The Doctor’s Handwriting

doctors-handwritingECG

Once upon a time, I used to have very neat writing, but medical school, surgical training, and the endless beauraucratic paperwork has beaten it out of me by the time I have become a fully qualified specialist.

My writing got so bad – that this week, when I left my husband a shopping list of things I needed urgently, I got a surprise in return. The list was:

  1. face wash
  2. moisturiser
  3. coffee beans
  4. shampoo
  5. conditioner

When I got home, I asked him whether he got the stuff I needed, and he said it was in the kitchen. I found the shopping bag sitting on the bench, I looked inside. And I found, face wash, moisturiser, coffee beans, shampoo and not one but two boxes of condoms. He must have thought all his birthdays and Christmases have come at the same time when he saw that on my list.

It is a good thing that most medical records are converted into electronic files, and doctors are no longer required to write, other than scribbling their signatures on printed reports, scripts and request forms. I was told once that the secret in writing doctor’s handwriting is to look at the first letter, and then the last letter. Look at the length of the line in between these two, and the brain should fill in the rest. To me, it’s a bit like deciphering an ECG (and for a surgeon, that is no small feat, as it is often the physicians who actually has the ability to read the subliminal messages in the wavy lines of an ECG). I would have a look at the squiggles, and see if at least one of the lines is recognisable. One can often decipher the overall meaning of an ECG (and a letter for that matter) once a something in the middle makes sense.

Even though now it is considered to be negligent if the writing in medical charts or communications is not decipherable, this has not stopped some hilarious misunderstandings due to bad hand-writing.

I was reviewing an inpatient with facial burns, whilst covering for a colleague. The patient asked me if he had to keep using the ointment my colleague prescribed him. I asked if he was getting a rash or reaction from the ointment. He said no, but he was getting bad diarrhoea and going to the toilet at least 4 times a day, usually after he has used the ointment. I looked at the notes to see what my colleague has written, and he wrote “Paraffin, top, prn” which basically means, vaseline topically to the burn wound, pro re nata (as required). I then looked at the medication chart, it was transcribed by the pharmacist into his medication chart as “Paraffin, 10g, PR” which means, 10g paraffin per rectum. Poor man was probably wondering why the nurses kept shovelling vaseline up his bottom when his burn is on the face.

Once, during a consultation, my patient handed me his referral letter from his doctor. He told me that he came to see me about his skin cancer. I nodded and read the short brief scribbled note.

“Dear Dr T, thank you for seeing this 46 year old man with a biopsy proven basal cell carcinoma over his right scrotal area.”

I stilled for a moment. Silently, I cursed my colleague, and wished he had sent this patient to a male surgeon. But I gave a mental shrug and got over it very quickly. I tried to make the patient feel comfortable by having a chat with him about his medical history, medications etc. Then I told him that if the cancer was small, I should be able to excise it under local anaeasthetic only, a bit like a vasectomy. I ignored his strange look. Finally, when I ran out of things to say, I asked if it was ok for me to call a chaperone so that I can examine him properly. He gave me another look, but shrugged ‘whatever you want, doc.’ I asked him to step behind the curtain, get undressed and lie on the bed.  He looked distressed, then said, ‘but doc, I just need to roll up my sleeve, it’s here.’ He stuck his right wrist under my nose. Over his scaphoid area, was a small skin cancer. (For the non medics – scaphoid refers to the area at the back of the hand, near the base of the thumb.) Yep. I was walking a close line to being reported to the medical board for inappropriate sexual harrassment behaviour.

Once I received a letter from a doctor working in the country, who has been dressing my patient’s wound at home. Mrs M was a 50 year old lady who had very bad ulcers on her legs, and her doctor felt that they have deterioated, so sent her back to my office. I got her onto the bed, and opened the handwritten letter while my nurse was undressing her wound.

“…..I would be grateful for your input in her wound management, as I feel it is worse. The woman is pregnant, so I have tried to use some topical antibacterial dressings. If you feel that she requires oral antibiotics……..”

I looked up at Mrs M and frowned. ‘Is there something you would like to tell me?’ I asked her. She smiled sheepishly and admitted that she’s put on too much weight since she last saw me. I thought, well there are women who are having babies in their fifties, so I said ‘Congratulations, so how many weeks are you?’ Mrs M looked up with a start, then started laughing so hard she couldn’t get her words out, but I eventually worked out she was denying her pregnancy. I told her that’s what her doctor wrote. She insisted on reading the letter, after which, she started on another fit of laughter, with tears running down her face. My nurse snatched the letter out of Mrs M’s hands, and squinted her eyes as she read it several times. Then she pointed to the sentence ‘The woman is pregnant’ and said, ‘I think this says, the wound is pungent?’ Yep. The wound did stink out my office when the bandages came off. Mrs M needed to be readmitted to hospital, for antibiotics and dressing on the surgical ward. Not the maternity ward.

When I was working in general surgery, I once received a patient  with questionable bowel obstruction transferred from another hospital. They were particularly concerned about him because he has not been able to tolerate any fluids orally. I was not convinced he had a true obstruction, but reluctantly accepted him despite the fact I was up for my second night on call in a row. He arrived through emergency with a hand written letter.

“….Mr XX has had ongoing retching for 24 hours, he last opened his bowels 3 days ago, and has farted since 6am this morning……”

I was livid. If Mr XX has passed wind, it meant he wasn’t really obstructed. He probably just needed to have a good enema. I couldn’t believe that I got woken up at 2am in the morning to see someone with constipation. I rang up the referring doctor and ripped through him (fuelled by lack of sleep) about unable to diagnose and treat constipation. When the poor man on the other end of the line got his chance to say something (because I stopped to take a breath), he said that Mr XX hasn’t passed wind for 3 days. I put on my self-righteous tone and referred to his letter. ‘No, no, no!’ the young doctor cried, ‘I wrote he has fasted since 6am’. Let’s just say, humble pie was not easy to eat at 2am after 48 hours of no sleep.

The best one arrived via fax. It was another handwritten referral letter I received from a local family doctor. Luckily, I was reading this before the patient came to her appointment. (Warning: I apologise in advance for the foul language you are about to encounter).

“Thank you for seeing Mrs Z, her cunt has been worrying her. she has tried many self-remedies to treat it  she has applied several different herbal salves, soaked it in methylated spirits, pricked it with a needle, and tried to level it with sandpaper. She’s so fed up with it, she would like to see you about having it cut out…..

Ouch. Ouch. OUCH?!?!

Nah, I thought. I must have misread something. So I re-read the letter again and again. I scruitinised the offending word. But it was as if I was hypnotised, once the word ‘cunt’ was in my head, I couldn’t possibly see another word within that particular scribble. The harder I tried, the more blinded I was to any other possibilty. There was a curve like a ‘c’, and an end that is definitely a ‘t’. I took the letter to my secretary and asked her to read it. She started, ‘Dear Dr T, thank you for seeing Mrs Z, her…’ she stopped suddenly. Go on, I urged her. She looked at me with pleading eyes and told me she couldn’t bring herself to say the word. I gave it to my nurse, she raised her eyebrows at me. I thought about ringing the doctor and get him to send her to a gynaecologist. But my curiosity got the better of me. When she came into my room, I asked her to show me her problem. She smiled, bent over in her seat, and took her shoe off.

Under her big toe, was a plantar wart.

I have to admit, I have always struggled with hand-written letters from my colleagus, and I hang my head in shame on behalf of my profession. But personally, I have a valid excuse. After all, English is my second language and I failed spelling when I was in primary school, so I am pretty much illiterate when it comes to reading letters anyway.

Guest Blog: Take it Like a Man

My very first guest blogger article – thanks to the awesome Women in Surgery blog site.

Women in Surgery

Oooh, exciting! This week we have a guest blog! The awesome Tiffany from Surgery at Tiffany’s (a blog which I can highly recommend) has kindly agreed to share her response to out post about whether or not women in surgery are less confident than their male counterparts.

If you are interested in guest blogging on this site some time, please get in touch. It would be great to make guest blogs a somewhat regular thing! But now, without further ado, here is what Tiffany has to say:

When I was accepted into plastic surgery training back in my mid-20’s, I was the only female plastic surgery trainee in the state. There was only one female plastic surgeon working in town, but she was trained overseas and imported into our hospital. She was my mentor and ally. She told me stories of her training and gave me valuable insight into…

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Just a Matter of Pride & Vanity

So, on Friday night, I found myself in my wardrobe, amidst clothes flung on the floor, jewellery spreaded out on my dressing table, shoes strewn along the carpet, and a very frazzled looking, insecure woman staring back at me in the mirror. The dress I held in front of myself flew out of my hand onto the floor in an exasperated sign. Another one bites the dust. I tried chanelling Angelina Jolie…..

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I  looked up at the reflection. Messy, frizzled hair cascading around my bare face devoid of makeup, loose pyjama top stained with food remanents, tracksuit pants that are two sizes too big, and peeling red nail polish on my toes. I looked closer. Damn, is that my gray hair peeking through my last hair colour 8 weeks ago? Brown eyes are so boring, maybe I should get eyelash extensions to enhance my eyes. I made a pout – my lips are so thin, it’s hardly worth the effort of putting on lipstick. When did those lines started to become so prominent around my eyes and forehead. Hubby is right, I really frown too much, maybe I should start giving myself some Botox……

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It hit me then. Oh God. I have become one of them.

Them – being my cosmetic patients. The ones that sit in my office, telling me over 45 minutes about the extra fat bulges that shouldn’t be sitting on heir hips, the breasts that are too small for their designer dresses, the waistline that is not well-defined enough like a washboard, the fine wrinkles that give their age away, the flat cheekbones that makes their nose look big, the turkey neck that makes them look old, the receding chin that lacks character etc etc etc. Usually by the end of the consultation, my eyes have rolled to the back of my head, listening to their lists of imperfections. Sometimes I am tempted to whip out my ipad and show them pictures of women whom I have had to remove facial and body parts for cancer, just so that they can appreciate what God has given them.  Sometimes I work really hard at being patient and sympathetic. Because after all, I am a plastic surgeon. Making people as beautiful as they want to be is my job. Although I have to admit, the biggest frustration of my job is that sometimes my definition and their concept of being ‘beautiful’ can be two vastfuly different things.

So I digress.

What has put me in this state?

Earlier this month, I received a message via facebook from Georgina. She was coming for a conference. She was dying to catch up because she hadn’t seen me for years. She just got married last year to the hottest guy and would love me to meet him.

She hadn’t seen me for 12 years to be exact.

Georgina and I have known each other since first year of high school. We were family friends. Our mothers car-pooled. My mother took us to school and her mother (Mrs S) took us home. We went to the same private girls’ school, lived two streets away from each other, had the same piano teacher, attended the same ballet school, she was a swimmer and I was a rower, so we trained at the same time. When we grew up, we went through medical school together. She is now a specialist working in another state.

Georgina was from a very wealthy family, I was a scholarship girl in a private school. Her father was a medical specialist and Mrs S was a housewife who lunched at the local country club. My parents were migrants who owned and worked in a small mortgaged coffee shop. Our house was old and falling apart around us, my father was forever ‘self-renovating’ it. They lived in an elegant white mansion, with an automatic gate, french window seats, custom-made silk and brocad curtains, a dining room that fitted a long shiny mahogany table which sat 20 guests…. you get the picture. Mrs S used to pick us up from school in her shiny BMW, with fresh Happy Meal boxes from MacDonald’s for us to eat, then we’d go to her house until my parents were home from work. Georgina and I would play dress up in her room, muck around on the piano, swim in her big pool and hang around the cook in the massive kitchen for scraps from whatever feast she was cooking the family for dinner.

Georgina had the biggest wardrobe I had ever seen, and every few weeks, she would give me clothes that she didn’t want anymore. She was bigger than me, so most of the time, my mother had to take in the sides and lengh.  She taught me how to put on makeup and paint my nails. She coached me how to walk in high heels. She educated me in the difference between Chanel and Gucci. She showed me the colours of Louboutin Red and Tiffany Blue.  I was always in awe of her and her family. I thought I was so lucky to have her as my friend. She was a popular, confident girl who excelled in everything, and held different official positions throughout high school. She always changed into one of her beautiful designer outfits when we went out after school.  She was allowed to wear high heels when she was 15. Handsome looking senior guys from the private boys’ school next door used to hang around her. She got asked to the prom every year of high school. I was a typical nerd. I had braces for three and half years. I wore uniforms that were too big for me (because mum couldn’t afford to buy a new one each time I grew). Although I did well in my core-curriculum and music, I was bad at sports, clumsy and awkard. I was constantly in flannel shirts, jeans and scruffy sneakers when I wasn’t in my uniform (legacy of my older brother’s wardrobe). I was shy around boys, and never went to a prom, except mine. I took my older brother.

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Looking back, I can’t say we were really friends. I desperately believed that we were friends, even though we never spoke to each other at school. But when we were at her house, we spoke about everything, from our favourite movies, difficult equations in maths, places we’d like to travel to and our fairytale weddings. I guess we were friends by default. Two very different young girls thrown together by circumstance. We spent everyday together through our teenage years and early twenties. Her house was the only place I was allowed to go to without parental supervision on weekends. The parties I was permitted to attend were those she was invited to. We hung around the same crowd when we were older, our brothers were best friends, so it was unavoidable that we were always in each other’s presence.

Then little incidents started to fall in place for me. There were several, but a few stood out.

Once when I was bored of playing cricket with my younger brother, to escape his pestering, I walked over to her house on a Saturday afternoon. I pressed the bell at the gate. Mrs S answered. I told her it was me and if I could come over and and play with Georgina. She said of course and called for Georgina. I don’t think Mrs S realised that the intercom was still on, because the next thing I heard was Georgina’s whining voice. ‘Is she here again? Mum, she’s so annoying, do I have to play with her? Can’t you just tell her I am not home?’

‘Hush Georgie, be nice to Tiffany. She is a very good girl and you have a lot to learn from her.’

‘She’s such a dag. Mum.’

‘Go and let her in.’

I hesitated. I wanted to leave, but I managed to convince myself that she didn’t really mean it – because if she did, she wouldn’t have let me in. So since that day, I tried really hard not to be ‘annoying’.

When I went to my prom, I didn’t have a dress. Mrs S offered to my mother that I could borrow one of Georgina’s many prom dresses. I was at their house, trying on different dresses, most of which were too big as Georgina was a swimmer and had much wider torso than myself. Mrs S then brought out a dress from her wardrobe. She said it was her prom dress when she was a girl (and when she was a lot slimmer). It was a long beautiful tight shimmering number. It fitted me perfectly. Georgina said that I looked old in it. I thought she was just jealous that I could wear her mother’s dress. Days before the prom night, she told everyone at school that I was wearing one of her mother’s old dresses and that I looked like I had no boobs with a fat tummy in such a tight dress. I went home and cried, I told my mother that I didn’t want to wear Mrs S’s dress. She made me wear it on the night. I spent the whole night sitting in the corner, with my brother’s black Parka jacket over Mrs S’s dress.

When we were at uni, my boyfriend (now husband), M, was in her group. I remember thinking that she was my ‘closest friend’ (plus she was also one of M’s friends), so I should let her know that M and I had started dating. She shrugged with disinterest when I told her. She was more eager to tell me about how several male doctors at the university hospital had been asking her out. Two days later, M asked me if i ever had braces. I said yes and asked him why. He said that Georgina told him about my braces and how I used to look hilarious when food got stuck in it. I asked him what else did he and Georgina talk about, and he started telling me some pretty embarrasing things I used to do at school. I got angry and said that Georgina was trying to make me look bad. He just laughed and said that I was over-reacting. He thought the stories were adorable.

Finally, the last time I saw her, we were sitting exams to apply for specialist training. I was studying in the library, in a cubicle desk next to the meeting room. The meeting room is often booked out by study groups. I preferred to study alone. The walls were very thin, I could hear the conversation in the room. Georgina’s voice stood out. One of the girls was admiring her shirt. Georgina said that she got it from an exclusive boutique in the city. The girl mentioned that I worked there on weekends. Georgina laughed, ‘isn’t it ridiculous how long Tiffany has worked there?! You’d think her dress sense would improve for the better.’ When I bumped into her leaving the library later that day, I said goodbye. Then I quit my job at L’Amour Boudoir a week later.

Now I asked my reflection in the mirror. Why the hell did you say yes to this dinner.

Maybe I wanted to give Georgina the benefit of the doubt? Maybe she has changed and matured. She did probably consider me as a friend and has missed having me around to talk to. She sounded genuinely interested in finding out about my life. She really wasn’t such bad person, she had her own insecurities and fears. I’d like to think she was jealous of me, but that would have just been plain silly, because I envied her and she knew that I wanted to be just like her.

Or maybe because I wanted to show her how far I have come in life, that I now live in the same sphere of professional stature and wealth as her family. But why would I care what she thinks of me now? Why did I have the need to show her that I was the same or maybe even better than she is? I wanted to show her that I am now more worldly, and have developed my own sense of style. Looking at my reflection in the mirror – there was no evidence of any of the above. The little insecure teenager in me had been brought to the surface by Georgina’s visit.

Thus my indecisiveness in ‘what to wear’. This was so unlike me. I am used to making a split second decisions on a bleeding internal jugular vein, a prompt judgement on managing severed fingers, not to mention accurate assessment on resectability of complex cancers. And now, I found myself stuck in front of the mirror, dithering over one black dress over another (honestly, they all look the same), and worrying about a few lines on my face. I sighed and threw my hands up in the air.

Then a voice downstairs brought me back down to earth. ‘Hey, beautiful, have you finished dolling yourself up yet? We are going to be late.’ I can see him, sitting on the sofa, flickering through Star Trek episodes on the remote, in his blue-striped shirt to match his eyes, navy linen blazer fom Zegna, crossed legs covered in tailored Armani pants and suede loafers courtesy of Bally. Half an hour ago, I was sitting on that sofa, exactly as I was and he as he was, snuggled up in his lap while he was talking about his day. Then I saw in the mirror what he would have seen.

One thing I have learnt from working in the field of plastic surgery for over 10 years is, the clients that feel truly beautiful, are those that already did before surgery. All I do for them is to enhance the parts which they wanted improvement.

So I berated the bedraggled image in the mirror. You are a well-respected plastic surgeon. You are fit, toned and have a perfect Body Mass Index of 23. You look good for your age, and that’s without Botox. Your husband can’t keep his hands off you because you are gorgeous. He spoils you with classy jewellery. You can afford expensively tailored designer clothes and shoes. You have everything at your fingertips to make yourself one damn stunning hottie.

By the time I had my hair piled up over the gray roots, Chanel make -up applied over the fine lines, Helmut Lang black dress zipped up, Louboutin pumps hiding my neglected toes, Tiffany diamonds in place, and a shimmering Louis Vuitton clutch in my hand, I felt like the envy of all women.  And men. For all my self-righteous tirade on Vanity, I have had to admit to myself that a healthy dose of it does wonders for one’s self-esteem.

Because when I walked into the restaurant that night, it didn’t matter what Georgina and her hunky husband thought, I felt like a million dollars, like Angelie Jolie in The Tourist.

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With my very own Brad Pitt.

 

 

 

‘Doctor’ is my Job. Not who I am.

I hate travelling alone. Somehow or rather, I always end up having a conversation with whoever sits next to me. I don’t mind the conversation, but sooner or later, the ‘oh-so-casually-asked’ question comes up: ‘So, what do you do for a living?’

I always hesitate. I always consider lying about what I do. I just don’t want to say I am a doctor.

It took me a while figure out why. Apart from the fact that once people find out they are talking to a doctor, they lose all interest in talking about anything else. Anything else but every medical condition or surgery they have ever had. Then they move onto each of their family members and friends. In between, they give you their five cents’ worth of why they knew better than the doctor, and how Dr Google was so helpful. By the end of the flight, they would be asking for a free in-flight consultation as to what my opinion was in regards to dear old departed Grandpa’s gouty big toe.

I get that. I really do. I find myself doing the same when I talk to people in certain jobs. When I first met my friend who is an airline pilot, I told him about all my terrible flying experiences. I could literally see his eyes roll to the back of his head as I carried on. But he has no qualms in telling people he is a pilot. In fact, he loves it, because he says it is a great drawcard for chicks.

I don’t think it is a drawcard for me. You could see the interest dimmer in men’s eyes when I tell them I am a doctor, or the body language wthdraws when I mention that I cut people up for a living. Well, not exactly in those words. It is often hard to tell whether it is because they are intimidated or they are just not interested in female doctors. Of course, once they get over that fact – and they haven’t moved onto someone else with a greater one-night-stand potential – I get the low-down about their latest health problems over a beer. No Siree, there’s no flirting for the female doctor at the bar, It’s all serious talk about their latest health problems. When boys fantasize about playing doctors and nurses, I guess they just never really imagined playing the nurse.

People judge people by what they do. Assumptions are made- some are true, but majority of the time, it can be quite far off the mark. These are often based on stereotypes. So, when I tell people I am a surgeon, people usually presume that I am a smart, rich, arrogant, bossy, ball-breaking feminist. Some even assume that I am single. Interestingly, some people talk differently to me once they realised what I do for a living. It is almost insulting when people make comments like ‘You know, you are not like a typical surgeon. You are so normal and down to earth.’  Yep. I eat, drink, wee and poo like any other normal person.

But most of all, I hate telling people that I am doctor, simply because it is not who I am.

I am a surgeon, and yes it consumes my life, but it is still just a job for me. I would still be me if I was a teacher, waitress or cleaner. I would still have the same work ethic, the same standards and the same approach to my work. I don’t identify myself with what I do for a living, but rather, what I do in life.

I think it is a good thing.

It allows me to separate my personal life and work life better. In the time continuum, they do overlap. For instance, when I am out shopping for groceries, I get a phone call from work. But I don’t think of myself as a surgeon doing groceries, I identify myself with everyone else around me doing groceries, the only difference is I am getting a call about work when it’s a Sunday afternoon. When I have issues at work, I don’t bring it home to my personal life.  When I have problems at home, I deal with it like a concerned wife, not like a surgeon.

It is also good for protecting myself. When I get abused by patients, or complaints from colleagues, I find it easier to see it as a criticism of my work, and less an assault of me as a person. They don’t know me, not really, they are just angry at the doctor. This allows me to look at my work more objectively and find out what I may be able to change or improve, rather than get all upset because I feel incompetent, hurt and lose my self-confidence.

My husband likes it. He thinks that I keep the non-doctor part of myself only to those closest to me. He often chuckles when he hears me speaking on the phone to my colleagues at home. ‘You talk like you have balls.’ Not the most eloquent compliment he could bestow on his wife, but he loves the fact that as soon as I put the phone down, I revert back to the quirky chick he married. The one that snuggles up to him on the sofa and lets hm believe that she worships the ground he walks on, whilst taking a piss out of him all at the same time.

Most of all, separating my job and my identity allows me to have a life outside work. I have other interests, many of which are not exactly congruous with what I do for a living. I suppose most people think doctors play golf, sail, travel during their spare time. Me? I enjoy bashing up my Sensei and his gigantic sons during my karate training sessions (free medical care offered if I win).  Other weekends I go to the gun range and work on my not-so-perfect trap-shooting technique, in between cheese tasting with the large Italian community at my local gun club. I seriously think that I would be more comfortable calling myself a mediocre amateur trap shooter (who loves her chilli cheese), than I would a surgeon.

Discovering my identity outside my work gives me the opportunity to find out who I am, and confirms that I am not my work.  It gives me a purpose in life even if someone strips me of  my job and all the associated status it represents. It determines how I do my job.  How many times have I heard of senior colleagues continually postponing their retirement? It is because they are too afraid of retiring – they have nothing besides their work and they are at risk of losing their identity once they stop being a doctor.

I would hate to think my view is a reflection that I am not committed to my work or that I don’t love my work. In fact, I really believe that I make a better surgeon if I am also a regular human being. I hope that people don’t just see me as a ‘doctor’, but rather a kind, thoughtful, considerate, empathetic, intelligent, decisive and trust-worthy person. A person that they feel confident in as their doctor. Because that’s who I strive to be.

Back to the plane.

‘So, what do you do for a living?’

‘Oh,’ I would shrug, ‘not much. I am a lady of leisure.’ I wave my hands around elegantly like a practiced socialite. ‘but I am fairly busy,’ a sweet innocent smile thrown in here, ‘I go to lunches with my girl friends, I love a bit of shopping; I organise charity functions and I always attend my husband’s work-do’s, you know.’

Usually I get an indulgent smile. ‘Well, you lucky girl.’

I would give a very girlish giggle. ‘I know, my husband spoils me.’

The conversation takes a brief break as the air hostess wheels the coffee cart up to us. She bends over to me.

‘Dr Tiffany, can I offer you a coffee?’

Damn. Sprung.

May be there is a doctorate in home-decorating?

A Letter of Apology

This is probably going to be one of the most un-feminist blog I will ever write, but this is one letter that I need to wite.

This is a letter of apology. A letter of apology to my husband.

Dear M,

Every night when I come home from work, I look at your face, and I constantly search for signs of disappointment, resentment and regret in your eyes. I wait for the day when you realise that you have made the wrong decision, or got the raw end of the wife-deal. I count down to the day that you realise you have married a neurotic, anal-retentive female surgeon who is a useless housewife.

Instead, you greet me every evening as if you haven’t seen me for weeks. You hug me as if you have missed me every moment of the day and you kiss me as if it will erase every bad moment I have had during the day.

So I feel that I owe you an apology. Well, several apologies to be exact.

I am sorry for all the last minute cancellations, of romantic dinners, first-time outings, long-awaited concerts, thoughtfully prepared picnics and all other events that we were supposed to have attended.  For the outings we have managed to attend, I am sorry for each and every time we have had to leave early because I have had calls from the hospital.

I am sorry for every date that I have stood you up for, because I got ‘caught up’ at work. I am sorry for when I have kept you waiting, sitting alone at restaurants because I couldn’t just leave an anxious patient ruminating on their fears.

I am just really very sorry that it seems you are not the number one priority in my life.  I give up any enjoyment with you at the drop of a hat because I think someone else needs me more than you,  and they need me more urgently.

I am sorry for all the hours I spend doing paperwork at home when I could be spending it with you. And for bringing them home in the first place because I didn’t have time to attend to them at work – I have been too busy spending time with patient.

I am sorry for the long days and evenings I spend with my colleagues, in clinical work and in meetings; the nights and weekends when I should be having lazy late brunches instead of lecturing, teaching and demonstrating in tutorials for the junior doctors and students; the weekends when I travel to attend conferences instead of walking on the local beach with you.

In fact, I am just plain sorry that I spend more time with my patients, students and colleagues than I do with you.

I am sorry that  when I get home I am so tired that I can’t carry on a decent conversation with you over dinner, or the number of times I have actually fallen asleep in my chair during dinner.  This includes evenings on the sofa when you are telling me about your day and I respond with loud snores. I am sorry for the times when I am not listening to you because I am thinking through an operation, or figuring out diffiult clinical dilemmas in my head. I am sorry for answering my text messages from patients and colleagues while we are talking. And yet, you listen to my constant whinging about my work, hanging on every word and providing advice to help me think clearly.

So I want to say sorry. Sorry that most of the time when I am with you, I don’t give you my 100% undivided attention.

I am sorry that you have not married a Domestic Goddess, that I don’t cook, clean, or pack your lunch for you. I don’t see you off to work every morning with a kiss and a wave in the driveway. I am sorry that you have to do the groceries, drop off the dry cleaning, hang out the laundry and cook me dinners at all hours of the night when I come home from work. Despite all this, I am ashamed that I still begrudge the times you lie on the couch watching sports, stay up all night bingeing on your favourite TV shows and the Saturday nights you spend drinking at the football match with your mates.

I am sorry that I get so busy, I forget our wedding anniversaries and your birthdays.

I am sorry that sometimes I haven’t been able to be with you when you needed me. I am also sorry that sometimes when I get so upset at work, I lash out at you. I am also sorry that I cause you to worry, when I indulge in frustrated tears.

But most of all, I am sorry for each and every day that I forget to thank you for loving me, the way I am.

Diagnosis: I Don’t Give a S#@% about myself

One of the most frustrating things I encounter at work is trying to help people who doesn’t want to help themselves.

Here are the 10 top clinical signs (for the novice):

1. The beautifully tanned patient who is sunburnt all over, (looking like he/she has just spent their weekend on the beach), and is about to go into the operating theatre to have a melanoma excised.

2. An obsession with blenders. The lap band is tight to maximise weight loss, the patient is supposed to be on a portioned healthy vitamised liquid diet. Instead, he lives on a  ‘vitamised diet’ of Big Mac and French Fries, liquified via a blender. ‘I just don’t understand why I am not losing weight…

3. The dangerous oxygen tank. The patient who just had 1/2 of his right lung removed for cancer – so now he is dependent on oxygen – lighting up a cigarette in the hospital courtyard. Taking a drag on their cigarette in between inhaling a whiff of oxygen from their mask. Honestly – if you want to kill yourself, that’s ok, but to blow up the hospital???

4. An X-ray that shows a new fresh hand fracture through plates and screws over an old fracture. Excuse: ‘Well, punching my fridge is better than punch my Dad in the face, rght?’

5. The MIA patient. The patient was called for the operating room, but he couldn’t be found anywhere. Because he was outside for his ‘last smoke’ before having half f his lip removed for  lip cancer. ‘You only told me that I couldn’t eat or drink before my anaesthetic, you didn’t say I couldn’t smoke.’

6. Patients with bags of ‘unfilled’ medication scripts. One is really unsure as whether these patient don’t take their prescribed medications (for their heart disease, cholesterol, diabetes, infections etc), because they can’t be bothered, they don’t want to or they just ‘don’t believe in taking medications.’

7. DNA’s (did not attend). Patients who have appointments for their cancers to be assessed and removed do not turn up to their appointments despite multiple phone calls, or simply, they have important work-commitments or holidays and need to move their appointment to 6 months later when things are quiet (and the cancer will be inoperable.)

8. The broken plaster on a broken arm. Sometimes, the non-existent plaster on a broken arm. ‘I know my arm is broken, but it got so itchy I had to take the plaster off’.

9. The gigantic fungating cancers. It takes time for cancers to grow. When I see a very very large cancer, I wonder why patients don’t come in when it was the size of a coin. Once I had a patient with a skin cancer on his chest. It was the size of a dinner plate, and it had already eaten into his breast bone. I asked him why he left it until now to come, he said that he only came in because it was growing into his neck and he couldn’t hide it behind his business shirt and tie at work anymore. Did he know it was a cancer? Yes, but he was too busy at work to take time off for an operation.

10. The smoker with a cigarette dangling out of his neck. The throat cancer patient who had his throat removed now has to breathe out of his tracheostomy. He was found lighting up with a cigarette taped to his tracheostomy. A short-cut highway of delivering poisons directly into his lungs. Well, I guess he won’t get oral cancers from smoking this way.

The Differential Diagnoses:
1. I have a severe case of NFI (No F&%$* Idea)
2. I am so f$%#@ scared that I’d rather bury my head in the sand
3. My health is my doctor’s responsibility because that’s their job to fix it

But sometimes we just have to face the harsh diagnosis of: I don’t Give a Shit about Myself.

 

Things you shouldn’t say to your surgeon before your operation

I have had a very long tough day of operating, so please allow me some self-indulgence in writing this blog. I sincerely apologise in advance for the sarcasm and disillusioned humour to follow!

The last thing anyone wants is an annoyed surgeon operating on them. I mean, would you be obnoxious to your chef or the waiter that is serving you? (We all know they will spit in your food) Would you be an ass to your dentist just before he/she picks up the dental drill? So why, oh why, would someone piss their surgeon off just before being wheeled into the operating room?

‘I have been waiting for 2 hours since 8 o’clock.’

My answer: ‘Oh, that’s great, you arrived nice and early so you are now all ready to go in.’

What I really want to say: ‘Sorry, I just finished my 2-hour champagne breakfast, hic.’ or ‘Are you in a rush to go somewhere after your operation?’ or ‘I’d better go faster during your operation then, so you can get home sooner.’

‘Are you sure you have done this before?’

My answer: ‘More times than I can count, you will be ok.’

What I really want to say: ‘No, but there’s always a first.’ or ‘No, but I watched it on You-Tube last night, and I think I got the general idea.’ or ‘Yes, when I was a medical student, on a pig in the lab.’

‘How come this operation costs so much?’

My answer: ‘Because it is a major operation, it takes a lot of time and expertise to do.’

What I really want to say: ‘Because you have come to a surgeon, not the local butcher.’ or ‘You are free to shop around, maybe it will be cheaper if you get it done over the internet.’ or ‘I don’t do surgery because I love helping people, I do it for the money.’

‘Would I have a scar? Will it be ugly?’

My answer: ‘Yes, you will have a scar, just as we discussed before. It will fade.’

What I really want to say: ‘Of course you will have a scar, moron, you are going to be cut open and I may be good, but I can’t perform miracles.’ or ‘No, you won’t have a scar, because I do it all by telepathy.’ or ‘Yes and Yes.’

‘Please do a good job and don’t kill me.’

My answer: ‘Don’t worry, we will do our best to look after you.’

What I really want to say: ‘Ok, for once I won’t make a mess of it, but have you signed a will yet? You know, just in case.’ or ‘Do I get a bonus if you get to live through this?’ or ‘You are expecting too much from me, I don’t think I can handle it.’

‘If the operation doesn’t turn out to be what I wanted, can I get a refund?’

My answer: ‘No, but if that’s the case, I will do my best to give you a result you are after.’

What I really want to say: ‘Sure, if you want a refund, we will have to put the cancer back too.’ or ‘No, because I can’t take the implants out of your boobs when you’ve changed your mind and use it for someone else.’ or ‘No, because I have never learnt how to undo a facelift.’

‘Have you been working all day? Are you too tired to do my operation? Can you please pay attention when you are doing it?’

My answer: ‘This is a normal working day for me, I am fine and you will be fine too.’

What I really want to say: ‘I will be fine. My hands will be steadier once I have had a drink.’ or ‘Don’t worry, watching the tennis on my laptop during your operation will keep me awake.’ or ‘I am fine, my ADHD is under control, I have just had my 6 oclock dexamphetamine.’

‘Do I really need to have this operation?’

My answer: ‘Remember what we talked about before? I would not be recommending an operation unless you need it. You will be ok.’

What I really want to say: ‘Did you hear anything I said last week during your consultation?!?!’ or ‘No, you don’t need this operation, I just like cutting people open for fun.’ or ‘Yes, you really need this operation because I really need to save up for my Ferrrari.’

‘You look too young to be doing this, do you know what you are doing?’

My answer: ‘Oh, that’s so sweet, thank you. I am actually older than I look. I have done this for several years now, so I think both you and I will be ok.’

What I really want to say: ‘If you prefer to go to Old Shakey next door, you are welcome to swap surgeons.’ or ‘I have done heaps of this operation on cadavers during medical school. I graduated with honours last week.’ or ‘I only look young because you are so old.’

 

Ok. That last one was bad. I should stop here. I should go to bed, get some sleep.

Because come tomorrow morning, I have to find my professionalism, tolerance and patience. Again.

An Impossible Letter to the Health Minister

This is an open email distributed by the doctors working in the public health system of Queensland Australia.
The Queensland state government has presented new contracts consisting of ‘improved’ work conditions for its doctors.
These conditions include:
1. If a doctor resigns, 6 months’ notice is required, or paymentf 6 months salary to the hospital is required for leaving
2. On dismissal, there is no process for appeal
3. Doctors can be rostered to do any shift, with no specification on having available junior staff support
4. Work conditions (pay, allowances etc) can be changed without notice by adminstrators
5. Work hours, duties, locations can be changed by discussion, not agreement
 
It is a contract which several independent industrial lawyers have advised against signing.
It s a contract where the government will own the doctors’ livelihood. Doctors will be held hostage by their contracts, which may come in conflict with patient care, as they may have to make decisions to appease the administrators, rather than what’s best for the patient.
 
*Please note, I didn’t write this email, but I wish I did.
 
 
Date: 7 March 2014 10:48:17 PM AEST
 
Subject: Nothing here is impossible Mr Springborg

Dear Minister Springborg and Premier Newman,

We have been told that your legislative changes are irreversible, and the train carrying these individual contracts has already pulled out of the station, and cannot be stopped.

We sincerely hope that your talks with the SMO representatives around the concerning issues in the contracts result in a successful outcome for all.

If SMOs are not convinced that our ability to continue to practice public health medicine with safety is secured, then the state will be in grave danger of losing its’ brightest and best.

Please listen:    We say to you that nothing in your legislation, and the individual contracts, is irreversible. This train wreck can most certainly be stopped.

You are dealing with a group of people who understand what is truly irreversible and impossible, as they have stood in the face of death and tried to stare death down, bargained against time with their knowledge, skills, equipment and courage, and sometimes failed, and often times not.

When you have to tell parents that their child has autism and intellectual impairment and that their lives will forever be filled with difficulty and challenge, and watch their grief unfold – that is irreversible.

When you watch a child bleed to death before your eyes as you pump blood in their arm only to see it pour out of the gaping hole in their skull, where it has been sheared off from a motor vehicle accident – that is irreversible.

When you tell parents that their baby has cerebral palsy and will never walk or talk, or even eat independently, because their brain is malformed or damaged beyond repair   –  that is irreversible.

Nothing here with your individual contract legislation is impossible to change – we’ll tell you what is impossible.

When parents beg you to save a child’s life after a second failed bone marrow transplant for leukaemia, as you’re watching them die from an infection they have no white blood cells left to fight  –  that is impossible.

When you’re trying to bring back a heart beat in a child who has been pulled from the bottom of a pool, an hour after its heart beat stopped  –  that is impossible.

Don’t you dare sit there and tell us that this legislation is irreversible and that stopping this contract roll out is impossible. Because we know that all it takes is a show of hands in a parliamentary room, and the swipe of a pen across a piece of paper.

No fancy machines, no million dollar drugs, no transplanted tissues, no 12 hour operations, and no miracles of fate.

Just understanding and good will from your colleagues and yourselves. And if you’re up all night to achieve that, then welcome to our lives.

We have each others’ backs, us medicos  –  we always have and always will.

Because we have all stood there with the sick and the dying, and we know how lonely that journey is without colleagues at our shoulders, and support and resources at our backs.

So we will stand together, even if we have to walk away, together  – until you listen, and pull on the brakes, and stop this train wreck from playing out to its end.

Please enter the discussions with good will, and open minds and hearts, and leave your egos on the coat rack outside.

The health of the state is in your hands – please don’t throw it away.

Sincerely, Senior Medical Officers of Queensland Health.

Teaching by humiliation

This is not a blog about bullying. Just about teaching.

Last week, I witnessed a scene in an operating theatre.

Two doctors were operating on a patient. One was the senior consultant and the other, the junior resident. The tension in the room was palpable, and even the humming of the ventilator sounded like a jumbo jet. The operation was not going well. There was constant welling of blood in the body cavity they were concentrating on, and the sucker tubing gurgled continuously with bright red fluid. Stress was evident as expletives started to escape from behind the older doctor’s mask., directed at the younger man.  The junior resident was trying his best to help, but he was obviously straining under the other man’s diatribe, apparent in his worsening tremor and the inability to stop the blood from flooding the operating field.

Then, miraculously, the senior surgeon managed to control the situation, and it was as if everyone in the room released their long-held breath in unison. The older surgeon gave an arrogant laugh, ‘It would really ruin my numbers if that one got out of control.’ He daftly tied the loops around the bleeding arterial branch. The operation continued, but as it progressed, it was clear that the resident was starting to annoying the older surgeon with his scrutinised clumsiness. At times when the younger man got in the way, his hands were swatted away like a bothersome fly, accompanied by over-dramatic exasperated sighs from the senior surgeon.  When the resident missed a suture with his scissor, it was snatched out of his hand with an expletive, as the older man made a deliberate show of cutting his own sutures, to demontrate the younger doctor’s incompetence.

The tremor in the young man’s hands deterioated. By the time it came for him to close the wound, one could almost hear the instruments vibrating against the patient’s skin. Criticisms started with a few grunts, escalating into abrupt barks of ‘Don’t’ and ‘Stop’. Finally, the needleholder was grabbed from his hand roughly by the senior surgeon. The older man started to close the wound himself in angry jerky movements, at the same time, a barrage of insults descended on the young doctor.

‘Pathetic aplitude for surgery….’

‘You will never make a surgeon…..’

‘What were you thinking taking on this job…..’

‘I don’t know how you could have made it this far as a doctor…….’

‘you are useless…. It wouldn’t have taken me this long if it wasn’t for you……’

‘Why is it that I always get the most pitiable incompetent junior doctors….. ‘

It was as if the avalanche was unstoppable, hammering down at the young man whose head was bowed over his scissors, staring at the wound in concentration as if it was his lifeline. As the last stitch was cut, the older man threw down his instruments on the table and tore his mask off.

‘Put the dressing on and get out of my operating room, before you sabotage anymore of my operations, you worthless excuse.’ He marched out angrily.

The room was quiet. No one said a thing in the last two hours. Including myself. Why? You may ask. Because we were all too afraid, that if the attention was drawn away from the junior doctor, the torrent of abuse would only continue, just at a different target. We knew this from experience. Dr M* was well-known for his vicious disposition. Anger management classes and suspensions did not apply to him, as everyone knew that he was about to become the next Director of Surgical Services. Over the last few years, complaints about him mysteriously got lost, and disgruntled staff members seemed subdued when questioned.

But, it wasn’t the unfairness, or the endless onslaught of malice that shocked me, but the silent tears that were now running into the mask of my younger colleague as he carefully applied the bandages on the wound.

In front of me, was a grown man, reduced to tears.

I knew Peter* well. He was an eager young medical student when I was a first year training resident in surgery. It was an interesting time, with me trying to find my feet as a newbie in surgery while he took everything I did as gospel. Peter was like a curious sponge, everything I taught him, he investigated and researched until he fully understood all there was to know behind each surgical fact.

But that was more than 10 years ago. The man in front of us now was a final year trainee, about to step into the world as a fully qualified surgeon within 3 months. He was a husband to a fellow doctor and a father to 8 year-old twins. What would the children think, if they ever saw their father, standing with his shoulder slumped, his hands shaking, and tears pooling in his mask? It broke my heart. This was a grown man, broken, momentarily, by the maliciousness of another.

Awkardly, I walked over to him. I took the bandages from his limp hands, and I rested my hand on his back.

‘Three months, Peter. Three months. Just hang in there.’

He stared at the floor.

I gave him a gentle shove. ‘Go and write up your operation notes. Grab a coffee. You have another case to go.’

He seemed to gather himself. He took his mask off and swiped at his eyes. He nodded, then looked up. Like all surgical trainees – hard veterans of regular abuse – he reached deep inside himself, found his ultra-thick ‘surgical hide’, and threw it over himself in a protective shroud. Like a magical cape, the despair was suddently erased from Peter’s eyes as if the last 3 hours did not exist. Red rims and puffy eyelids were the only evidence that something may have been amiss. A lop-sided smile broke through. ‘I need something stronger than coffee.’ A self-depreciating laugh followed as he strolled out of the room, looking for all as if he had just accomplished a simple case without a hitch.

It is true that bullying is rife in the field of surgery. It may sound as if I am making excuses, but the stress and pressure can often result in unintended explosions of emotion – which majority of the time, is usually let lose at the most junior person in the room – and never in a positive way. The inferno is often directed at the person least powerful to fight back – which is our trainees or students. They are dependent on their senior surgeons for their assessments and recommendations. Not to mention references for future positions. Surgery is a small world, and a close one.  Reputations have a way of establishing itself as early as one’s training years.

It is such a cliché when I say that it was the way I was ‘brought up’ in the world of surgery, and I honestly believe, it made me tougher. A surgeon need to be able to withstand unforeseen stresses, make snap decisions in dire situations and be able to get on with the next operation even when the previous one has failed. I remember being completely accepting of the fact that when I signed up for surgical training, I was going to get abused, yelled at, bullied, hassled and most likely reduced to tears at the most inconvenient times. I remember the incredulous looks from my non-surgical colleagues when I said (tongue-in-cheek), ‘but there is no such thing as bullying in surgery. It is called teaching.’

I remembere being pulled aside by my mentor in my early years, who tried to warn me about a particular senior surgeon’s bad temper, and his love for torturing trainees with spiteful intimidation. I just shrugged, to her amazement, I was not concerned, ‘Well, the way I see it, is that he doesn’t have to teach me at all, but if he is willing to teach me, even if it’s by humiliation, I am willing to learn.’

Sure. I know I am tough. But I had to be. When I was training in surgery, I was one of the very few females in my specialty. I was determined not to give anyone an excuse to call me a girl – because I was a grown woman, and I was gong to be as good as any grown man around me. Some were harsher with me because they thought I belonged in the kitchen, some were easier on me because they were susceptible to a pretty smile, heels and pencil skirts. Constructive criticisms were given, some verging on bullying, whilst others just needed to be accepted with a stiff upper lip.

Now, don’t get me wrong. I don’t think it is right to teach by abuse, but everyone knows how hard it is for an abused child not to repeat the same life-cycle as his/her parent. I cringe everytime I hear myself say, ‘back in my days…..’

Because back in my days, if a trainee has not looked up an operation the night before the operating list, he would have been sent to the library for the remainder of the list until he knew how to recite the all the procedures back to front. Then, maybe, he may be allowed to hold a scissors and cut the sutures for the senior surgeon.

Despite the long-history of the harsh realities in surgical training, generation change has definitely brought new approaches to teaching. A trainee is like a trade apprentice. Except teaching only knowledge and skill is not enough. The importance of cultivating empathy, integrity, responsbility and collegiality all need to be incorported into the rearing of a good surgeon. And if we start with abusing them, none of these quality will get an opportunity to flourish. Not if their everyday aim was to survive the day without being reduced to tears, or feeling as small as an ant that is just about to be crushed under a surgical boot.

I remember vividly the first advice ever given to me.

You will become a good surgeon if you are a good person, but you aren’t necessarily a good person just because you are a good surgeon. When surgery fails, your integrity is the only thing that will lead you to make the right decisions.

Peter is a good man. He will one day make a great surgeon.

*All names have been changed to ensure confidentiality and protect personal identities.