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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The Myth of being Plastic Fantastic

Some days I am a little sick of the stereotyping inflicted on me as a Plastic Surgeon, so I am here to put all the urban legends  to rest. There are plenty of myths about plastic surgery from both public ignorance and misconceptions established by shows such as ‘Nip Tuck’.
Myth #1 We use plastic.

Once I had a young tradesman whose face was smashed up by the windscreen in a truck rollover. Just before he was put to sleep (and this is after I have spent an hour explaining to him how I was going to put his face back together), he asked me, ‘So doc, where do you put the plastic?’

*Insert eyeroll*

I have lost count the number of times I have been asked that question. Plastic surgery doesn’t mean we play with plastic or put plastic in people. In fact, if we were to use any form of prosthetic device, it is usually silicone. The ‘plastic’ in plastic surgery is derived from the Greek word plastikos. It means to change shape, or to mould. The aim of plastic surgery is to change the shape of any part of your body, for cosmetic or functional reasons.

So, sorry folks, we don’t shove blocks of plastic into people.

Myth #2 We can perform surgery without leaving a scar or we can remove scars

Here’s a couple of frustrating conversations I have regularly with patients every week.

Scenario one:

Me: We have to make a cut around the skin cancer on your face to remove it. Once we stitch it up, it will leave a straight line scar.

Patient 1 (outraged) : A scar? But you are a plastic surgeon; I have come to you to have this done so there will be no scars.

Scenario two:

Me: I hope you have recovered from your fall last month. Your cut lip has healed really well since the stitches came out, it looks great.

Patient 2: I hate it. I can’t believe you put a scar on my lip; I want you to remove it.

Ok people, I know plastic surgeons are incredibly good, but we can’t perform miracles. Where there is a cut, there will be a scar. We can’t remove scars either. If you want scarless surgery, you should have had your surgery done when you were a foetus – that is the only way to perform surgery without leaving a scar. And if you want us to stitch up your injuries, it was not me who had created those scars; it was your stupidity in falling into a window whilst you were pissed.

So what makes us better than others in scarring? We stitch differently to other surgeons, we use finer sutures, we know how to hide and minimise scars. We have techniques which can camouflage or improve scars. We have the knowledge and means to treat bad scars.

So, apart from making people look hot, we can make your scar look sensational too. But unlike God, we cannot remove history which has been carved onto your body.

Myth #3 All we do are boob jobs, facelifts and buttock enhancements

‘I don’t understand why I have to come to see a plastic surgeon to have my skin cancer cut out, it’s not like I want a facelift or something,’ said the man sitting in front of me with a fungating growth coming out of his nostril. Unfortunately, I was the one who had to break the bad news to him, that the cancer in his nose was so big that we would have to amputate his nose. Any surgeon would be able to remove his cancer, but he would be left with a hole in the middle of his face. The reason he needed a plastic surgeon was because we can remove the cancer and reconstruct his nose.

The acronym for our specialty is actually PRS – it stands for Plastic and Reconstructive Surgery. There are two components to our work:

Reconstructive surgery: which is surgery to improve and restore function, to minimize disfigurement and reconstruct structure which was lost due to trauma, disease, cancer or birth defect. Basically, our job is to fill up a hole anywhere on the body. Sometimes we excise tumours ourselves, but often we work in tandem with other oncological surgeons such as orthopaedic surgeons who resect bone and soft tissue tumours, ear nose and throat surgeons who resects tongue, nose, throat cancers, as well as breast surgeons who perform breast cancer surgery. The way I see it is that my oncology colleagues are the ‘destructive’ surgeons and I am the ‘constructive’ surgeon. I remember when I first started training I was hesitant as to how much margin to take around a tumour. My supervising surgeon took me aside and said, ‘Just remember, Tiff, the reason you are going to be a plastic surgeon is because you are not afraid to make a big hole. Unlike other surgeons, you can fix holes.’

Aesthetic or cosmetic surgery: which is surgery to enhance, or to rejuvenate a specific body part, it is designed to improve a person’s appearance by reshaping facial or bodily features. So yes, we get a chance to make people beautiful. We make boobs bigger, smaller, perkier or firmer. We lift up butts, thighs, arms and faces (not specifically in that order). We inject, insert, eliminate and suck to enhance contours. There has not been a single part of the human body that a plastic surgeon has not attempted to alter, although I gladly admit that I have had no training or experience in anal bleaching – nor am I interested in expanding my field into that area.

Myth #4 Our work is frivolous and we perform non-essential surgery.

As my husband (who is a heart and lung surgeon) sums it up succinctly, ‘Honey, I save lives, you just make the world beautiful.’

Even though spoken in jest, unfortunately it is a view held by many, including hospital administrators, insurance companies and sadly, our colleagues in other specialties. I have had medical students who did not attend their plastic surgery sessions with me at the clinic because they feel that it is not something they need to learn about. I was once told by a second year student that plastic surgeons are not real surgeons who practice ‘true medicine’.

People seem to forget that plastic surgery is not just about cosmetic surgery, but that the most important aspect of our role is to improve a person’s self esteem. No matter how much the self-help books may claim about not placing too much importance on one’s appearance, and to stop using your looks to determine your self-worth, the reality of life is simply – people do judge you by the way you look. And that includes yourself.

It is amazing the difference we sometimes see in our patients. Like the 12-year-old boy who was constantly teased at school for his bat ears – he got it fixed before he started high school. He became a completely different person; he happily went to the barber to have him shaggy long hair removed, started going out with his friends and strutted into my office at 8 weeks postop as if he owned the world like a typical 12-year-old boy. My favourite last month was a 30-year-old mother who had a nasty burn scar over her neck and chest from a childhood hot-water scald. The scars stopped her breasts from developing properly and distorted whatever little breast tissue that did develop. After surgery to correct the deformity and implants to provide shape, she swapped her oversized jumpers for tailored dresses, and started becoming more involved in mother’s groups. She wore a pink singlet with a pearl pendant dangling in her new cleavage when she came to her appointment, despite the visible old burn scars which covered her neck.

Surprising it may be, we do perform surgery that saves lives and limbs. We are often called upon to join small blood vessels under the microscope for organ transplantation in children. We reconstruct the neck after throat cancer, so that the patient can still eat, drink and breathe. We put fingers back on after they have been accidentally severed, and we transplant soft tissues into smashed up legs that otherwise would have had to be amputated.

Unfortunately our work often goes unrecognised, as throughout history, we have had to repeatedly fight for our patients’ right to access plastic surgery. When hospitals have budget cuts, our operating lists are often the first to be cut. Breast reconstruction after cancer was the last one they slashed from our hospital, because once the cancer has been removed, it is no longer considered life-saving surgery. Health insurance companies which exclude plastic surgery cover leave their members with a policy which pays for the cancer removed, but not the plastic surgical procedure to reconstruct or repair the hole.

Admittedly I sound like I am trying to justify our existence, but I truly believe that even though we are not saving lives every day, our work makes a siginificant difference in people’s lives.

Myth #5 We date our patients

There seems to be a misconception that we fall in love with our creations. I explored this particular issue with my male colleagues. The answer was a categorical no, although they have had plenty of invitations from patients to cross that line. Not only is it ethically wrong and fraught with medicolegal implications, it is also rather disturbing that someone would fall in love with an image they have created, which may have nothing to do with the actual person underneath.

Myth #6 We make lots of money because we charge ridiculous amount of money

I am not blind to the fact that as a plastic surgeon, I am often the target of many sarcastic jokes about money. This not only comes from patients, the general public, but sometimes our own colleagues in the medical fraternity. When I was sitting my specialist board exam, one of the candidates for general surgery taunted me, ‘I think your essay question would be on whether a Maserati is better than a Lamborghini.’ I was not shy to show him the finger as I sweetly replied, ‘well, I do hope you know the answer to your essay questions, which hole to put your finger up.’

Once I was leaving work, and one of my patients walked past me as I was putting my bag into the boot of the car. He took one look at my ten year old Toyota Corolla and shook his head. ‘Oh, doc, you need to get a new car, people would think you are not very good if they see you driving that car.’ I just shrugged and said, ‘Don’t worry Mr B, I leave my Ferrari in the garage for weekends.’ At his stunned look, I had to tell him I was joking.

It is not uncommon sometimes for our patients to comment on the cost of surgery, especially if it involves cancer surgery. For some reason people seem to think that we should do their surgery out of the goodness of our hearts if they have cancer….. but that’s another story altogether. One of the reasons that plastic surgery costs a lot more money than most other surgery is the rebate from health funds are low (because our procedures are not deemed to be a necessity), but also our practice has a lot of overheads, especially with wound care, garments, implants and dressings. We also employ a greater number of staff than other specialties, because there is a lot more patient contact time pre and post operatively. Plastic surgery patients and procedures are more complex to organise, and often requires various number of phone calls and coordination. Not to mention, our patients are usually high maintenance and requires constant reassurance.

Yes, some of us drive Aston Martins, stay at 6 star hotels, wear Gucci and walk in Louis Vuitton, but we work hard for it, and our responsibilities may not be life and death, but there is still a lot of stress involved in our surgery because we know the end result will have a life-long impact on our patients’ life.

Myth #7 We drive fast cars, hang out with celebrities, party like animals, snort cocaine and have the most glamorous life of any doctors

This is simple. We drive fast cars, because we have very busy lives and have places to get to. That’s my excuse and I am sticking to it. And trust me, my Corolla is pretty fast.

The only celebrities we hang out with are those that come for treatment. As I don’t perform a lot of cosmetic procedure, most of the celebrities I have contact with are those who have injured themselves or need reconstruction for cancers. They don’t usually act anything like celebrities when they are in my office and the last thing they need is for me to ask them for a selfie.

We try to party like animals, but often our job stops us. We are notorious for pulling out of social commitments at the last minute. One of the worst thing about being a reconstructive surgeon, is that our colleagues take all day to remove the cancers, and we have to sit around waiting for them to finish (or we may have to watch them so they don’t destroy our reconstructive options whilst cutting out the cancer). Once they are done, they piss off to enjoy their evening, while we start our work, usually at the unsociable hour of 4-5pm, working well into the night to patch up the ‘mess’ they have left behind.

What glamorous night life?

As for cocaine, yeah, I know colleagues who do it at parties, but honestly, it usually doesn’t take long for the Board to find them. It is rare that a plastic surgeon is stupid enough to risk their career and reputation to develop such an expensive habit.

Myth #8 We all have had some ‘work’ done on us

I would not deny that some plastic surgeons have had work done, but not all. Although I can’t say the same for the wives or staff! Personally, I don’t trust anyone enough to have plastic surgery done on myself and it is a little difficult perform a facelift on yourself when you should really be asleep throughout the procedure. I know colleagues who inject themselves in the mirror, but I have this unusual need to close my eyes when I see needles coming towards my face, so the results would be rather questionable if I went down that path.

Most of my staff have injections, not because I force them, but it is something I offer them if they want it. And who could say no to free Botox? Because I am very conservative in my treatments, my staff are actually free advertisements of my work. When one of my staff admits to having treatment, the patients are reassured that they won’t look like Jocelyn Wildenstein when they leave my practice.

But, truthfully, the greatest benefit in giving my staff Botox is its efficiency in stopping my practice manager frowning at me and my receptionist frowning at my patients.

Myth #9 Our practice staff are picked for their looks

So, supposedly, this means that our staff should be beautiful young girls with faces full of injectables and look-at-me enhanced breasts. I mean, it is free advertising after all, and who would’t want to be surrounded by luscious females?

Truth number 1 – Most surgeon’s practices are run by their wives. So, which wife would be stupid enough to surround her husband with gorgeous young things?

Truth number 2 – Young girls who are obsessed with their looks don’t usually have the right personality nor the prioritisation skills to run a business well.

Truth number 3 – Experience comes with age. So unless you want to be surrounded by rookies who have no idea what they are doing, you would pick more ‘mature’ staff members to make your own life easier.

Truth number 4 – Patients and clients sometimes find perfection intimidating. They are more comfortable talking about their inadequacies to someone who has flaws as they feel that someone would understand what it is like to be ‘ugly’.

Myth #10 We can make Queen Latifah look like Heidi Klum and vice versa

This is the ultimate myth. I always know it is going to be a difficult consultation when a 5’3, 200+lb person walks in and slaps a picture of Gisele Bundchen on my desk.

So here’s my spill:

  1. I cannot make you taller – go see an orthopaedic surgeon or stick to your heels
  2. I cannot make you a natural blonde – you need a hairdresser or a beautician
  3. Neither can I change the colour of your skin – that’s a disease called vitiligo
  4. Lipsouction is not a form of weight loss – get a personal trainer and stop eating junk
  5. A tummy tuck will not give you six-pack if you haven’t got one to start with
  6. I cannot turn back time to make you look 40 years younger, maybe 10, without the pimples
  7. I cannot make your woo-hoo look perfect nor make you a virgin again (yep, this is a genuine request, apparently Dr Google says it is a great anniversary present for your husband, or wedding present if you are marrying a younger man.)
  8. I cannot reverse gravity with a cream, it is called surgery
  9. And of course, I cannot perform scarless surgery
  10. Oh, and I cannot execute plastic surgery which will make your husband stop sleeping with his 20-year-old secretary, unless you want me to ask my Urology colleague to do a quick operation on your husband.

So, we may be Plastic Fantastic, but we are really just like any other regular surgeons. We cannot perform miracles, and we cannot change who you are. You need to speak to either God or a Shrink about that one.

 

 

Not a Saint Hospital

One morning I found a note on my desk from my secretary. It said:

The Medical Director at St X would like an appointment with you to check that everything is going well for you at St X.

It wasn’t unusual to get a ‘summon’ from the Medical Director of these private hospitals. Usually, it is a low-key chat to make sure that the private surgeons working there are not having issues with the operating theatre equipment or staff, and that they have no complaints about ward care of their patients. It was just over 2 years since I have started bringing patients into St X for my surgical lists so I was expecting an invitation from the MD sooner or later.

I asked my secretary to shorten my next St X operating list, and arrange an appointment with the MD afterwards around 5pm for me.

This was the conversation:

MD: Hi Dr T, thanks for taking the time to see us. So, how’s everything going?

Me: Great. I have had no problems, the theatres are great, the nurses on the ward are helpful, my patients have had no complaints. They are liking the private rooms and….

MD: (Nodding vigorously and leaning forward to cut me off). Well, I want to talk to you about Mrs Y.

Me: Oh? Is she causing problems with the staff?

Mrs Y was a patient of mine on the surgical ward whom I had just admitted two weeks ago. She was a teacher in her late 50’s who sustained severe spinal injuries when she was a teenager and is now wheelchair bound. Mrs Y was also a long term insulin dependent diabetic who unfortunately had severe ketoacidosis last year and ended up in ICU, ventilated for 2 months. During her illness, they didn’t look after her pressure areas so she ended up with severe grade IV pressure sores over both the ischium and sacrum by the time she was transferred out of ICU. She was then discharged from hospital with this problem as no one wanted to deal with it whilst she was an inpatient. Mrs Y went back to teaching, and spent hours every day in her chair. When her blood sugars started to deteriorate and her family doctor noticed an unpleasant smell during one of her visits, it led to the discovery of her persistent pressure sores. By the time she came into my office, she was hyperglycaemic, septic with infection as both pressure sores were wide and deep enough for me to put two fists in each. I could see her ischial bone at the base of one, and the rectum at the base of the other, and because she was incontinent from her spinal injury, the wounds were severely contaminated with faeces as she sat in the wheelchair in her soiled diapers. Understandably, both her and her husband were by now, agitated and frustrated with unhelpful medical staff and hospitals.

I admitted her into St X, because it was a large tertiary private hospital with all specialties on hand. She required an urgent endocrinology review, infectious disease input, a general surgical procedure to divert her faecal output via a temporary colostomy, dressings and pressure care. Needless to say, she started to improve within 7 days. She required intensive nursing care with four times a day dressing change (to prevent accumulation of pus that was continually exudating from the wound) and two hourly turns to prevent development of new pressure sores while she was bed bound.

Mrs Y, at the beginning of the week, cranky from feeling ill and hating being bed bound, was not the best compliant patient. She was a teacher after all and did not like being told what to do. She was also a little distrustful of the nursing staff as it was poor nursing care in ICU which resulted in her current problems. However, after seeing herself improve over a week, she became the most pleasant and grateful patient on the ward. She helped the staff by setting an alarm clock and turning herself so that all the nurses had to do was to pop their heads into her room and check that she was in a different position. She also changed her own colostomy bags so that the staff didn’t have to deal with this particularly unpleasant job. The nurses told me that they enjoyed looking after Mrs Y.

I was rather surprised that the MD had brought her up in our meeting.

MD: No no, nothing like that at all. (He cleared his throat awkwardly). Patients like Mrs Y, well, we find it hard to accommodate them in this hospital.

Me: I know, I know, spinal patients should really be in dedicated spinal units, but there are no private spinal facilities for these patients. Mrs Y has been paying her private health insurance for over 30 years, so she didn’t want to go to a public hospital; she wanted to be looked after in a private hospital.

MD: We understand that, but private health funds in general don’t pay us very much for looking after patients like her. She requires intensive nursing care so we actually don’t get any profit for such a heavy nursing load.

Me: (Speechless for a second) So, let me get this right. You don’t want patients like Mrs Y because her admission doesn’t generate enough profit for the hospital?

MD: I just wanted to make you aware of this, so that you will remember in the future not to bring patients like her into our hospital. We would prefer day surgery patients, but if you feel strongly about keeping them overnight, we are more than happy to accommodate that. As for Mrs Y, I believe you are planning to keep her in hospital for a while?

Me: Yes. At least 3 months.

Both Mrs Y and I had a long discussion about this. She had agreed to take a whole semester out of teaching and come into hospital to have her sores treated properly. This meant bed rest with appropriate pressure care, no sitting in her wheelchair and regular dressings. I had explained to her in depth that if we could make her overall health better, these sores may heal without intervention. If not, they may need an operation. However, even with an operation, she will need to be off the surgical wounds for 6 weeks before she could sit on them. She knew she was in for the long haul, because she didn’t just bring her suitcase when she checked into the hospital, she also brought her Nespresso machine. According to Mrs Y, 3 months was a long time to go without good coffee.

I watched the MD’s face cringe.

Me: I can’t rush the healing process, and I have to wait for the infection to settle.

MD: Maybe you can find a little operation for her so that we can get a little more money out of her health fund during her stay?

Me: But she doesn’t need an operation. She just needs dressings.

MD: We are probably going to lose money if she stays that long.

Me: Would you like me to transfer her to the public hospital? (The MD looked up at me with surprise and a glint of hope in his eyes). I could just say to Mrs Y that St X doesn’t want you here because they are unable to make a profit out of your stay. They think you should really be in a public hospital despite the fact you have paid your private health premiums for the last 30 years…..

MD: No, no. (He started to clear his throat again). There is no need for that. I suppose since we are a hospital affiliated with the church, we can show charity by letting her stay her for a while.

Me: Righto. Is that all? (I started to get up to leave).

MD: But, (he stopped me turning towards the door), if you do a few more of your cosmetic cases here at St X’s, it may compensate for her stay.

He stood up and reached out to shake my hand.

Me: Well, I cancelled two breast augmentations this afternoon because of this meeting. I have transferred them to my lists at another hospital tomorrow.

I ignored his hand, turned to open the door, and walked out of his office without a backward glance.

Mrs Y stayed for the full 3 months and went back to teaching full time, sitting in her wheelchair with a beautifully healed bottom.

 

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.

Stalker #2

stalker 2

It was the summer of 2008. I was driving to work one day, and my mobile phone rang. I answered it on my hands-free, thinking it was because I was running a little late for the ward round, and the nurses were being impatient. However, the sharp retort froze on my tongue when the caller introduced himself.

‘Hi Doc, it’s Bruce, I am the head of security at the hospital.’

Oh crap. They found out it was me who has been parking in the Director of Surgery’s spot on weekend call.

‘Could you give me call on this number when you arrive at the car park?’

Great, now they are going to make sure I don’t use anyone else’s reserved spots.

‘We need to escort you to and from the car park from now on. We have had to take out a restraining order against a patient of yours, and we have been assigned to ensure your safety.’

WTF?!?!

During my final rotation as the senior registrar in plastic surgery, I was often entrusted with difficult cases, or difficult patients. My boss at the time was the HOD (head of department). He was referred a patient from the cardiac surgery unit. It was an elderly 70-yar-old lady who had bypass surgery which unfortunately went pear shaped. She ended up in intensive care for a month with complication after complication. One of the consequences of her general comorbidities was break-down of her lower leg wound from where they harvested her veins for the bypass grafts. There was no sign of healing due to her poor general health.

When I saw her wound, I told the HOD that there was no way a skin graft would take. It was slimy with a biofilm of bacterial colonisation. The bed of the wound was completely white and scarred with no healing granulation tissue. It would be like laying turf on concrete. The HOD told me to take her to theatre and just lay a graft on it. He could tell that I didn’t agree by the silence that ensued.

‘I know the graft won’t take, Tiff, but we need to graft her. Her son is being difficult and demanding.’ At my raised eyebrow, he sighed. ‘I know, I know, it’s the wrong reason to operate, but he is making life hell for the cardiac team.’

I shrugged, documented his decision in the chart, spoke to the patient and booked her for theatre. 10 days after her surgery, the graft became sloughy, and the wound went yellow. Surprise, surprise, I thought, but I spoke to patient, explained why the graft didn’t take and she agreed that it was a long shot, but was very grateful I tried. We both agreed that more dressings were required. I didn’t give it any further thought.

Couple of days after that, I was caught up in an 8-hour case in the operating theatre, during which my pager kept going off. When I un-scrubbed from surgery, I noted that they were outside calls. I rang the switchboard, and they told me that there was a man who was very insistent on talking to me. I asked them if they knew who he was, they said he wouldn’t say. It was well past 7pm, so there was not much I could do, so I put it to the back of my mind and headed home. Then, my mobile phone rang whilst I was driving home that night, I thought about not answering it as I was about to enter the under-river tunnel, where I would lose mobile phone signal. However, the number showed that it was the hospital, so I picked it up.

‘Hi Doctor, I have one of your friends on the line looking for you.’

I rolled my eyes, must be one of my colleagues who wanted me to pick them up for work tomorrow. ‘Sure, put them through.’

‘Hello?’

‘Are you Doctor Tiffany?’

Something in his voice got my attention. It was not a voice I recognised. ‘Yes, it’s me. Who am I speaking to?’

‘You did an operation on my mother couple of weeks ago, and it was a complete failure. Now she has an infection in her leg, what did you do to her?’ He was yelling down the phone.

Initially, I was too shocked to reply. I remember vividly listening to the agitated heavy breathing that reverberated over the phone during the silence.

‘I am sorry, I am not sure who you are referring to, could you tell me who you are and your mother’s name please?’

Unfortunately that just earned me another blasting. ‘How can you not remember who you’ve operated on? What kind of doctor are you? My mother is…… you….. not good…… bad….find you…..’

There was no point. I was now in the tunnel and the signal was cutting in and out, which eventually cut off completely. I sighed. That was probably going to make matters worse now because he would probably think I had hung up on him.

When I exited the tunnel, I rang the hospital and spoke to the switchboard lady that connected me before. I asked her who he was, and whether there was any way I could get in contact with him, the switchboard lady sounded surprised and said, ‘but doctor, he said he was one of your really good friends and wanted to be put through to your mobile immediately because he was running late for a dinner you were both going to.’ I had to tell her that it wasn’t a friend but a patient’s relative. She apologised profusely. I had to point out to her the fact that if he really was my friend whom I was meeting for dinner, he would have had my number without having to go through her.

There was nothing I could do, and he never rung back.

It was two days after that, when I got the phone call from security. So I dutifully called them when I arrived at the car park. Within seconds, as if they were already waiting for me there, two men in uniform materialised around my car and walked me to ward. They reminded me to call security when I leave for the day.

When I arrived on the ward, sudden silence ensued. My residents looked at me with fear, and the nurses were whispering. I was just about to ask them what was going on when the HOD came out of his office. A look of relief passed his face when he saw me.

‘Tiff,’ he smile. Now, that was something rare, my HOD did not have ‘smiling’ as one of his usual repertoire of facial expressions. The look on my face must have been one of complete confusion, because he took my arm and literally dragged me along with him. At 5’3 to his 6’2, I had to run to keep up with him. ‘We are going down to see the Head of Security.’

So, at 7.30am, I found myself sitting in a small room in the hospital basement, opposite a large bald man in security uniform. He was leaning on his desk which appeared tiny under his bulging biceps. Loose paper littered the surface of the desk, some of which overspilled onto the floor around his chair.

Bruce the Biceps nodded at my HOD as if to ask him to start. I turned and looked at him. He cleared his throat and uncrossed his legs. ‘You remember Mrs Y?’ I nodded, he was referring to the lady from Cardiac Surgery whom I grafted nearly two weeks ago. ‘You remember how I told you his son was being difficult?’ I frowned, because I only very vaguely remembered anything other than clinical stuff from our conversation. ‘Well, apparently, he was told by his mother that the graft didn’t take, and then the nursing staff got her mixed up with another patient, and told him that the leg was badly infected.’ He paused. ‘Apparently he created a scene on the ward couple of days ago, and demanded to see the surgeon. The nurses told him that it was not possible as the surgeon was operating. During lunch break, he snuck behind the nursing station and was caught reading her chart by one of the nursing staff. He got your name from the operating notes. ‘

Mr Biceps nodded ‘he then pestered the switchboard all day to be put through to you, but they said that they could only page you. None of those pages were answered.’

I sat up, ‘But I was….’

‘Operating, I know.’ Mr Biceps reached over the table and patted my shoulder, ‘Switchboard also told me that he managed to get through to you on mobile phone late that night?’

I nodded and told him my story. He grimaced. ‘I really should re-do that protocol on phone safety.’

‘Anyway,’ my HOD said, obviously uncomfortable with the whole situation, ‘Apparently yesterday, he turned up on the ward again, demanding to see you. The nurses told him that you weren’t in the hospital for the day, he left the ward.’ He threw his hands in the air in frustration, as we both knew I was at work yesterday, ‘I don’t know, maybe they were trying to get rid of him. He then rung switchboard and asked which hospital you were working at. Switchboard was reading off the old roster and told him that you were at St M’s.’

‘But that was my last rotation,’ I said.

‘Yes,’ Mr Biceps nodded, ‘but he was just following the information he was given, so he drove over to St M’s, went to their front desk and demanded to know where you were. Their receptionist told him that you didn’t work there anymore and has been transferred here.’

‘Geez,’ I rolled my eyes, ‘the guy must have thought he was given the run around. The phone calls, then the hospitals…..’ I grimaced, ‘if he wasn’t pissed off before all this, he would have been livid by now.’

‘Uh, huh.’ Mr Biceps agreed, ‘and that’s when he lost his sh…. marbles. He accused everyone of trying to protect you, and that you were hiding from him because you were guilty of trying to kill his mother. He then threatened to shoot you.’

That got my attention. ‘He what?!?’

‘That’s when the front desk at St M’s called security,’ he heaved a sigh, ‘They should have held him, instead, the num nuts over at St M’s told him to leave and not come back. They didn’t even get his name. Then they called me.’ Mr Biceps shook his head. ‘It took me a whole day to work out who he was; I had to make phone calls to the ward, to switchboard and to your boss here.’

He looked at me sternly, ‘I don’t take death threats to our staff here lightly, so I called the police.’

‘So they have arrested him?’

‘Hush,’ my HOD patted my arm, ‘listen to him, there’s more.’

‘The police looked him up on their system, and realised that he had a gun licence.’ He and I both knew that gun licenses were hard to get in Australia, but it didn’t necessarily mean the person owned any firearms. He took a deep breath, ‘and he had half a dozen firearms registered under his licence.’

  1. Now not only did I have a loony after me, but a loony with guns.

‘But the law states that if anyone with a licence or firearms threatens anyone with witnesses, they can confiscate his licence and firearms,’ I said. My boss looked at me in surprise, he didn’t realise I taught Gun Safety courses.

He nodded. ‘Yes, so the police went to his house, cancelled his gun licence and confiscated his firearms,’ he paused, ‘but they also found a few extra unregistered firearms in the same cabinet.’ He then looked at me with a concerned expression, ‘Because they didn’t have a search warrant, they couldn’t look for any others.’

‘Wow, this is getting better and better,’ I said. My boss winced at my sacarsm.

‘They arrested him, but couldn’t hold him. They could only slap him with a fine for the unregistered firearms.’ Mr Biceps scratched his bald head in frustration. ‘So I asked them what they were going to do about your safety, since he may have other firearms which we don’t know about. They have applied for a search warrant and we have applied for a restraining order against him. I was told both of these should come through today.’

‘So,’ my HOD said, ‘he will not be allowed within 200m of the hospital. I don’t want you to go anywhere near that ward she’s on, I will assign another registrar to look after those patients.’

‘And you must be accompanied to and from the car park every day,’ Mr Biceps added. ‘We can’t afford to have any safety issues here at the hospital.’

‘That’s all great,’ I said, ‘but what happens when I am not at work?’

They looked at each other blankly.

My HOD recovered first, ‘he won’t be allowed within 200m of you either.’

Which was all sweet, but I wondered how either of us would know if we were within 200m of each other, since we had never met, and had no idea what the other looked like.

Lucky for me I never found out, because four days later, he was caught sneaking into the ward to see his mother and punched a staff member when he was being forcibly removed. They found a shotgun in his utility truck parked in the hospital car-park. He was arrested and kept in custody without bail. His mother was then discharged from hospital a week after that.

And I thought the highest rate of homicides for plastic surgeons are male patients unhappy with their nose-jobs. Funny how they have stats on that.

 

To Read about Stalker #1, click here.

Old Shakey

Doogie Howser2

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.