SOMY (Stories of My Youth) Series: These are just some of the people and experiences that made me who I am today.
Yegor was an IMG. An International Medical Graduate. These are doctors who have been trained and/or worked as doctors in other countries before they immigrated to Australia. These doctors, on arrival, will need to apply for their medical licence through the Medical Board, some will need to sit language tests, some will be told to re-sit exams, and others will be put into ‘supervised’ positions in the hospital. Another way a doctor may migrate into Australia and find work, is to utilise section 19AB of the 1973 Health Insurance Act – to work in ‘an area of unmet need’ or DWS ‘District of Workforce Shortage’. Quite a significant proportion of our rural medical service is run by OTD’s (Overseas Trained Doctors).
Yegor was a surgeon in Vladivostok. He was always evasive about the reasons for his migration, but he would often talk about his home town, about the big ships his father owned and how the inner harbour used to freeze over during winter. As far as anyone knew, he was in Australia alone, without family. Yegor was my registrar and I was the freshly baked intern, during my rotation in Emergency Department, my third month out of medical school.
Yegor’s sense of humour was difficult to grasp at times, his sarcasm is often accentuated by the fact that he was a fully qualified general surgeon with over 15 years experience, stuck in a junior doctor position, working for Emergency Physicians at least ten years younger than him. ‘They were in diapers when I was digging out bullets in real patients,’ he would often say to me. It was, therefore, not surprising that he has had a few complaints from both staff and patients alike.
He used to laugh at me when I expressed my interest in surgery. ‘What for? Women are better with babies than men, leave us useless men something to do.’ And yet, he taught me how to insert my first chest drain, he supervised my first stitches into a lip laceration, and he showed me how to reduce a radial wrist fracture in a 70 year old lady. He would take time to teach me at every opportunity, and often says to me, ‘A good surgeon is smart, not quick.’
During night shifts, he used to give me a 100 dollar bill, and send me on a drive to the nearest 24-hour McDonald’s. He would tell me not to get out of the car, and use the drive-through. I would then return to the department with burgers, chips and drinks for everyone, including the Ambo’s. Once I have dished out everyone’s orders, he would pull out a chair next to him at the Hub bench, put a box of chicken nuggets and milkshake in front me, waving for me to sit down. ‘Eat.’ He would then hoover his Big Mac under a minute, with his eyes on the monitors in the resus bays and tell me about the different cardiac rhythms on the screens – all at the same time. Everyone took his generosity for granted, but he never seemed to mind.
Yegor could not stand stupidity and was never afraid to speak his mind (this applied to both staff and patient). One night, a 22 year-old IVDU (IV Drug User) presented to the Emergency department with her 6 year-old son. She was annoyed with her son because he did not want to walk, so she had to carry him everywhere. After some blood tests, it was obvious that the child was malnourished and dehydrated, on the verge of renal failure. There were also cigarette burns on his legs, and his clothes stank of stale alcohol. Yegor went up to the woman and said ‘Why did you have children?’ to which the drug-addled young woman just shrugged, ‘it’s not as if I asked for one.’ He then turned to me and said, ‘women like her should get a very high-dose pelvic x-ray when they come here.’ Then he stomped away, leaving the mother looking at me quizzically, ‘Why do I need an X-ray? I am not the sick one.’
An 85 year-old man presented with abdominal pain at 2am, and a history of bloody diarrhoea. He had just came back from a trip to India 12 hours before, and when he presented to the GP in the evening, he was told he must have eaten something bad. Yegor was convinced the patient had ischaemic bowel (which is a surgical emergency). He was having difficulties on the phone trying to get the surgical registrar to get out of his bed to review the patient. It was obviously a tense conversation, evident in the way he was clutching the handset whilst his other hand was crushing an empty polysterofoam cup. Slowly, each one of us in the Hub stopped what we were doing and started to listen in. When Yegor’s voice goes quiet, his accent thickens, and everyone knew some real shit was about to go down. ‘Listen to me, young doctorrrr,’ he delibrately rolled his r’s, ‘if I don’t see you in here in ten minutes, I will carve your name on his gravestone, that is before I cut off your balls so you will never breed little doctors.’ He then calmly put the handset back down on the phone.
When the surgical registrar arrived, looking as if he was ready to kill someone, Yegor went up to him with a big smile and said in a big booming voice, ‘Welcome! The great Pizda has arrived to save a life. Thank you so much for coming. Let me take you to see your patient.’ It was only after the patient went up to theatre that an orderly who spoke Russian told me what Pizda meant. Unfortunately, ever since then, Dr Pizda stuck with that particular surgical registrar.
Yegor did not like to see suffering. He was once reported for giving a patient too much narcotics for kidney stones, the patient fell asleep (finally, after carrying on for hours with pain) after his third dose of Pethidine and his oxygen saturation started to drop. A code had to be called but he recovered with minimal intervention. It was only discovered later that the patient had sleep apnoea and omitted to tell anyone.
Yegor shrugged at the incidence, ‘I had kidney stones, it’s like giving birth to those little animals with spikes through my penis.’
‘Echidnas,’ I said to to him.
He looked at me, ‘Is that a better medicine for pain?’
‘No,’ I said, ‘the little animals with spikes.’
‘Brrr,’ he physically shivered, ‘poor mama echidnas.’ I didn’t have the heart to tell him that they came in eggs.
Anyway, I digress. A 45 year-old man came in with terminal pancreatic cancer one night, because he was in agony. He was not only in a lot of pain, but was gasping for breath. His abdominal cavity was riddled with cancer, and his lungs were filled with malignant fluid. It was a difficult conversation with the patient’s family who did not seem to realise that their loved one was dying and wanted full resuscitation protocol to keep him alive. It was not helped by the fact that they did not trust Yegor with his heavy Russian accent and wanted to see a ‘local doctor’.
I found Yegor sitting with his head in his hands in the Hub, staring blindly at the chest x-ray on the light-box. He must have heard me approach, because without turning around, he said, ‘In Russia, we have a bullet for this disease,’ he put his finger on the X-ray, directly over the heart, ‘this is where I would put it.’
Yegor never went back to be a surgeon again, his abrupt manner and directness had rubbed many senior medical and administrative staff up the wrong way. Even though he was a sound clinician and has not once been reported for medical error or negligence, he was not successful in his multiple applications to be a surgeon. He worked in the public health system under supervision as a junior doctor in various specialties for many years.
I rarely saw him after my internship in Emergency. Once, when I was a junior training surgical registrar, we passed each other in the corridor. He winked at me when I greeted him. As we were walking away from each other in opposite directions, he said loudly, without turning around, ‘Aaah, krasavitsa, you break my heart, why work with these bychit? You are too good for them, they don’t know how to treat women.’
The last I heard, he was working as a locum doctor in Arnhem Land.