiled serenely as if to reassure me that I wasn’t offending her. ‘I have been doing this for 10 years. You never know,’ she looked up wistfully at the baby picture on the wall of the waiting room, ‘this might be my lucky cycle.’

Ten years? I remembered thinking. How can anyone put themselves through ten years of IVF? Isn’t Life trying to tell you something if you haven’t gotten pregnant after that many tries? Somebody please shoot me if I ever become so obsessed that I have lost that much perspective and insight! I promised myself there and then that when it is time, I will give up and get on with my life.

Little did I know.

I remember laughing at my specialist when he told me that the success rate of an IVF cycle was 30%. At the time, I told him that no one would offer their patient a surgical procedure with that kind of success rate. He said that unlike surgeons, he was an optimist. To him, it meant that every three women he treated, one couple will have the baby they desperately wanted.

Even that conversation did not prepare me for the amount of disappointments that followed. The first cycle I have ever had, I was so excited when all the tests showed that my body was responding enthusiastically to the hormonal treatments – so much so that they managed to harvest 10 eggs. Ten eggs?!! My partner and I were joking about a soccer team.  Two days later, when I presented for implantation, they told me that 5 eggs had not survived and did not fertilise.  I felt a little let down, but he reassured me that a volleyball team was fine too. I was given two embryos, while the others were put in deep freeze. Needless to say, the implantation was not successful, and only one embryo survived the thawing process at my next implantation cycle. That was not successful either. The whole process repeated itself. Cycle after cycle. Again and again. One disappointment after another.

Fast forward 8 years. I had spent over seventy thousand dollars, changed two specialists, endured hundreds of blood tests, ultrasounds and more than a dozen anaesthetics for egg harvests. I have had emergency surgery for an ectopic pregnancy, which was then complicated by postoperative haemorrhage, two spontaneous miscarriages, several D&C’s for non-viable pregnancies and so many episodes of morning sickness that I had lost count. During those years, I ran out of tears. I learnt not to celebrate or be hopeful with any positive results, I reminded myself to be patient.

It was a very difficult time in our lives. My husband (M) and I weren’t married at that stage (because we chose to save money for treatment rather than a wedding, and we couldn’t have time off from work at the same time), both of us were trying to get onto the surgical training program, and we did not tell anyone (not our family nor any of our friends). One of my spontaneous miscarriages at 8 weeks occurred whilst I was operating. my heart sank when I felt a slight gush between my legs. I finished the case, went to the bathroom, cleaned myself up, doubled over in pain from the cramps, and cried. Ten minutes later, I took some painkillers, washed my face, opened the bathroom door and carried on with the rest of the operating list. One of my D&C’s was done in the morning at 8am. I went home, slept it off, and then started my surgical on-call at 6pm that night.Through the years, we told no one, and I worked hard at hiding the treatments, the nausea and vomiting, and all the procedures from my colleagues. I didn’t want sympathy or questions. This was something personal and painful.

My father once told me that if I worked hard enough and wanted something bad enough, I can get anything I want in Life. I wanted to yell and scream at him for telling me a lie. No matter how good I was, how hard I tried and how much I wanted – I couldn’t have a baby. I realised, during those years, that sometimes I just simply have absolutely no control over my destiny.

Then, two months before my specialist exam, I found myself sitting in the waiting room for my usual blood test.

‘Hey Tiff.’ I looked up. It was my specialist. She waved me in. I sat down in front of her, and she smiled at me. ‘Do you know what today is?’

My head was still full of classifications for skin cancers and the reconstructive ladder from two whole days of studying, I could only look at her blankly.

‘You are twelve weeks today.’ When I just stared at her in stupefied silence. She reached over and touched my hand. ‘You are now in second trimester of your pregnancy.’

I was pregnant? I asked myself in shock. Of course I was. I was so used to miscarriages and non-viable pregnancies that I never allowed myself to believe tha I was pregnant in case of another disappointment. But now I am 12 weeks, the chance of me losing my pregnancy is minimal. It was as if something opened inside me. It was Hope. I was so excited I could barely write down the time of my first baby ultrasound before I left her office.  That night, M and I talked. We planned what we were going to do with our career in 6 months when the baby arrived, we dreaded what we were going to say to our parents, we argued about names, we calculated our finances. We held each other tightly, with his hand on my belly that night as we fell asleep in the early hours of the morning.

The next morning, both us blurry eyed from too much excitement, I drove M to the airport – he was leaving for an interstate conference which was booked over 6 months ago. He told me he couldn’t wait to get home in a week’s time, so that we could continue our debate on baby names. Then I drove to the hospital, to have my first baby ultrasound. I hummed to the music on the radio, and I vividly recall the happiness that bubbled inside me, I could barely keep a lid on it, it was threatening to overflow. I had forgotten about my looming exams; even the thought of having to do long hours of studying when I get home didn’t dent my elated mood.

Little did I know, that half hour later, my world would come crashing down around me.

The first inkling that something might be wrong occurred when the ultrasonographer went out to get two other colleagues. There was some whispering between them. They told me that it was most likely a girl. Then they asked me to wait. An elderly woman, with silver hair piled on top of her head in a loose knot came in and introduced herself. She was obviously a very experienced obstetric radiologist. She also had a go with the probe. She concentrated very hard on the screen and started to press quite hard on my belly. She asked me to change my position several times. Then she left, and I could hear her having a conversation with someone on the phone.

I laid there, resting my hands protectively on my flat tummy, and tried to make out the shapes and shades on the screen – but, like every other ultrasound I have ever tried to read, the picture looked like an abstract art of cows in a snowstorm. The silver-haired-lady walked in. She sat down beside the bed.

‘Tiff.’ She took a big breath. ‘The ultrasound is showing me an abnormality with the baby’s heart.’

With those words, within that split second after she had uttered them, I withdrew into myself. It was as if the world had suddenly gone from full Technicolor to black-white. She kept talking. I heard everything, but it was as if she was on the other side of a glass wall. The sound was muffled, and there was a loud buzzing noise in my head. I felt…. nothing. I was told to go straight to my specialist, so numbly, I did. The specialist sat me down and told me the implications of the findings. She told me that it was my decision what I wanted to do, and that termination was available up to 20 weeks of pregnancy. I wasn’t sure what expression I had on my face, but when I left her office, the receptionist kept asking if she could call someone for me. I smiled through a face that felt like it was carved out of a stone and decline. I drove home. I turned the radio off in the car. I couldn’t bear the noise and the normality that the radio represented.

I rang M. He was quiet on the phone. As a cardiac surgeon, he knew the implications of having a child with congenital heart disease. He sees the suffering of these patients and their families day in day out. He knew this particular condition, it was one with a bad prognosis. He told me that if we went ahead, one of us will have to stop working. He told me that we will be burying our child when she turns 13 if we were lucky. He told me that it wasn’t a life he would want for anyone, let alone his own daughter.

He wasn’t telling me anything that I didn’t know already. I have congenital heart disease. Mine wasn’t anything structural, but it affected my childhood and subsequent years. I spent a lot of time in hospital as a child, I saw things in hospital that a child wouldn’t normally know about. I met other sick children, their parents and all acopic behaviours that came with it. I was introduced to the concept of death before I turned 5 years old, and I experienced the sensation of dying at the age of 6. I suffered from pathological envy – of all the normal children that went to school everyday, kicked balls and played tag in the park. I endured the embarrassment of collapsing in public places and schools, lying on the ground, gasping for breath and helpless while strangers stared on with pity in their eyes.  I remember my brothers resenting having to visit me in the hospital, and spending hours sitting in doctors’ waiting rooms. I used to watch them play while cuddled in Dad’s lap, wishing I was the one climbing up the slide and digging in the sand. I was not allowed to socialise with other children in case I caught an illness, as one of the gastros I contracted from my brother tipped me over into heart failure. He cried when my mother explained what had happened (so that he wouldn’t do it again), he was upset because all he wanted to do, was to share his favourite cookie with me.

I remember feeling like I was 20 years old when I turned 13, even though by then, I was getting better, getting to do more things I had missed out on as a child, and going to school like any regular kid. I felt old at school, I couldn’t fathom why a conversation on who was friends with whom held so much fascination, and what one got for their birthdays was worth boasting about. I just wanted to reach my next one.

My experiences made me what I am today, and I am thankful for some of it but it was not a childhood I would have chosen, for myself and or anyone else. Was it worth the survival? I am not so sure. My condition is treated and stable, and I have been able to lead a very productive life, but severe structural congenital heart disease is on another completely different level of suffering. It means repeated open heart surgery throughout childhood and enduring multiple associated illnesses. Every hours in the day will evolve around medications, treatments, and painful tests. All this would be for nothing but suffering a short 10-15 year life-span, which consisted only of limited moments of true care-free quality. It was be a life filled with restriction and fear.

Then there were the selfish thoughts which I was afraid of exploring. Was I strong enough to watch my child endure all this, as there was no doubt that I would love her so much that it would be as if I myself was going through her suffering. And I knew how much harder it would be, second time round and seeing it happening to someone I love rather than myself. Would my world collapse when she dies? Would my marriage survive all this? Was I prepared to give up my career for a decade or more and not develop resentment for doing so? Would I regret or hate myself when I see her suffer? Thoughts that I knew I would be judged on by others.

I thought of talking to my mother, but she didn’t know and I wasn’t married, it was going to be a conversation with a lot more issues than the ones I was facing now. I wanted to know what it was like for her to watch me during my childhood. She didn’t know that I had problems until I was born, but if she did, would she have made a different decision?

So we made our decision, and as it would have it, I was due for a long weekend at work, so I booked in with my obstetrician.  I asked M if we were doing the right thing. He told me that we were doing what was right for us. I asked him if he was upset. He said that there was no point in getting upset about something we had no control over. I begged him to come home. He told me that there was no point for him to fly home as it wasn’t going to change anything, he had a presentation to do and it was important to his career. I didn’t dare to be demanding, and so I didn’t argue. I told myself that one day I may be able to forgive him, but I would never forget that he wasn’t here when I needed him most.

I checked myself into hospital on the Friday and had my procedure. I woke up and found that my face was wet and my fair was saturated with my tears. I was kept overnight because there was no one home with me. I checked out the next day, and couldn’t bear the thought of having polite conversation with a taxi driver, so I walked home. It took 45 minutes. When I unlocked the front door of my house and sat down on the lounge, I curled up in physical pain and cried. I didn’t move for 24 hours.

On Sunday, M came home, and it was as if nothing had happened over the week he was away. We talked about his trip and the conference. We talked about the friends he caught up with, and the places he visited while he was there.  Monday came and we both went back to work and back to our normal routine. It wasn’t as if he was avoiding the subject, he didn’t cut me short when I spoke about it. He was just quiet and listened to whatever I needed to say. We talked about the possibility of starting another cycle of treatment after my exams, and he told me that I needed three months to allow my body and mind to heal. The conversations were always devoid of any emotional overlay. One would have thought we were talking about the weather. He would then ask about my studies, and how much more I had to do before the exams. Life moved on.

Three months flew by, my exams were successful and we had just been out to celebrate.  That night. we were both lying in bed, listening to each other’s breathing, waiting for sleep to overcome us.

He suddenly spoke into the silence.  ‘When I was on the plane over, I decided on Michaela, but we would call her Mischka.’

It was then I realised. He was grieving for our daughter.

——————————————————————–

WMP: But why wouldn’t you want to have babies?

Me: (another polite laughter), I don’t need children when I have patients. They keep me busy enough and I can’t even tell them off when I want to.

I stopped IVF treatment a few years ago. It was enough. I have tried for over 12 years and I was out of tears.

 

The Expert Opinion of Medical Students

med student

Ok. I am an old and cranky surgeon. And this post is going to make me sound positively ancient. It starts off with

When I was a medical student……

Is it just me, or are the medical students these days getting more brazen, opinionated and full of self-importance?

I used to love clinical teaching. Our students used to turn up early on consultant ward rounds, some with prepared case studies of patients on the ward, and helped out our residents and interns with preparations of the round. In the operating room, they used to stand quietly at the head of the patient, peering over the anaesthetic drape and asked intelligent questions. Questions that showed they had checked what was on the list and read about it the night before. They stayed until the case was finished, whether it would be 6pm or 1am. They were eager to scrub in if they were offered the chance and absorbed information like sponges.

Nowadays, they turn up on the ward round at the same time as me, with no idea of the patients on the ward, nor their names and procedures, let alone their histories. The interns and residents struggle with charts, dressings and memorising lab results for each patient, whilst the students look on with vacant smiles, hands firmly tucked into their pockets.

When I was a medical student, I used to arrive an hour before my consultant, print out a patient list, and write out all lab results next to their names for the intern. I would then put all the charts onto a trolley, opened to the latest page, and stamp in the date, ready for the round. While the round is happening, I would carry a box of gloves so that the senior doctors can open the dressings, and be the official scribe in the notes while decisions are made and patient discussed. I would hand the latest lab results to my intern and make sure he/she was aware of any abnormalities. I never spoke unless spoken to. My role was to be helpful to the junior staff and be a thirsty sponge to absorb all the information bantered around my head.

Over the last few years, something changed in our medical students. I don’t know why these young minds are being poisoned, but I sure would like to correct whatever delusions some idealistic non-clinical academic lecturer are feeding them. Whatever fibs they are being told – may work great in theory and on campus, but disastrous if they really want to gain the most out of their clinical attachments. The attitude these beliefs breed in our medical students, alienates them from the real doctors in the ‘real’ world.

1. You are an important member of the clinical team.

Then they get fed this bullshit story about how once there was a patient nobody knew why he was dying and some medical student came alone, discovered the diagnosis and saved the patient. It is an Urban Legend, people. Don’t come onto my team thinking you are going to discover some astonishing fact, talk to us as if everything you have to say is of utmost importance, and please don’t look at us expectantly for a thank-you for your effort. Oh, I don’t dispute that sometimes the medical student finds something that no one else on the team knew, but it is often either of small significance, or most commonly something that would not have changed the big picture.

Nope. You kids are not important. You earn your importance. If you put in the work and help out with the team, then maybe, just maybe, you are useful. Students are actually economic burdens. Teaching takes time, time cuts into efficiency, and decreased efficiency means less thorough-put. Less thorough-put means I don’t meet my KPI (key performance indicators), and failure to meet my KPI means I don’t get my bonus. Oh, and did I mention that I don’t get any extra pay for being a teacher or having students on my team? So to cut a long story short – teaching you kids cost me my bonus. For those who put in the work, I consider it worthwhile, I’d be happy to give you my bonus just so you can stay on the team longer and learn more, because sometimes listening to my students talk intelligently makes me puff up with pride.

You are also not so important that you can call me ‘Tiff’. My intern, residents and registrars call me Dr Tiffany, and that’s forgivable because I have a unpronouncable surname (thanks to my Eastern European husband). So, at the very least, you could do me the same courtesy. Yelling down the corridor, ‘Hey, wait up Tiff’ is just not acceptable behaviour for a student on my team. Why the hell would I wait for you when you are late to the ward round anyway?!?!

2. As a medical student, you have ‘rights’

Hahahahahahaha. Sorry, I had to laugh at the absurdity of this concept. What ‘rights’ would you be referring to?

Last month, we were doing a six-hour operation which started at three pm. The student was scrubbed in to help with some retraction. As a ‘reward’ for his efforts, the senior registrar showed great patience and took her time teaching him how to stitch. When it turned six o’clock, the student wanted to be excused. The registrar made a comment that if he stayed, he could practice more suturing and close one of the wounds. His reply was, ‘I am not paid to be here. I am only here to learn. As a student, I have the right to leave when I have done my allocated hours.’

The registrar looked at me and said, ‘Great. Dr Tiffany, why don’t we all just leave the patient on the table and go home? I think I am  on the 40th hour over my allocated hours for this month. The anaesthetist here is on his 37th hour, How about you?’

Another example of the so-called ‘rights’ was demonstrated to me by a student who stood at the head of the table observing an operation last week. It was a difficult case – I was digging through scar tissue to access some very fine blood vessels without clobbering any of them and causing a blood bath. There was concentrated silence in the theatre for 2 hours. During which time, I was trying not to get too annoyed with his continuous fidgeting, coughing and sighing. When we finally negotiated through the difficult part of the operation, and I was able to relax (i.e. multi-task), I asked the student if he saw what we were trying to do. He shrugged and said that he didn’t really understand because I didn’t talk to him. I held onto my patience and pointed out all the blood vessels I have dissected out and asked him if he recognised them.

‘No, I have never seen them before. I wouldn’t know what they are. You are supposed to teach me today, but i haven’t learnt anything. I have just stood here for two hours. I don’t think we learn very much watching operations, when are you giving us a tutorial? We have a right to proper teaching.’

Time paused. I could see myself pointing to the door, and yelling ‘Get the F%$#& out of my theatre and don’t ever let me see your #$@% face ever again!’

Instead, I said, ‘If you go home and read about the anatomy of this area, you can give me a tutorial tomorrow on it, and I will tell you whether I could have done that dissection better.’

3. Your opinions are important

Trust me when I say, No, Your opinions are best kept to yourself. In regards to opinions, I have two rules I live by: One, your opinions are only worth mentioning if you are either as old as the person you are giving the opinion to, or you have at least half the experience of the subject as the person you are talking to. Two, some opinions are best left unsaid even if it is a good one.

So if you have had no experience in surgery, you need to shut up, watch and learn. I asked a medical student on her first day once, about what she think Plastic Surgery was about. She said that she knew it was all about reconstruction after removal of cancer and injuries, but ‘in my opinion, it is not really essential, so I think they should cut it out of the public health budget.’

Hmm. Let’s imagine the scenario of Miss Smartass getting run over by a car, then carted into my theatre with crushed legs. There I was, standing over her, waving my amputation saw, as she is drifting off to sleep under anaesthetic,  ‘so who think plastic surgery is not essential now?! Mwahahahaha.’

My pet hate is the student who watches me do an operation and tries to tell me how they would do it and why. Ah huh, and sorry if I sound rude, but how many of these have you done? I had to laugh once when a student actually replied, ‘Oh, I haven’t done any, but I have seen quite a few.’ My dear boy, this is not a football game, everyone is an expert because they have watched the game for years. Trust me, if you put any one of those loud, opinionated, beer-drinking, fat bastards who are always yelling obscenities from the couch, onto the football field to play, do you think they can score?! You think they’d win the game? Why don’t you just finish off this operation while I go for my tea break.

4. Medicine can be mastered with ‘Problem Based Learning’ (PBL)

I don’t think I have ever hated a mnemonic more than PBL. Don’t get me wrong, I understand the basis behind PBL, but I think PBL should be taught at the level of training registrars and residents. Teaching PBL to medical students, is like teaching a 17-year-old how to drive without him/her having passed the traffic rule-book written test. You cannot solve the problem, without rote-learning the basics. Yep. Rote-learning, reading, studying and memorising. No shortcuts or ‘I will be able to work it out.’ If you don’t have the knowledge, you won’t be able to ‘wing-it’. And trust me, when someone is bleeding to death on the operating table, they wouldn’t want you to ‘wing-it’ either. Medical school is all about garnering the basic knowledge required to make decisions, and clinical experience during internship and residency is about using that knowledge to perfect the art of clinical judgement. I am still doing problem based learning every single day I am at work. It is something I believe I will continue to do until the day I retire.

Back in the days when I was a medical student (here she goes again *eye-rolls*), we had structured learning of all sciences. It was boring, it was tough, and the amount we had to know seemed irrelevant and insurmountable. But man, was it all so useful when I started surgical training. I am a firm believer that my role as a clinical teacher is to demonstrate to my students the importance and relevance of the basic sciences. I am not trying to teach them how to do an operation, diagnose a disease or to predict prognosis. That is something I teach my surgical trainees. For the medical students, all I am trying to do, is to show them that if they know their sciences well, there will be a whole new world for them to explore with the knowledge they have.

5. There is no such thing as a Stupid Question

WRONG. There is such a thing as a stupid question. Like, ‘What sort of surgery do you do?’ Ok, let me get this right. You have been assigned to my team for 6 weeks and you have no idea what specialty we are in?

If you are thinking of asking a stupid questions, it is better that you say nothing at all. There is nothing more annoying than silly questions from medical students which reflect their complete lack of preparation. Not to mention the polite but pathetic inane questions that accentuate their complete disinterest, absence of comprehension and desire to be somewhere else. Just give me the goddamn attendance form, I will sign it so that you can get your irritating bored ass out of my theatre.

I do like questions when I operate. I like intelligent questions from my students. When a student asks me a question which showed that they have actually done some background reading, I am in seventh heaven. I would take them on a tour of every detail, every aspect and every possible outcome of the surgery we are doing. It is almost orgasmic when my diatribe generates more intelligent questions, showing that they understood what I have been trying to show them, and their interest in what I do. To me, that is like the ultimate ego-stroke.

Sometimes the students are very quiet in my theatre. I suspect it is because they don’t want me to know that they have NFI (No F%$#&ing Idea).

6. Participate in ‘Active Learning’ – speak up and question your clinical teacher

This is like a fast train wreck combining both number 3 and 5.  This is an example of ‘active learning’ from a 3rd year medical student I had last year.

Expert Medical Student: Why are you removing the rib like that?

Me: Because it is a safe way of doing it and it is how I normally do it.

EMS: I don’t think you are doing it right.

Me: Why do you say that?

EMS: I have seen Dr X and Dr Y do this operation last week and that’s not how they did it.

Me: There is usually more than one way of doing an operation, we all have our own preferences.

EMS: But I think their way is better.

Me: Because?

EMS: They are older and much more experienced, so I think you should do it like them.

I wondered if I would get reported if I picked up my sharps dish and bitch-slapped his face with it.

Me: Why don’t you just watch the way I do it and see if it achieves the same result.

EMS: I wasn’t trying to be rude or anything, it’s just that we are told to question everything so that we can learn why you do what you do.

Me: Ask me why then.

EMS: Why what?

Deep breath.

Me: Forget it.

I love my students. Really. I do. I am just very selective whom I show my love to. I love them by teaching them, and I only teach the ones that put in the effort, show respect for their teachers, don’t take our time for granted and don’t make unnecessary noises. I am too old to waste my time and effort on the others.

I sound like an old, arrogant and cranky surgeon. In actual fact, I am afraid to say that my rant reminds me of the Professor of Surgery I had when I was a medical student. Oh God, I really am ancient. I will know I am archaic when I find my portrait next to his in the hallway of the department of surgery.