Standing on the Threshold

Well, helloooooo Strangers.

It has been over two and half years since I last posted and it has taken me a long time to finally decide to knock on this door again.

When I first started blogging, I wanted to write about everything that mattered to me, in an honest and truthful way. In a world of political correctness and judgmental self-proclaimed ‘experts’, not to mention medico-legal confidentiality issues, it was difficult to for me to blog without anonymity. I did my best to be non-specific about my identity, so that I could stay true to my blog (i.e. to be honest about how I felt and to be able to write about real events without violating confidentiality). The medical fraternity is a very small world, especially in my specialty which is predominately male. It became increasing difficult to field specific comments and personal emails without being deliberate dishonest or misleading in an attempt to hide my identity. I was not prepared at all for the onslaught of people who were not just happy to read my blogs for what they are (a female surgeon’s perception of the world, or just a story); there were those who wanted to ‘expose’ me in my personal and professional life, some well-meaning, but majority of the time not necessarily in a positive way.

I did not start my blog to ‘advertise’ my business. I did not write my posts to ‘seek attention’. I joined WordPress because I love telling stories, and I love writing. I have been told by non-medical people that I have a knack for making Medicine easy to understand and humorous at the same time, and I just wanted to refine my ability to do so because it is something I enjoy immensely: to let everyone see the health profession in a positive light. At the time I found a perfect outlet in blogging, because it was the ideal way for me to explore different writing styles, to expressed the ‘wanna-be-writer’ in me, and respond to the variety of reactions my posts have evoked in people. Not to mention, I have ‘met’ some pretty awesome fellow bloggers and made great friends in the process. Many of whom I was so happy to find are still blogging.

A few months ago, I was truly honest with myself and asked the hard question: What was it that made me feel uncomfortable when people started confronting me about my true identity? I knew it was because once I have lost my anonymity, I felt uncomfortable to put down in writing on how I really felt about things. Then I snickered at myself as a voice within me sneered, ‘did you just hear yourself?’  What I was really saying was that I was afraid of what others would think of me and I was ashamed of my opinions.  So, it was self-preservation that kicked in two and half years ago and stopped me from writing.

I never took myself as a coward.

That’s when I gave myself a hard mental slap in the face. Why should I be ashamed? And why should I be afraid? I should be proud of who I am and where I am in life. I don’t claim to be an expert in everything, even in the area I have been trained. I don’t push my opinions onto others, or tell people what to do. I simply tell a story the way I see it, or voice an opinion formed by my experiences.

I am dedicating my first ‘return’ post to all my friends on WordPress. I sat down to write today because I have just spent the weekend reading all the comments you have posted on my past blogs. I could still feel the positive vibes and the encouragement each one of you have put on my page. But more importantly, I realised that it was not just blogging that I have missed but also all of you with your warm funny comments that I used to read with my morning coffee. You are the reason I wrote today.

So here I am, standing on the threshold.

A Traditional Christmas

After three flights in 30 hours, and a 2-hour drive at manic speed across the Austrian border, we have finally arrived home for Christmas. When I say home, I mean hubby’s family home in Eastern Europe. Although this is definitely not the first time I have spent Christmas with the in-laws, this place is a vast contrast to our home in Australia so I still need to switch on my adjust button whenever I come here.

On arrival, Mamka would laugh in genuine delight at the sight of her first born, one that she has not seen for far too long. Amongst the excitement, 87-year-old Babka would lift herself out of the chair, making sure no one notices her difficulty. The traditional three kisses on the cheeks are exchanged all round, and as usual, my cheeks are patted by weathered hands for good measure. A rowdy exchange occurs between the two brothers; they slap each other’s backs amongst verbal insults. M and I take off the layers of our winter gear, while his brother mumbles at the weight of our luggage as he drags them across the threshold.

M’s mother, grandmother (or Babka as she’s fondly known), and 34-year-old brother live in an apartment in the town centre. This is a 2-bedroom apartment that has not been touched since the 1960’s, the whole floor plan would fit easily into our lounge room. It would be unheard of for us to stay elsewhere when we visit, even though his brother has to move out of the second bedroom onto the lounge room sofa to accommodate us. The décor of the apartment has not changed since M’s parents have gotten married and moved in in the early 70’s. Old cupboards in orange pine lacquer line the walls, each with scratches and peeling edges. The shelves are bent in the middle under the weight of timeworn books, vintage ornaments and items of all sorts for the last 50 years. Childish stickers adorn the glass panels of these cupboards; old photos, trophies and toys line the benches, all live documentations of his childhood.

The apartment is in desperate need of renovation. The toilet flushes but does not rest evenly on the floor, thus it rocks if one sits down on it with full weight. The small balcony off the kitchen French doors shows cracks in its concrete floor, barely strong enough to hold any human weight but serves as a perfect spare fridge/freezer in the cold winter months when the outside temperature is barely above 5 degrees Celsius. The bathroom holds a bathtub that is as old as the apartment itself where one still has to shower the old fashion way – sitting, soaping one handed whilst wrestling a shower head with the other hand. The stove and oven is one that is only seen in a museum nowadays with iron holders and old racks. The sink is barely large enough to fit a soup pot; old plastic drying racks rests on top of a laminated bench. What dishwasher? I would have gladly purchased one for them, but not only is there no space for such a luxury, but they do not actually have the appropriate plumbing to fit one.

The ‘second’ bedroom really is the front sitting room and part of a passageway into the main bedroom (which is shared by mum and grandma), thus there is no privacy to speak of. Babka lies in her bed most of the day, watching soap operas with the volume dialled up, as she is not one to admit to the need for a hearing aid. Occasionally she ventures out of bed for the essentials, one of which includes a cigarette and a glass of beer every couple of hours. It is a regime which prevents pressure sores and satisfies her curiosity as to what everyone else was up to. She never goes outside the apartment anymore; the osteoarthritis in her knees prevents her from walking more than a few steps at a time. A cane sits stubbornly ignored by the door and whenever her knee is mentioned, she would hold onto the cupboard and do a little jig just to prove that it is all a figment of our imagination.

Everyone smokes continuously in this household, everyone, that is, except us. This is irony at its best considering M is a heart and lung surgeon. Cigarette smoke constantly permeates the whole apartment, which then infiltrates into everything in our luggage, a reminder of our visit when we move onto the next European destination. Opening windows to air the apartment is never an option, as the bitter cold of European winters, when permitted to slip inside, renders the heating systems ineffective.

It is not uncommon for us to escape the apartment with long walks, the biting wind and icy footpaths a better alternative to the indoor haze. Once rugged up, with gloves and a rubber soled boots over wool-covered feet, we would tackle the local hill up to the township castle, or trudge by the icy river at the base of the retaining walls. Two hours of fresh air not only flush out our smoke-ridden lungs, but also brings sanity back after being stuck in a small shared space. Hubby is often silent on these long trips, as he takes a rest from being bombarded, not only with the latest local gossip, but also with questions about the latest developments in his life from his mother and grandmother. This is also a time when he enjoys a reprieve from being the translator between the three women in his life. It is a concept that the older women do not seem to understand as they continually talk while he tries to translate to me, until he gives up – usually by the end of the first day of our visit, at which time they berate him for not involving me in their conversations.

Breakfast is not for the faint-hearted here. Mamka would get up around 7.30am. She sits down at the vinyl covered dining table, leisurely enjoys her first cigarette before her preparations. An hour later, we would wonder in, with hubby being in charge of the coffee and I, in charge of toasting sliced bread. Once everything is placed on the small dining table tucked in the corner of the closet kitchen, Babka shuffles in on her slippers and in her pyjama dress. The first meal of the day starts with a shot of Vodka or Cognac, of which she knocks down in one toss with a big satisfied sigh. A black coffee is then savoured with toast and homemade spread. The spread alternates between the fishy one (a blend of sardines, mackerel, mayonnaise, butter, and mustard), or the cheesy one (a beaten mix of blue cheese, beer, butter and seasoning). This is accompanied by freshly sliced brown onion, radish and strips of paprika. Often with a look of disdain from Babka, I stick to my jam or marmalade on toast. As I daintily chew through my breakfast and sip my coffee, I would recognise the word ‘princess’ in conjunction with my name as she comments on how I eat ‘like a sparrow’. Once breakfast has been consumed, a cigarette is then lit, accompanied by a shared bottle of beer. As an excuse to get away from the fumes, I would volunteer to do the dishes. In reality, it is not the meal which bothers me. No, it is the burp that comes out of hubby about two hours later when we are on our walk, when he decides to steal a kiss, at which time a rumble starts in his stomach and releases as one toxic explosion in my face. One might think I am swooning at his kiss, but I can assure you that it is no other than the stench which permeates my nose for the rest of the day.

Christmas here is celebrated on the 24th, at four o’clock in the afternoon, as the winter sun descends rapidly behind the hill, we head to the town cemetery, armed with bags of candles, matches and fresh greenery. The place is full of people and constant traffic passes by the gate. It is an exercise that may take time depending on how many friends and acquaintances Mamka runs into. At every visit, we hear the story of whom each graves belong to, and stories of the deceased. Candles are lit, the marble headstones are cleaned, and the greenery is laid on each family grave. She mumbles a prayer quietly and we move on. The walk home is usually filled with peace, places of interest are usually pointed out. This is where M went to high school; that way is where Mamka used to work, and this is the road that leads up to Babka’s old house.

Dinner is usually served around seven, in the small lounge room that barely fits a sofa, two lounge chairs and a rectangular glass coffee table. His brother is made to remove his pillows and blankets, and he is in charge on turning the lights on the Christmas tree. The smell of fresh pine leaves from the tree cuts through an odd mixture of stale cigarette smoke and evaporated oil of deep-fried carp in the lounge room. Family crystals, silverware and porcelain are laid out on Christmas-themed table clothe. A round of Vodka or Cognac is shared as a toast to health before the meal starts. Grace is spoken, with blessings bestowed on all at the table, where Mamka paints a cross is on everyone’s forehead with a honey-soaked garlic clove. This is rather troublesome for one who sports a fringe such as myself – for the rest of the evening, I have to try and ignore the discomfort of having my dark locks plastered to my forehead, not to mention the slow descent of excess honey into my eye lashes and my nasal tip as we work through the courses.

Entrée consists of poppy seed pudding with poppy seed coated prunes. Once we are floating on poppy-induced Christmas cheer, the fish is served with a potato salad. Beer is consumed like water, and one is never allowed to rest on an empty glass. As we munch through our meals (eating carp is never a graceful affair), we again listen to both older women tell the story of how each dish came to be part of the Christmas tradition. It was an eclectic mix of the two families. Your father’s family didn’t like fish, so they always had cabbage soup. We never had the prunes coated in poppy seeds, that’s something your father’s mother brought into the house.

An apple is cut by grandma after the mains, and if a star is found when sliced in half, it bodes good luck and prosperity for the new year. It therefore doesn’t take a genius to figure that the apple need to be cut perpendicular to its core, although it can be nail-biting in case worms are found in a rotten fruit, disrupting a perfect star-shaped core. Dessert is a self-serve affair, consisting of chocolates hanging from the Christmas tree. Sometimes this could be a little sparse when the sweets mysteriously vanish from the branches during the days before Christmas Eve. Mamka however always have a spare stash for such an emergency, of which she hides in the TV cabinet next to a large collection of DVD’s until required.

Presents are given and opened before the stroke of midnight. Each person is given the attention and time to open their presents and thank the giver. By now if the poppy-seed doesn’t make one happy, the beer would make one exuberant about any present, no matter what it may be. Without doubt, Babka would run a dry commentary on each present revealed whilst happily nursing her umpteenth glass of beer in the large lounge chair.

This is Christmas. A tradition that my husband has shared with his family since he was born. A tradition that makes me grateful to be a part of when I am here, as a member of this small loving family.

Vesele Vianoce to you all.

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Living in an Epidemic

When I was reading about the Ebola outbreak last night, I thought of my time in Taiwan during the SARS epidemic. So I went back to the diaries I kept during this time and found couple of interesting entries. I was there as a Fellow in one of the world famous plastic surgery units during 2003. A Fellow is a young doctor who travels to another hospital unit to train for a specified period as a ‘trainee’ doctor, usually to learn from a specific doctor or a particular procedure/technique.

I have left this entry unedited, as it is a true perspective of an Australian living in Taiwan during the SARS epidemic, both as a doctor and local resident.

25th Aug 2003

It’s been more than two months already since the first wave hit Taipei. I still remember the panic that hit the city during that first week; it was when they closed down Ho-Ping Hospital in central Taipei, with all its patients and staff isolated within the hospital. It was constantly being aired on the news and the hospital exterior was being videoed 24 hours a day, a bit like reality TV. There were scenes of flying badmington cocks over the railings of the balcony, and I remembered the presenter reporting that it was great to see that the occupants of the hospitals keeping up their spirits, and exercising to keep fit. The comments from my male colleagues in the TV room at the time were less than polite. I think something was mentioned about there are better things to do when you are couped up with a whole bunch of young nurses. *eye roll*

Then there were news of individuals who were to be isolated at their own homes because they’ve been in contact with SARS suffers. After which, news of non-compliant isolated individuals venturing out of their homes were reported with the police were called to herd them back home. They have now posted guards around quarantined buildings to stop residents from ‘escaping’. Cases were on the rise, another hospital got shut down, and the mortality is starting adding up.

I have missed my chance to go home. Four weeks ago our department director gathered all the overseas Fellows in his office to let us know that if we wanted to go home and leave the country, he would still be happy to write us a certificate for our fellowship and recommend us for jobs back home. There were 7 of us, two from Harvard in the US, 2 from Italy, 1 from UK and another from Ukraine. The Ukrainian and I stayed. It was really a blessing in disguise, because now, instead of elbowing other Fellows out of the way for an opportunity to do cases, we are both operating more than 12 hours a day. I joked to my concerned parents back home that I spend so much time in the operating theatre with its filtered and uni-direction airflow, I am probably at the lowest risk of getting any respiratory virus. They weren’t amused. Wherease my boyfriend just said that if I got SARS, he wasn’t coming to visit. I’d like to believe that’s anger and frustration talking. I can understand why he’s so pissed at me. I think I would be too if our positions were reversed.

The one thing I have discovered about living in this SARS epidemic is that there seem to be more pregnant women than usual at the moment. One nurse mentioned to me that since we have to take our temperatures every day as required for all hospital staff, she has finally managed to get pregnant during her last cycle as she knew her exact ovulation date. A fellow colleague also mentioned that you can pick the pregnant nurses during this epidemic, as they are usually the ones wearing an N95-grade mask. These are heavy duck-billed masks which have viral filters and are very hot and uncomfortable. Most staff members such as myself (who want to breathe and admittedly am a bit blasé about the whole thing) just wear the regular light ones.

Oh well. You’ve gotta learn to see the bright side of life when living in an Epidemic.

Administration has been harping on about wearing the right masks, but I seriously believe that if I wash my hands (which are raw from scrubbing all day), and keep away from sniffling, slobbering people, I’ll be fine. I have been avoiding public transport as much as possible. I have blistered on my feet because it takes me one hour each way, walking to and from work. After 8pm, I just sleep in one of the spare beds in the Burns Unit. I suppose I am like every other deluded doctor at the moment, we think we are being ‘adequately’ careful and probably invincible.

A thought just occurred to me. If I die in this epidemic, I won’t be able to hear ‘I told you so.’

Well, I guess if I am not back tomorrow, you know I am being ventilated in ICU with SARS.

 

 

Doctors are the worst patients

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There are plenty of reasons why doctors shouldn’t get sick. The best one being – we make the worst patients. I, of course, am no exception. Despite having had plenty of practice in the past of being a patient, somehow, I just don’t seem to learn. Every time I get sick, I am always a doctor, trying to be a patient.

So why are we such bad patients? Because we think we know better. We are the one saving lives, and sometimes we refuse to admit that we are the ones that need saving.

6 weeks ago, I caught a viral infection, not hard when you work with sick people all the time. I kept working, because as far as I was concerned, if I wasn’t intubated on a ventilator in intensive care, or in a casket, I was not sick enough to stop working.

Reason #1: We don’t realise how crap we really feel until we stop worrying about how crap everyone else feels. When you are deeply buried amongst blood and gore during an operation, you concentrate on what’s in front of you, rather than the tightness and clogging in your own lungs.

Two weeks later, instead of improving, I developed a hacking cough which sounded like I was trying to expel my lungs in piecemeal. As I was struggling for breath whilst talking to patients in my clinic, one of my colleagues suggested that I go and have a chest x-ray done. I did. I looked at it with my colleagues (bear in mind we are both plastic surgeons who rarely ever have to look at chest x-rays), we decided that my lungs looked normal, that I would live and carry on. However, just to be on the safe side, I texted a photo of my x-ray to my husband, who is a lung surgeon, and looks at chest x-rays every day.

Reason #2: For every doctor who self-diagnoses, there is an idiot patient.

I received a text from the husband. Go and see a real doctor. I shrugged it off, he was obviously happy to look at everyone else’s x-rays, but couldn’t spare two minutes looking at his own wife’s x-ray.

Reason #3: Sympathy is sparse when you are married to a fellow medico (and surrounded by friends who are doctors). You have to be showing signs of multi-organ failure before you get breakfast in bed.

I carried on with my afternoon operating list, during which, couple of times I had to sit down because I felt light headed from being short of breath. I felt tired, and was taking more care than normal, but the list went on smoothly without a hitch.

Reason #4: It takes a sledgehammer to slow  down a surgeon. Because we are so focused on our work, we often don’t realise we are pushing our bodies to the limit until we collapse in a heap.

I got home late that evening, at which point my husband looked at my bluish lips, my ashen complexion and yelled, ‘What the F$#@ are you doing at home? You should be in hospital.’ He pulled up the x-ray photo I texted him and shoved it into my face, ‘you have right upper and middle lobe pneumonia.’

Reason #5: When we self-diagnose, we either completely miss the obvious, or become total hypochondriacs with the worst over-diagnoses. In my case, it was the former. Also, note to self- I obviously am not qualified to read a chest x-ray.

I climbed into bed in my work clothes. I couldn’t think of anything more mortifying than going into hospital for a cold and cough. There was no way I was going into hospital for this. So exhausted was I that I fell asleep within 10 seconds.

Reason #6: We never think we are sick enough to seek medical attention.

The next day, as I was doing an early morning ward round, I ran into a friend/colleague who is a general physician. He took one look at me, frowned at the sound of my wheezing and coughing, and promptly declared that I needed to be admitted to hospital for treatment. I told him that I had a full clinic, and will have to check into hospital later that evening. He suggested that I get myself into hospital as soon as possible; I told him that I couldn’t cancel all my appointments and let my patients down at such short notice.

Reason #7: We think that the Earth would stop spinning without us, and that our patients couldn’t possibly survive without us.

The day was particularly long – like a train in slow motion. Several patients looked at me in concern and told me I didn’t look well. I asked my secretary to shift all my appointments and operating lists for the next few days, so I could be admitted into the hospital. Some patients were angry and upset, some complained that they are busy people and already had arrangements in place for their booked surgery. Apparently my illness was going to interfere with their plans. Some were worried that their treatment were delayed and felt that I was neglecting them.

Reason #8: Some of our patients think they couldn’t possibly survive without us.

So I checked myself into hospital that evening. I was put on oxygen, given nebulisers, antibiotics and tucked into bed to rest. It was only when I was forced to do nothing that I suddenly realised how terrible I felt. My chest felt tight, my ribs ached, and my body gave in to the continuous coughing that rattled my bones. My limbs were like jelly and my muscles barely contracted, behaving like useless slabs of soft meat patties. I couldn’t sleep as the call bells pealed throughout the night, sounds of doors opening and closing interrupted my light slumber, and occasional moans and yells from other patients made me toss and turn. The next morning, the physiotherapist spent half an hour bashing on my chest to clear up the clogging in my lungs. We then decided to venture out of the room for a walk, and that is when I saw one of my own patients walking down the corridor on her zimmer frame with her physiotherapist. I looked down at my pyjamas in shame and high-tailed it back into my room. I started thinking about leaving the hospital.

Reason #9: Even though as doctors, we spend the majority of our lives in a hospital, we actually really hate staying in one.

When my physician came to see me, I spoke to him about the possibility of having my treatment at home. He was able to adjust my antibiotics and decided that I could be discharged as a ‘hospital-in-the-home’ patient, where I will be going home with my IV cannula in place, and just come back to day hospital for my IV antibiotics, physio and nebulisers once a day.

Reason #10: A colleague will always assume that as doctors, we would be trust-worthy, compliant, sensible patients. WRONG.

As soon as I arrived at home, I headed to the study and switched on my laptop. I reviewed all my dictation and letters, chased up lab results of my patients and caught up on some bookkeeping for my practice. The day after I was discharged, I had a case which could not be cancelled, so I asked my anaesthetic colleague to remove my IV cannula so that I could scrub for surgery, then to replace it after surgery before I headed back into hospital for my treatment.

Reason #11: We know how the system works and we have connections. Doctors will always find a way to circumvent treatment regimes to suit their activities.

But as I sat there at the end of the day, with the IV antibiotics dripping into my veins, and the nebuliser oxygen mask on my face, I suddenly felt so tired. So tired of it all, of putting on a brave face, of carrying on as if nothing is wrong when I felt so unwell, of worrying about my patients when I should be concerned for my own health, and most of all, I was just simply tired. My bones ached from exhaustion, and my mind was so worn out, it was completely devoid of any emotions.

Mentally, I was waving a white flag. My body was shutting down because it had reached its limits, and it was time I surrendered to the consequences.

Reason #12: It is terrifying for doctors to admit that we, despite our abilities to help people and save lives, are just like everyone else, mere mortals, in bodies that have limits.

After four frustrating, agonising weeks, I am finally on the slow road to recovery. It is only now that I have started to contemplate changes in my life, ways of improving my health, and strategies of looking after myself. In a moment of déjà vu, I felt that I may have been down this path before. Regardless, I was, at last, being a sensible patient.

That is, until next time.

Old Shakey

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People write passionately about discrimination in Medicine: sexism, racism and even fattism (yes, there is such a word, I checked). Today, I want to talk about Ageism.

Ageism = Prejudice or discrimination on the grounds of a person’s age. (Oxford Dictionary)

Like all forms of discrimination, it goes both ways. There is ageism from the doctors to the patient, and then there is ageism from the patient to the doctors. The latter is the cause of my ongoing angst.

When am I going to see the real doctor?

This is actually something I get on a regular basis, usually after spending 45 minutes with them, taking a history, examining, diagnosing and explaining their treatment options. I suppose I should really consider it as a compliment. I do know I look young for my age. I know I don’t look like I am about to turn 40 (*sigh*). This can be attributed to both my ethnic background, but also to the fact that I don’t smoker nor spend much time in the sun (I do, however, sport a very unattractive sallow chronic ‘fluorescent tan’.) Yes, I do look after myself, but despite being a plastic surgeon, I have yet found a colleague trusty-worthy enough to stick needles or scalpels in me, and I am definitely too chicken to do it to myself in front of the mirror (unlike some of my colleagues – *winkwink nudgenudge*). So, no, my youthful appearance is not chemically or surgically enhanced, all I can blame it on is my genes.

So, why, you ask, am I complaining about looking young? Well, here’s a list of reasons why my age-inappropriate appearance doesn’t exactly make my job easier.

I don’t mind having someone young for the cough and colds, but can I please have someone older for the serious stuff?

I am not having someone fresh out of medical school operating on me.

You are too young to understand my problems

I need someone who are older and know what they are doing.

You look younger than my granddaughter, how old are you?

I am not being judgemental, but you are too young, I want someone who’s competent.

I have a very complex problem, I need someone with a little bit more experience.

The standards for the young graduates nowadays are not like the good old days, I want an older doctor who has been through the real training.

I want a doctor who is at least my age.

Now, what in the world makes you think you have the right to ask for my age? You are saying it isn’t being judgemental. But it is. You are judging my capabilities as a doctor by my age.

These patients feel that because of my age, I lack experience and should only treat the ‘easy’ stuff. There are two incorrect assumptions here. Firstly, the inferred ‘lack of experience’ by my age. Most people don’t realise that to become surgeon, one has to finish medical school, gain basic medical experience working as a junior doctor before being selected via a rigorous process to become a trainee in surgery. The surgical training program can range from 3 to 7 years, depending on the actual specialty, any sub-specialisation training within that specialty, and any additional overseas training to gain a wider perspective. At the end of which, one has to go through a series of very stringent assessments before a specialist qualification can be granted. I was at least 10 years out of medical school before I became a fully-qualified specialist surgeon. All I can say is, if 10 years of working and training (and not forgetting the 6 years of medical school before that) doesn’t constitute ‘enough experience’, and my qualification ain’t worth shit to you, then go ahead and set your own definition of ‘experience’.

Secondly, the patient’s assumption what ailments are ‘easy’ to treat and what aren’t, may not exactly correlate to true clinical relevance. A cough and cold may be easy to treat, but it may also be a manifestation of something more sinister. I would never presume a cough and cold as exactly that – I am a plastic surgeon after all – I always refer the patient back to their Family Doctor, as that is something those doctors would have more knowledge of. Patients who infer that they know what is ‘easy’ and what is not, show not only a total lack of awareness for the complexity of medicine, but also their disrespect for their doctor’s judgement. What may appear to be ‘easy’ may just be a harbinger for an underlying problem which is very difficult to treat, or it may just be the tip of the iceberg where surgical complexity is concerned. One of the most critical aspect during our training is to be able to recognise when we are out of our depth. If your doctor admits to needing a second opinion or assistance of another specialist, you should be grateful that you have found someone who will not take risks with your health.

People think that lack of ‘life-experience’ due to age is a deterrent to being a good doctor who could understand the issues of the ‘older’ population. This myth is easily busted when I look around at my colleagues. Which one of us isn’t jaded by what we have seen during our careers? We have seen it all. Birth, Life, Death, Disability, Misfortune, Pain, Suffering, Drug Use, Crimes, Abuse, Deviants, Perverts, the Insane, Murderers, Liars, Malingerers, Sadness, Grief, Anger, the list goes on. Some of the things we see and the frequency in which we see them, gives us multiple life-times of the so-called ‘life-experiences’. Sure, we may not have experienced any of these ourselves personally, but sometimes watching somebody we care for going through it and feeling utterly helpless can be just as real to us as the person who is experiencing it. Many of us view some of our patient’s misfortune as personal failures, and they take their toll on our own mentality.

Each specialty also has their demographic of patients; to assume that we have no inkling to a patient’s particular age-related issues is really quite ignorant. Most of my patients with skin cancers are elderly; I understand they may have issues getting to and from hospitals, care at home and simple matters such as attending appointments for dressings. We organise nursing home-visits for their dressings, and sometimes, arrange suitable surgery dates so that their family can take time off work to care for them. Most of my breast cancer patients have young children. We fit their appointments around school pick-ups and their surgeries out of school holidays so they can spend as much with their children as possible. Doctors are not unaware of our patient’s personal situations; we are not blind to possible social issues surrounding health problems. We, ourselves, have elderly parents, young nieces and nephews, friends outside of medicine and older/younger siblings. Often when we meet new patients, if they are not of similar age or demographics as ourselves, we can still relate them as one of our own relatives or friends.

So you think we don’t have enough ‘life-experiences’? Well, tell me, have you ever had to listen to a mother’s heart-breaking sobs in the middle of the night while she is sitting next to her dying 3-year-old baby? Have you ever had to spend two hours stitching up a battered wife’s mangled face and then watch her leave with her husband because she refused to report him despite your best efforts in counselling her? Have you ever stood in a room, watching a whole family saying goodbye to a man dying, while you are busily pumping him full of morphine because you know there’s nothing else you could do for him? Have you carefully removed a brain tumour from a patient who only hours before, had a psychotic episode and scratched, punched and spat at you? I could go on, but did you just say you were abused as a child? I have lost count of the number of child-abuse victims I have seen, but I understand everyone’s story is different. A different variation of the same……

Education has changed dramatically over the years, and this has definitely influenced Medical Schools. Standards are different, and they are different for a reason. The emphasis in medical training has changed, from purely scientific rote-learning to a more holistic clinical approach. Yes, I may have bitched and moaned about some of these changes as a teacher, but I can see why these changes needed to happen. To be honest, I don’t envy the students and trainees nowadays, an explosion in medical knowledge and technology over the last two decades has added a phenomenal amount into their core curriculum. Some of which I have yet to catch up with because it bears no relevance to my current sub-specialty. When I attended medical school, notes were written on paper, lab results were given over dial phones (yep, I am that ancient), X-rays were on films and put up on light-boxes, blood pressures were taken manually, pulses were counted with a pocket watch, surgical drills and saws were hand driven (not powered by electricity or gas). Back then, the list of diseases I needed to exclude for any presentation could be written on half a page, the number of tests I needed to do could be counted one hand and the number of ways I could treat it could barely fill a chapter in a textbook. Things are so different now, possibilities in Medicine are endless. Medical education nowadays place importance on basic core knowledge so that a graduate is not expected to know everything, but rather, to be able to pick out and apply relevant components of their knowledge to clinical situations. Most importantly, they need to know how to approach the problems and where to source the information they require. The point of today’s schooling is to generate a doctor that thinks, rather than one that relies on a checklist. So give your young doctor a chance, you might be surprised, he/she may think of another approach to your chronic problem. Something that is different to the same old thing which hasn’t been working for you.

We all know that we are getting old when we think everyone else is looking younger, especially when we see our pilots boarding the same plane we are travelling on. Commercial pilots start their careers in their late 20’s and to a lot of us think they are just kids, really. They are responsible for hundreds of lives for hours, but their age does not reflect their capabilities in getting all of us to the correct destination, safely. Why? Because of their qualifications. No airline would put a pilot at the helm of a plane unless he/she has passed all the requirements and assessments, whether they are young or old. In fact, once the pilots have reached a certain age, they have to be re-assessed for their ‘fitness’ to fly.

Some patients actually admitted to coming to me because their previous surgeon was getting old and I looked young (if only they knew!). Some do so in the hope that I have more up-to-date knowledge on new techniques, new technology or new approaches to their chronic problem. Some change surgeons because they have become concerned as their previous surgeons are deemed to be ‘too old’ to still be operating (ageism in the opposite spectrum), whilst some disliked the more paternalistic approach and ‘old-school’ attitude of their previous older surgeons.

Some older surgeons nearing their retirement have insight into their decreasing capabilities. Their eyes aren’t as sharp anymore, their hands have started to tremor, or they are now on several heart medications and struggle to cope with long cases. They cut down on the number of cases they take on as well as limit the type of operations they do. Many become surgical assistants to their younger counterparts. When I first started, I had one of the retiring Professors of Surgery as my regular assistant. It took a long time for me to adjust to giving him orders and correcting him when he is not doing something right. The nursing staff used to giggle when I would say, ‘Would you mind sewing that drain in for me, Sir?’ But it was a very happy arrangement. Prof could still get his hands dirty without the stresses and responsibilities of a surgeon, at the same time, I had instant access to any advice I needed. Not to mention the stories he used to tell as we were operating, those were gems to learn from. He would always tell me that he was not there to judge my competence, but to be my assistant for procedures I was more than capable of doing on my own.

So next time you meet a young doctor, don’t ask them how old they are, ask them what their qualifications are. And if they are just learning, give them the benefit of the doubt, because you could contribute so much to their education and experience by sharing yours with them. You never know, when your doctor retires, and when you are much older, they will be the ones in their prime, in charge of your health.

So you still want a doctor who is at least your age? Ok then, why don’t you go down the corridor and see Old Shakey next door?
Doogie Howser

* Disclaimer: Please do not take this blog as a disrespectful post to generations of surgeons before myself; I fully acknowledge the fact that their expertise could not be surpassed by myself. I am deeply appreciative of their willingness to share with me all that they know, as well as their unfailing support to me as a fellow surgeon, despite my age.

 

 

Hospital Fashion

 

*The latest fashion on the hospital corridor catwalk*

The latest fashion on the hospital corridor catwalk

Am I getting old? Am I becoming a prude? Am I behind in the fashion trends? Or am I just jealous? I am totally appalled at the attire of the female interns and medical students these days because I have had enough of skimpy dresses, mini-skirts and porn-star platform stilettos in my clinic and ward rounds. I think it is time for me to be a bitchy old female surgeon and write a fashion rule book for my young novices.

Rule # 1 Cover up

There are many reasons why short skirts and low cut tops are just not very practical when you are a doctor. Basically, there is a lot of bending over to do. In clinics, when you have to examine patients, you are constantly bending over. Now, there’s nothing more humiliating than having your undies on display or having your boobs pop out when you are crouched down to look into a patient’s throat. On the ward, when you are taking blood or putting IV cannulae in, again, you are flexing those hips and putting your bum into the air. Don’t forget, usually there’s somebody right behind you, either it be the person accompanying the patient, another doctor, a nurse or even one of your colleagues to enjoy the view of your derrière hanging out under the hems. As for those puppies in front, it is awfully distracting for everyone concerned not to stare at the deep canyons of your v-neck, or the shadows behind an unbuttoned blouse. Imagination of lies beyond those valleys has an uncanny ability to lure one’s attention. Similarly if you are sitting at the desk, short skirts ride up, and a crotch on view is particularly attention-seeking. If you cross your legs to avoid that scenario, the skirt will move up more, displaying the milky-white flesh of your naked thighs, which have a visually enticing power of their own. You want your patient to actually listen to what you are saying? It would be best if you redirect their captivated interest away from your exposed flesh.

So girls, button up, cover up and let those hems down. You don’t want to give your elderly patients a heart attack or the disinhibited psychiatric client a stiffy. Don’t be surprised if one of the 90-year-old’s in the Dementia ward sneaks his hand up your backside, or a 30-year-old in the trauma unit talk to your boobs. The only place where you are safe to prance around half-naked is in the intensive care unit, where the majority of your patients are unconscious.

Oh, and see-through clothing does not equate to covering up, especially when you wear hot pink lacy bras and thongs under a thin white dress. That’s called beach-wear.

Rule #2 Lycra is not attractive

What is the story these days with squeezing your body into clothes two sizes too small a-la-Kardashian style? Trust me, you can look amazing in fitted, tailored clothing that allows you room to move without having to suck it all in with a rigid sheath that makes you look like the Michelin man when you bend over (see? there’s the bending over again).

Tight clothing doesn’t let you move. You would be surprised at some of the positions you may have to be in when you are a doctor. Contortionists only have to hold a position, but doctors not only have to coil into positions that require expertise in a game of twister, but also perform medical feats at the same time. I had to dress a patient’s foot wound once, squatting on the floor with my head upside down. If you are ever involved in chest compressions on a patient who has collapsed on the floor, those tube skirts may not hold when you kneel over the patient with your legs apart, and the bum-hugging pants may split if you have to hunker down to secure an airway.

Also – trust me on this one – tight clothing does not constitute covering up. It can be rather revealing in faithfully outlining certain parts of your anatomy; visible thong lines, beaming headlights and camel toes are just a few things that come to mind; all of which are seriously distracting in life-and-death conversations.

And if you really think that tight clothing flatters your figure, the names whispered behind your back are usually not as complimentary. Health workers love to give each other nicknames, and I really don’t think you would want to be stuck with Dr Bootylicious in a place where you may want to advance your career in the future.

"You will not be going to clinic in that outfit, young lady!"

“You are NOT going to clinic in that outfit, young lady!”

Rule #3 Wear shoes that will save your feet and your patient’s lives

Tottering on 10 inch heels on a surgical ward round is not attractive, especially when you are trying to balance files, clipboards, gloves and your phone. Unlike physician rounds, surgeons don’t round with file-trolleys that you can lean on, and we also walk really fast, as most of us have to get to the operating theatre or clinic by 8am. So if you can’t keep up in those ridiculous shoes, no one will be slowing down for you.

A survey was done to show that 15-20km was the average distance an intern or resident has to walk during a working day. You will soon learn that one of your jobs is being able to be at 3 places at the same time. When they build hospitals, they usually try to put all the surgical clinics, preadmission clinics, surgical wards, and the operating theatres as far away from each other as possible. They also put in ultra-slow lifts that fits no more than 10 people, so you will find yourself racing up and down the stairs out of necessity. The moral of the story, wear shoes that will save your feet, because you still have a long long long way to walk for the rest of your medical career.

Wear something covered. I know some men have feet fetish and find pedicures irresistible, but having glamorous open sandals will not protect your pretty toes. Imagine walking around with vomit between your toes all day or even slipping on pee as you walk. As doctor, you will also be handling a lot of sharps, and having one of your tootsies stabbed with a fallen needle or nail ripped off by a drug trolley may just make it a rather bad day at work that you could do without.

Most of all, if there is a Code Blue (cardiac arrest), you need to run. Murphy’s Law dictates that the area where your patient has collapsed would be the furthermost place from where you are when it goes off and none of the lifts will be working. So, if you are teetering on your heels, you might as well start making your way straight to the morgue. Because by the time you have staggered down there in your stilettos, the patient would have been declared dead and bundled up into a trolley on his way for a coroner’s review.

*This is what happens when you run on stilettos*

This is what happens when you run on stilettos

Rule #4 Hospital lighting is not kind to heavy makeup

Unlike the romantic, flattering illumination of disco and restaurants, the hospital is brightly lit night and day. Hospital fluorescent bulbs do not give a warm soft glow; instead, they paint your skin in a starkly pale blue shade. It is exceptional for clear vision when one is perusing pages and pages of patient charts and examining every abnormality on a patient’s body. It is also particularly revealing for showing up every imperfection of your skin and each granule of make-up. The thicker you lay it on, the harsher it looks, until those dark eye-shadows and red lipsticks become a portrait of Alice Cooper.

alice cooper

The other thing you will learn is that lengthy days are detrimental to your facial palette. What may begin as seductive thick mascara on eyelashes and carefully layered blue shadows on eyelids will become the makings of a vacant racoon stare after 48 hours on-call. The blush would make its way down from the cheekbones to your nose, so you’ll look like you have a runny nose. While the lipstick will either be completely chewed off or will have migrated onto your teeth. Half of your powder and foundation would have rubbed off, so your forehead will be particularly shiny in the brilliant lighting. Overall, the picture becomes rather unappealing even in a horror movie.

Rule #5 There is a reason why we got rid of white coats

White is a colour reserved for dinners without Spaghetti Bolognese and Chilli Crab. White is suitable if you don’t plan to land on the ground while playing tennis, and it is definitely suitable for your wedding unless you have very clumsy relatives.

If you wear white to the hospital, be prepared for it to be used as a virginal canvas for body-fluid-art. Most colours of organic liquids go very well with white. Poo-brown is an earthy contrast to a pale background, although there can be unpredictability to the exact shade and texture depending on the source. While blood-red is always visually stunning when splashed generously, although the colour does turn coppery if left for long periods. Sputum-Green has just enough shade to make a warm pastel base whereas bile from projectile vomiting tends to veer towards turquoise; Pus-yellow can be used to enhance the warm tone of the overall canvas. The sanguine stain of Urine-gold can be a bit tricky to see on white, but sometimes when there is bleeding in the bladder, hues of Haematuria-rosé are a little bit more noticeable. These are often complimented by regular ink-blots made by the leaking pen that never leaves your hand. The beauty of this art-work is that it is eternal; no amount of scrubbing, baking soda, washing powder or dry cleaning will completely removed these physical mementos of how you acquired them.

"I told you not to wear white if you wanted to shoot people."

“I told you not to wear white if you wanted to go out and shoot people.”

Rule #6 More bling, more bugs

I do understand that these days, fashion is all about accessories. Style is almost entirely judged on how people decorate their outfits, rather than the actual garbs. Well, all I can say that you will just have to accept that doctors cannot be part of the current ‘trend’.

Some hospitals have banned ties for men – as it was found to be the main source of cross-contamination between patients. It was not uncommon to see these ties taking a swipe at patient’s groins, or a dip into a pus-filled wound. Nurses can’t wear bangles, bracelets, and rings, because no amount of hand washing will disinfect these as potential bacterial-carrying vehicles.

So, young female doctors and students, I would advise that you leave your blings, danglies, chains and scarves at home – unless you like being a free taxi for bacteria, or keen to bring your work home, literally.

Rule #7 You are not auditioning for a Shampoo commercial

Meredith Grey drives me nuts. I just don’t understand how anyone could see what they are doing with that mousy hair floating around her face constantly. You might think flicking those luxurious locks on ward rounds is eye-catching, until you accidentally smack it into your senior registrar’s face. Long hair has a lot of perils in hospitals. Like the tie, it can take a dunk into cavities where you may not want it to go. You could inadvertently tickle your patient when you are bending over the patient (there it is again!). It could get caught on bed rails, IV poles, monitoring lines and plaster saws (yep, seen that happen). When you are doing a procedure, hours of preparing a sterile field can be instantly swept away with your hair. Bangs and hair in the eyes can also be detrimental to your vision, which may not be so helpful when you are placing fine stitches or handling fragile body parts.

Tie those loose alluring locks away from your face, ladies – you may find it disadvantageous to your modelling career, but at least it will save your day job.

"Maybe if I cut my hair, people will think I am a real doctor."

“Maybe if I cut my hair, people will think I am a real doctor.”

Now I know these rules are harsh, and I am not aversed keeping up with what’s in vogue. I am as much into the latest trends as the next fashion-conscious female. I am not advocating dressing-down either, as crack-showing skater jeans and ripped off-shoulder T shirts are not exactly confidence-inducing attire for the sick and injured. There are ways to look beautiful without being inappropriate, it is about retaining your individuality in the role you have picked to play in society. You have chosen to become a doctor, not a model, not a tart, and definitely not a hooker.

Just remember, the hospital is not a night-club. You are not going on a date (and if you are, it is rather sad you are having it in a hospital, so get a life!), neither are you selling your ‘wares’, and advertising your ‘goods’. If you are dressing up to snare a rich doctor husband, you would be setting your trap for the wrong kind of men. There are plenty of playboys in the medical faculty, as there is definitely no shortage of male doctors who think they are God’s gift to women. These ‘hot’ charismatic egomaniacs are more interested in the junk in your trunk and the boobies in your bra than your personality. They are more concerned in accumulating notches on their belts, and having available booty-calls on speed-dial, than learning about your aspirations. You would be mistaken if you think by attracting their attention, they will be willing to marry you/help you get the job you want/get you out of trouble/recommend you for a promotion.

I am not suggesting that we should masculinise our appearance, but there are ways of being feminine without flaunting ‘sexuality’, and being gorgeous without over-embellishment. Dressing elegantly in appropriate attire will go a long way to instil confidence in your patients. Your seniors will take you seriously and be more than willing to share their knowledge with you. It will not upset the nurses (who are stuck in unflattering uniforms with colours that make them look like tampon packages), and draw attention away from those higher up the ladder than yourself. And believe it or not, professional dressing will actually make you sound smarter than you really are. You want the men to stop ogling at you; you want them to look at you in awe.

So, Ladies, save your reputation, your career, your feet and your patient’s lives. Next time you pick your apparel for work, channel classics such as Jackie Onassis, Audrey Hepburn and Grace Kelly.

JackieOnassisAudrey HepburnGraceKelly

 

10 Things I Hate About You – Part II

10things5

Well, when I wrote the original ’10 Things I Hate About You’, I actually had no intentions in writing a Part II. However, as hubby pointed out, it was totally unfair that I got to vent all his less-than-appealing traits to the public without any input on his part. He felt that since he didn’t get to defend himself, everyone should know about the things he hated about me; our’s being an equal relationship and all.

Hang on a minute. As far as I was concerned, he loves everything about me. Absolutely everything. I am flawless, perfection itself, and can do no wrong.

Well, wasn’t it a reality check when he unceremoniously handed me this list.

1. You are permanently attached to your phone.

Ok, I need to be contactable at all times for my patients. You should understand that, you are a surgeon yourself. So what if I occasionally use it to check my Facebook, Instagram, WordPress, email and maybe crush some candies. I can’t NOT have it on me! What if a patient desperately needed my advice after surgery? And what if I missed out on my best friend posting her latest hot date on Instagram? I may need to give a life urgently on Candy Crush. It’s life-saving stuff, this little phone and all that it conveys.

2. You don’t know how to say ‘No’ except to me.

That’s a bit harsh. I can’t always say yes to you, otherwise we would permanently be stuck in bed. You know you might actually have an issue, the number of times you ask for it, maybe you should seek counselling or something like Mr X-files in Californication. Oh, what? Oh, you didn’t mean that? *Blush* Oh, ok. Yeah, you are right, I just can’t say no to people. It’s just one more patient to add to the list, one more favour to do for a colleague, one more committee to join or one more meeting to organise. I know it takes up too much of my ‘spare-time’ *insert sarcastic laughter here*, but I am just trying to help out. I don’t always say ‘no’ to you. I mean, you don’t really need me to cook dinner for you, do you? There’s Lite’n Lazy in the freezer that you can pop in the microwave if you are hungry. You do know how to operate the microwave on your own, right? How about some take-away? Just look it up on google and dial it on your iPhone. I am sure you will be able to find a present for your mother’s birthday – you don’t really need me, it’s not as if she’s liked anything I’ve given her in the past. It’s just that other people really need me, and you are so capable, darling.

3. You are always rushing me

Well, if you don’t always drag your feet whenever we are heading out, or take so damn long getting ready, I wouldn’t be rushing you at all, would I? If you would just spend one minute less admiring yourself in the mirror, and stop practising your Blue Steel, I wouldn’t have to scream at you to hurry up.

4. You don’t like my friends

You don’t like my friends. So we are even. You think my friends are opinionated, loud, and coo-coo. Well, let me tell you, your friends are narcissistic, chauvinistic and appreciate the wrong things about women. Yes, I know all about the tits and bum scoring system that you and the boys whip out on your nights out. And I don’t even want to know where they take you during those escapades.

5. You don’t find my jokes funny

I know, I am sorry I may have misled you. I used to laugh at your jokes when we were dating. I was being polite, and I wanted you to like me. Then, when we were past the dating stage, I just didn’t want to hurt your feelings. Now, I really just don’t find male stupidity funny. And you have to admit, the quality of your jokes have deteriorated from our dating days. You weren’t exactly telling me the types of jokes you are relaying to me now. No, I definitely don’t remember the words ‘boob’ or any references to the male genitalia in any of the jokes you told me all those years ago.

6. You don’t listen to me when I am talking to you

Sweetheart, let me know tell you something about women. We multi-task. Yes, it may seem as if I am not listening to you when I am texting on my phone, reading a post on Facebook, watching TV or ‘working’ on my computer, but in actual fact, I have been listening to you. I may not respond – usually because I don’t really like what you are telling me, but trust me, I heard you. I may make sympathetic noises, which I know annoys the crap out of you, but that just means you are ranting and raving about something totally inconsequential again. You do realise that you talk at me and not to me sometimes, especially when you start a tirade about some political issues in the paper. You would raise your voice, get all hot and bothered, and then you look at me as if I was the culprit causing all the trouble. What do you want me to say? I am sorry for everything that the Australian Labour Party has done?! Trust me, Hon, I am listening. I heard you the first time, as well as the second, third, fourth and fifth time.

7. You can’t sleep in and that means I am not allowed to sleep in either

You always complain that we don’t spend enough quality time together. Well, having breakfast together is quality time, right? I mean, if you want to spend as much of my waking moments with me, then you need to get up when I do. There is no point me eating on my own at 5am on a Sunday morning, if you ate with me, you could talk and I promise to listen.

8. You fall asleep at the dinner table

Trust me, this takes talent. It’s not easy to snatch speed naps in between courses. You should know better than to book an 8-course degustation menu at the 8.30pm sitting. By the time the dessert arrived, it was midnight. I am getting old, if you haven’t noticed; I am usually passed out with my glasses around my nostrils by 9pm. So if you want me to stay awake for dinner, you better feed me at nanna time by 6pm. Or clear my schedule for a nanna nap in the afternoon so that I can be prepared for a big night out.

9. You count my drinks

Ok, this is easy. There are a multitude of reasons I don’t like you drinking. You have a strong family history of alcoholism. You use it as an excuse to get out of driving (and you know I hate driving in the dark). You have very posh taste in alcohol – you would have nothing but Moet, Grange and 18 year plus single malt whiskey. You can tolerate such a huge amount of alcohol (thanks to your Eastern European genes), it gets rather expensive when we go out. You are a terrible drunk. You go straight from sober to the funny drunk with no warning. And you know exactly how I feel about your jokes when you are trying to be ‘funny’. The funny drunk stage only lasts for 10 minutes before you become the sleepy drunk, or rather, the unconscious loud-snoring drunk who obviously has issues with his own airway, because the snores are regularly punctuated by convulsive thunderous snorting when your addled brain reminds you to breathe. And you wonder why you find yourself sleeping on the couch the morning after.

10. You break the Fart Trust

Just give me a minute to explain the Fart Trust. The Fart Trust is the ultimate form of trust in a marriage. The problem lies in the fact that you and I have very different definition of the Fart Trust. To me, it means that you own up to your fart. To you, it means that you warn your spouse before you fart. Now, I understand you have issues with my ‘silent killers’, but I am a lady after all, and I don’t go around letting it rip loud and clear like you blokes do. If you asked me, I would gladly own up to my own farts but I don’t see why I have to verbally announce them.

 

So there, I do hope you feel better now that you have exposed my unappealing side to the public. Maybe it’s not fair that I get to defend myself with your list, but Hon, this is my blog. Get your own if you think your views have been poorly represented.

Oh, and of course,I love you too.

My Other Half

Anaesthetic

A surgeon is incomplete without an anaesthetist. I cannot perform surgery without one, I cannot concentrate on what I do without knowing that there is someone looking after my patient. A surgeon and anaesthetist are like husband and wife, yin and yang, each half of a twin, right and left hand……

The success between a surgeon and an anaesthetist is based on complete trust. The anaesthetists trust us not to harm our patients during an operation and we have implicit trust in them to keep our patients alive and stable while we perform the necessary tasks. As much as we love to be-little each other in jest, we are completely cognizant of the fact that we couldn’t do without each other; as I said, like an old married couple.

Often, conversations flow during a procedure, particularly long operations. This could range from clinical discussions, to personal relationships. These conversations are like those when one is lying in the dark with one’s best friend, where deep personal thoughts are said out loud, and honest responses are given. These earnest dialogues take place over the top drapes separating the anaesthetic corner from the surgical field. – so-called ‘blood-brain barrier’ – because the anaesthetists are the ‘brains’ or the smarter doctor (so they think) and we are often jokingly known as the bloody butchers. It is not uncommon to have my anaesthetist’s head peering over this drape, reassuring me when I become hesitant in an operation, comforting me when I lament on difficult patients, encouraging me when I am struggling with a particularly challenging procedure, and humouring me when I rant and rave about injustices in my personal life. But not all of our verbal exchanges are serious, often well-aimed insults are fired regularly across the patient, in an attempt to evoke witty repartees.

Last week, I lost my anaesthetist. She wasn’t just my other half, but she was my friend, my confidant, my rock, and part of my life. We started our careers in private practice together, we supported each other through some difficult times in our profession, and we shared many stories, experiences and challenges in our personal lives together.

It is difficult for me to accept that she is gone from my life. She was like a pair of comfortable old shoes, someone who knew me, someone I didn’t have to pretend with, an old friend whom I could just pick up an old conversation where we left off a week ago. Her sense of humour and directness fitted my moments of moodiness, her logic and reasoning soothed my indignant outbursts. She gave me sympathy when I needed it and empathy when I got frustrated.

She put my patients to sleep safely and efficiently, many times anticipating what I required in the anaesthetic without asking me. She never doubted my judgement or questioned my requests; she knew when to speak up and when to pipe down. She knew that in times of emergency, the last thing I needed was to have to spell out specific instructions to her, whilst trying to deal with my own stresses.

She had traits that frustrated me, and yet made me laugh at times. She had no sense of direction. Sometimes I would walk past her on my way back from the recovery unit, and see her wandering towards the change rooms. When I asked her if she was going off on a toilet break, she would say she was heading out to see the next patient in the holding bay (which was in the opposite direction). It didn’t matter that she had been working with me in that theatre complex for the last 5 years, from time to time, I still had to physically steer her towards the correct corridor, and the right direction.

She had a thing about firearms, which was amazing considering the fact that she was from South Africa and was given her first pistol at the age of 18 as a birthday present. When I took her to the local gun club to trial clay pigeon shooting, she was nervous and afraid, she pulled the trigger even before the clay pigeons were being flung! There were a few holes in the walls of the trap house where her gun was pointing at. At the time, even though we both laughed so hard at her inept attempts, I was particularly proud of the fact that she overcame her fear to give it a go.

One of the things I admired most about her was her ability to do as she pleased without worrying what others thought of her. She didn’t care about unflattering photos on Facebook. She didn’t mind dressing up as the dorkiest bride at a friend’s party celebrating Prince William and Princess Kate wedding. She tried everything and anything without judgement and reservation. She did her best for the patient even if it meant hassling or inconveniencing other colleagues. She did what was right even if it meant she had to take the long way round or spend extra money. She talked about her life and her opinions openly, without fear of being judged for what she believed in.

She was generous. And she was considerate. She bought me a pair of expensive padded theatre shoes because I was complaining of shin splints and calcaneal spurs after being on my feet 18 hours a day. She ordered coffee for everyone in the operating theatre whenever we were having a particularly long day. She would tell me to un-scrub and take a break if I was doing a long case.

She treated everyone the same. She knew all the anaesthetic nurses’ family members by name. She never failed to ask about their pets. She would treat the orderlies with respect, and she would tell me off if I had inadvertently offended her. She spent the time and energy teaching new nurses and technicians, and she would patiently explain her particular preferences even though she had been working at the same place for the last five years. She gave her best clinical skills to the thief who came into the emergency theatre after crashing a stolen vehicle, and to Nelson Mandela when he had eye surgery in 1994.

She was passionate. She loved the wild, and her homeland. She travelled to South Africa regularly to visit her family, and to spend time at her beloved chimpanzees and gorillas reserves. She was forever posting links about wildlife conservation and the cruelty of game hunting. She was constantly reminding us not to become complacent in protecting species that were less fortunate than us in protecting themselves.

Most of all, she was prepared. One could never pull the wool over her eyes. She saw reality as it was, life and death as it happened throughout her career. She saw cancer patients younger than her daughter, and accidents that changed young men’s lives forever. She and I often lament about how life is too short to bear grudges, to hold back and to be afraid. She wanted to protect those she loved, as we all found out when she passed. She had prepared an envelope for her most trusted closest friend, just for an unexpected time such as this. Her affairs were organised down to the last detail, and her will was legality iron-clad with no contestability. The fact that she took such pains to stipulate everything as the way she wanted, not the way she was expected, showed that she was a realist, with the foresight and consideration for those around her.

She was 59. One year short of the big 6-0. She didn’t look her age, because she lived her life with the enjoyment of someone who was experiencing everything for the first time. She was taken away from us too soon. Too unexpectedly. We are all still in shock, as to how it could happen to someone who was so full of life.

I am finding it difficult to grasp, that she is now gone.

When I walked into my operating theatre today, you weren’t there. Even though I went through the motions and completed my list without a hitch, I felt lost.

I felt lost because you weren’t there.

So I cry, because I know you will never be there with me again.

 

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.