Music in the Theatre

Another One Bites the Dust

Most days when I am operating, I choose a playlist on my iPhone and plug it into the speaker. I don’t have it on particularly loud, but I do have it playing, as to create background noise. Silence can often convey tension, and I find people work better together when everyone is relaxed. Often, patients will comment on the background music as they are being wheeled into the operating theatre, and some appreciates it as it takes their minds off on what’s to come. Sometimes I use it as a topic for conversation, to distract the patient as he or she is going to sleep.

My playlists consist of a wide range of music. I remember trying to load up my husband’s iPhone with music a few years ago, so he too can play music in the operating theatre. I asked him what he wanted on it. He told me whatever I want. The next question that came out of my mouth was, ‘Do you want something you like, or something that’s cool?’ It took me a while afterwards to realise why he was sulking.

I have lots of playlists. One for early in the day, all calm smooth jazzy stuff, then one full of pop and lively tunes for the afternoon. I even have a playlist called ‘closing music’, just something to put on when I am finishing up a long case – the first song being ‘We gotta get out of this place’ by The Animals.

Lately, the shuffling on my playlists seems to have a life of its own, with very bad timing. Just a week ago, I noticed my patient’s eyes look at me in horror as he was going to sleep. I couldn’t work out what was causing his distress until I realised that the sound system was softly playing Led Zeppelin’s ‘Stairway to Heaven’. It was not the first time in the last month that my playlists have shown impeccable timing and bad taste. Because the week before, Queen was blaring ‘Another One Bites the Dust’ as my patient was being wheeled into the operating room.

So here I have compiled a list of songs that should not be played when patients are about to have surgery. I have erased them from my work playlists.

Knockin On Heavens Door – Guns N Roses and Bob Dylan

Tears in Heaven – Eric Clapton

Dancing with Mr D – The Rolling Stones

Kill you – Eminem

Ready to Die – The Notorious B.I.G.

Great Gig in The Sky – Pink Floyd

If Tomorrow Never Comes – Ronan Keating

Killing Me Softly – The Fugees

Now if anyone else can think of any other inappropriate songs that they may not want to hear as they are being put to sleep, please feel free to add to the list.

 

 

 

 

My Other Half

Anaesthetic

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

I felt lost because you weren’t there.

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

 

The Expert Opinion of Medical Students

med student

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

When I was a medical student……

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

3. Your opinions are important

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

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

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

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

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

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

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

5. There is no such thing as a Stupid Question

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

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

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

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

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

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

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

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

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

Me: Why do you say that?

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

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

EMS: But I think their way is better.

Me: Because?

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

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

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

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

Me: Ask me why then.

EMS: Why what?

Deep breath.

Me: Forget it.

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

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

 

Pranks in a Hospital

Pranks at work take on a whole different level when one works in the health industry. I think I could have made some substantial claims from worker’s compensation as a result of the permanent psychological consequences of all the pranks that I have had to endure during my epic climb from a medical student to a specialist. Some were particularly memorable….

When I was a final year medical student, I was known as the ‘yes’ girl. I was one of those bushy-tailed, bright-eyed eager beaver who would do anything that I was asked to do by the medical team I was attached to. One evening, the senior resident on the team told me to go and check on a patient in Room 14 as the patient has had fainting episodes during the day. I was so chuffed thinking that my team trusted my judgement enough to give me such a responsible task, that I almost skipped down the corridor. I knocked on the door of Room 14, and there was no answer. I pushed the door open quietly and peeked. The room was dark and the patient was asleep. I headed back to the main desk and told the resident that the patient was asleep. He frowned at me and asked if I actually touched or saw the patient, I said no. He then asked me how I could tell the patient was actually alive under the blanket. ‘Go and wake her up so you can examine her.’

I felt so stupid that I hung my head in shame as I walked back down the corridor. I pushed the door open and approached the bed. I didn’t want to wake the patient up rudely by turning on the light, so I gently reached for her shoulder to shake her awake. Her pyjamas felt cool as I touched it and there was no response. So I grabbed the blanket and folded it back to wake her up properly. The minute the blankets were drawn back, the whole person flew/bunced/jumped out of bed and smacked me in the head. Apparently my scream was so loud on the ward, the nurses raced down the corridor with the resuscitation trolley. Not to mention some of the patient also wandered out of their room and followed in curiosity.

When the lights of Room 14 was switched on, there I was, on the ground, frantically batting away at the blow-up doll on top of me. My senior resident was laughing uncontrollably in the corner, and the head nurse stood over the side of the bed, shaking her head. Sniggers and giggles broke out in the crowd that gatherd in the doorway by the time I realised that I was not being attacked by a patient. All I could do, was to put the doll aside, give my senior resident a deathly stare and walk out of the room with whatever dignity I could gather. It was the first and final time I cried from a prank, because after that experience, I learnt that non-malicious pranks were actually a form of endearment bestowed upon favourite junior staff members by some of the senior staff.

However, that particular senior resident was apparently also very popular, because he was found ‘accidentally’ locked in the laundry cabinet three weeks later; it took 2 hours for hospital security to come and break the lock because someone had ‘lost’ the key.

My first job as an intern was on the gastroenterology and renal medicine ward, as part of the kidney/liver transplant team. On my first day, I was super excited because there was a kidney transplant to be done, and I was asked by the professor to help out in the operating theatre as they were short of surgeons.  The morning started with an introduction to all the nursing and allied health staff on the ward, then a ward round was done with the professor so I could get to know the patients. He and the other doctors headed down to start their big case, and I was told to follow once I have finished the paperwork from the round. The head nurse made me a coffee as I sat in the office, and told me that it was a welcome gesture from her and the other nurses. I thought that it was an awesome start to my career – everyone on the ward was friendly, and I was going to assist in a kidney transplant on my first day!

I was wrong. It was the most miserable day of my life. Little did I know that the ‘welcome’ gesture contained more than just Nescafe granules. The nurses added some PicoPrep (the stuff patients have to drink before their colonoscopy so that their bowels can be cleared out). Needless to say, during the kidney transplant two hours later, I had to excuse myself and unscrub 5 time within two hours. I tried so hard to hold it in that I had to change my pants three times because I didn’t make it to the bathoom.

By the end of the day, I was dehydrated, shaking with cold sweats running down my face while painstakingly suturing my first surgical wound. Commando.

Yep, no underwear, just in my scrub gear.

diarrhoea

My second job as an intern was in the Emergency Department. This particular ED I worked in was attached to the State Mortuary. So, one of our jobs a ED doctors, was to check, examine and certify the bodies brought in by the police so that appropriate paperworks can be completed to issue a death certificate before the they take it down to the morgue.  Majority of the time, all that was required was a brief look at the history handed to us by the police, a quick zip open of the bag in the boot of the police van, check of the carotid pulse over pasty-white neck skin and couple of signatures on a clipboard.

One day, there was a lull in the usual steady stream of patients.  Two police officers walked in. The senior doctor waved at them and offered to do the certification. The officers grinned and stopped him from heading out the door. ‘Is it a freshie?’ The doctor asked. They shared a smile. The senior doctor turned to the doctor’s area, ‘Who’s the most junior here?’ I put my hand up. He motioned me over. ‘Can you do me a big favour?’ He lowered his voice to a serious tone, It’s very important.’ I nodded eagerly. He pointed to the officers standing at the door. ‘Follow these two officers, there’s a body in their van that need a certificate.’

I puffed up with self-importance and swaggered outside with the two officers behind me. I should have known even before they opened up the door, but I thought the smell was just the usual bad sewage issues we have always had in the driveway drains. I was even more of an idiot not to stop when a swarm of flies escaped as soon as the van doors were open. Instead of doing what any sensible doctor would do – which is just to open a little bit of the bag, see some evidence of rotting flesh and close the zip quickly – I unzipped the whole bag, and tried to put my hand on the maggot infested neck to check for a pulse. It totally escaped my mind that since the guts were all hanging out in pieces, (obviously exploded from the build up of gas – courtesy of a week’s worth of fermentation), and the eyes were large nests of crawling maggots, not the mention the stench that permeated my whole being which made me want to run as far as I could in the opposite direction, were evidence that the patient is definitely DEAD. Yet I needed to feel his pulse to confirm that he was dead?! The officers were covering their noses with their hands and rolling their eyes at me. Really?? They seemed to say to me, Did you really have to open the whole bag and stick your finger into his neck?  Who found this silly little intern? She ain’t no Sherlock Holmes when it came to dead bodies.

When I grew up to become a surgical trainee, the antics continued in the operating theatres. I never realised how vulnerable a surgeon was when they were scrubbed, until the pranks started. Because the wound and equipment has to be kept sterile, once we are scrubbed, we cannot touch anything that is not sterile. For example, if someone punched me in the face when I  am scrubbed, it’s not like I can just punch them back, since they are not sterile. If I did, I would contaminate my surgical field and will have to take everything off and scrub all over again.

One of the worse things about being scrubbed is not being able to answer the phone. It is very often that our mobile phones go unanswered during surgery. Once in a while, if the nurse or anaesthetist is free and feel kind (as they hate being lowered to the status of the phone-answerer), they will take a message for the surgeon.

Once my senior surgeon was sitting in the operating theatre watching me operate when my phone went off next to him on the bench. He glanced down and said, ‘it’s your husband.’ I shrugged and turned around to say that it’s ok to just leave it unanswered.

But I was too late, my senior surgeon had already answered the call, ‘Hello.’

I called out, ‘just tell him I am scrubbed. I will call him later.’

He ignored me and spoke into the phone. ‘Sorry, she can’t come to the phone at the moment.’  A pause. ‘No, she’s not scrubbed. She’s busy doing a lap dance.’ A dramatic sigh. ‘In my lap, of course. And she’s very good at it too.’ He cleared his throat and held the phone away from his ear when a barrage of words came through the earpiece. ‘Look, why don’t you ring back later when she’s not busy. I can’t concentrate enough to take a message at the moment.’ He promptly hung up.

At my appalled look, he flashed me an evil smile and said, ‘Well, that will keep his mind busy for a while.’  For the rest of my term with him, whenever I saw his phone sitting on the bench next to mine, I considered ringing his wife. Luckily I refrained, because a few months after I moved onto the next team, I found out that he had left his wife for a young physiotherapist whom he was having an affair with.

When I was a surgical trainee, I was an easy target for the anaesthetists, especially the senior ones. They often told me that I was too serious and needed to lighten up. They wanted me to be different to the arrogant surgeons who couldn’t take a joke, or snap at anyone who tried to make fun of them. I worked hard during my training and spent more hours in the operating theatres than any other trainee in my service, so it was no surprise that I became fair game to all my anaesthetic and nursing colleagues.

Once I was performing a traumatic laparotomy, repairing bowel in a penetrating abdominal injury. There were lots of blood and my junior resident and I had our hands full trying to stop intrabdominal bleeding. It was unpleasant as his abdomen was also full of faeces as the bowel was lacerate in several locations. At one stage, some of the wash fluid, blood and poo were spilling over the sides of the operating table and I remember thinking that my surgical boots will definitely need a wash after work. Half way through the operation. I realised that my feet felt rather…. damp. I shuddered as I realised that most likely some of the crap has gotten in from the top of the boots (as I stupidly tucked my pants into them), and that I was probably standing and squelching in blood and poo. I wiggled my toes and felt my soggy socks slosh freely in fluid.

It was then I noticed giggling coming from behind the drapes at the head of the table (where the anaesthetic staff usually hide). I looked up at them suspicious, then I looked down. There in my boots were two intravenous lines, connected to two bags of saline, and there was water spilling over the top edge of my boots.  My feet were drenched in bucket-full boots. Honestly, you guys have the mentality of 5 year-olds, I said in exasperation. They kept laughing, like children laughing at fart jokes.

One night, we were putting some fingers back on. This can take up to 12-18 hours depending on the number of fingers we needed to reattach. Unfortunately I had to reattach four, which meant it was going to be a very long night. The anaeasthetic consultant came up to me and asked me how long it was going to take. I shrugged and said as long as I needed.  He then waited until I was scrubbed and sat myself down at the operating table. He then crouched under the hand table, and attached small neurostimulator pads on my calf. These are often used on patients while they are asleep, a shock is delivered through these pads into the patient, and cause a small electric shock, siginifcant enough to generate muscle contracture directly under the pads. This tests the muscular tension of unconscious patients to determine how relaxed and deep in sleep they are under anaesthesia. Well, In this particular instance, they were not on the patient – I found them on both of my calves instead.

He then retreated back to his position next to the anaesthetic machine and held up the remote control for the neurostimulator. With a slightly evil look on his face, he announced to everyone. ‘I will turn this on once every hour, just so you know how long you are taking.’

Trust me, if anyone was asleep in my operating theatre while I was pulling this all-nighter surgery, they were promptly woken up every hour with loud obscenities. I tend to get lost in time when I operate and the hourly reminder were coming faster than I expected, and each time, I would be caught unaware by the sudden jolt and contraction of my calf muscles.  These episodes were loudly accompanied by a physical jolt, yell of shock and swearing, repeatedly, in that order. It was only 12 hours later, when I finished the surgery that he told me he was actually giving me a shock at random, basically when he got bored.

To top it off, I didn’t realised that he and the nurses were in cahoots with each other. During the surgery, he apparently rang my mobile phone. I forgot to take it out of my pockets in my scrub pants before I scrubbed, so it was ringing away under my gown whilst I was trying to concentrate. The nurse offered to take it out of my pocket to answer it. I turned around in my chair and she fumbled under my sterile gown and shirt to grab my phone. Obviously, it was too late to answer the phone and she told me that it was a silent number, so I left it at that.

What I didn’t realise, was that the whole exercise was so that she could untied my scrub pants. So, as I stood up for the first time after sitting at the table for 12 hours, my pants fell down to my ankles. Lucky I was wearing my undies that day.

Of course, now that I am all grown up as a fully-qualified specialist, I am proof that good students emulate their teachers – and trust me, I learnt from the best. Although in today’s climate of political correctness, some pranks can be taken the wrong way and one must be very careful with the selection of target victim. But I am a true disciple of my forebearers and my pranks are legendary. After all, a sense of humour can be the life-saver in times of desolating fatigue, despair and desperation. I firmly believe that learning to laugh at ourselves is the key for humiliy and perspective. I have learnt, however, that you have to expect to get as good as you give.