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 BMW Club: Meet the Members

There are four of us. Three surgeons and one surgical assistant. All girls of course.

Once a month we meet up – Saturday early morning cafe breakfast, Sunday boozy brunch, Friday night at the bar, Saturday night at a pole dancing show, Sunday afternoon on a picnic blanket, Thursday night at the football game, you name it, we’ve done it. It is a ritual that has been going on for years between the four of us. It usually starts as a very civilised girls’ outing, then it deterioates into a BMW (Bitching, Moaning and Whining) fest.

About work, people at work, patients, headache cases, bad days, husband/boyfriend/lover, or the lack thereof. And as the drinks start to flow more liberally, the standard of conversation falls to the level of frank, graphic, rude basics.  There would be no subject which was forbidden and no detail that was left out. The aftermath is usually four dolled-up chicks in hysterics, rolling round in their seats, somewhere public.  Think Sex and City – without the airbrushed lens.

Sex and City2

The rules of the meetings were simple: dress up to impress (or to pick-up for the unattached in the group), no male accompaniment, no bitching between each other (but it’s ok to bitch about anyone else),  and if one person pulls out, the ‘meeting’ is cancelled (amazingly has not happened yet, considering that we all work in the field of surgery).

We are not all intimate friends with each other, initially it was a meeting of I-will-bring-my-friend and it-will-be-good-to-catch-up, but over the years, we have become a very close group. It is a group where we can safely discuss all our thoughts, fears and dreams, knowing we can receive honest, and most importantly, non-judgemental advice.

So, Sharon* plonked herself down at the bar next to me, ‘Goddamn patients.’ Obviously one of her patients is giving her grief. I looked at her in surprise, it seems we will be starting the BMW component early today. But then, that’s Sharon. She always sees the negative. If she wasn’t lamenting about her working hours, she was complaining about the patients, or proclaiming doom and gloom about the outcomes. When she’s done with her own misery, she will point out ours, in a sympathetic way, of course. I used to find her constant pessimism tiresome, but then I realised this was the way she needed to unload, because she sure as doesn’t do it at work to the patients.

Sharon is my age. She is tall, and has an eye for upper end designer clothes. Tonight, Her hands and wrists dribbled with BVLGARI jewellery, and her neck supported a Chanel diamond collar. She wore a bright red and gold wrap-around dress from DVF. She is single and lives with her parents. She dots on her nephews and nieces. She has travelled a lot despite a busy practice. She has connections with various famous surgeons around the world and often posts photos on facebook when she has dinners/meetings with each of them. One doesn’t say it out aloud, but we all know she is probably having long distance brief affairs with some of them.

Sharon and I went through surgical training together. We were like sisters, spending our working hours together, then the rest of our time studying together. She slept and ate at our house often and at one stage, our spare bedroom cupboard was filled her clothes and toiletries. We had a lot of fun times and hard times. The worst was when she failed her specialist exams and I had to be her boss for a year. It was hard for her to take clinical orders from me, and there were times when she took liberties which I had to reprimand her for. It really damaged our friendship, and it was because of her, that I decided I would never be ‘friends’ with any trainees and students who were under my team. Being ‘friends’ was detrimental to the ‘chain of command’ especially when it came down to patients whom I was responsible for. That was five years ago. We have since resolved our differences and sunk back to our old comfortable ways.

Sharon is a sophisticated sort. She loves art. She collects them, goes to all the gallery events, and takes art classes. She is also an avid amateur mixologist. She has an encyclopaedia of cocktails on her kitchen shelf with a whole cupboard of equipment, some of which looked questionable in function, but she assured me was for mixing exotic drinks. She regularly experiments on us, some creations went down smoothly like lolly water, others gave us unusual facial expressions which were eternally recorded on our iphones amidst drunken laughter. Once, she made a cocktail which blew our minds, literally, as she got the proportion of Tobasco wrong.  Sharon also loved her fashion, she was into classical fashion, that of Chanel, Gucci, BVLGARI and Prada. She obviously spends enough money at these stores that she regularly graces the social pages of the local news rags at some blah blah season launch.

“Hi Babes.’ That’s Emma*. She is the party-girl. She is on first-name basis with all the restauranteurs, chefs, club owners and bartenders around town. She is on the guest list of every boutique, restuarant, and club opening. She shamelesly name-drops at every opportunity and she can rattle off a description of the latest collection pieces from all the up-and-coming designers.  She is the epitome of all that is chic, trendy, modern and unusual. She wears impossibly high heels and revealing outfits, and that’s at work. Once we were in clinic together, and of my other colleagues looked at her outfit and whispered to me ‘Where’s the disco ball?’ I just laughed, and told him to wait until he’s seen her party outfits.

Tonight, she sashayed in with a tight blue Alexander Wang sheath dress highlighted by a plunging neck, Gianvito Rossi 150mm high pumps and her usual large rectangular cut ‘helicopter-platform’-size sapphire ring on her middle finger. This was her engagement ring. Emma is divorced. Five years ago, her husband (a fellow surgeon) came home one day from work and told her over dinner that he was having an affair with an anaesthetic tech, and that she was having his baby in 6 months’ time. Emma went on a bender then. She started drinking heavily and using crack. She was having an exhaustive series of one-night stands and experimented with various sexual adventures which we didn’t really want to know, but were not spared the details.

She and I have worked closely together for over 7 years. During her divorce, it was a very difficult time for both of us, she turned up to work so high on somedays I have had to send her home. She was reported to the Medical Board by a coworker and was then put on probation. Everyday, she had to be breathlysed, and urine tested before she could commence work. When she wasn’t sober, I had to make her call in sick so that she didn’t have to be tested, because one positive test at work meant being struck off the medical register. During those 18 months, I was carrying the load of two surgeons without a whimper, because I knew, by flying low on the radar, I was holding onto her job for her.

She has since recovered. Sure, she still drank too much on social occasions, and I am sure enjoys a bit of white stuff at some parties, but at least she is now reliable at work and has had a few selected relationships which lasted longer than a weekend. For all her sordid history, Emma is a good surgeon, she’s efficient, decisive and despite her outstanding competency has insight to her limitations. She maybe outspoken, opinionated and bitchy at times, but she has no qualms in standing up for what she believes in.  Unfortunately, she has a talent in attracting bad boys with terrible unresolved baggage and messy relatonships in general.

Many have commented on our unusual friendship, as we are like chalk and cheese with vastly different lifetyles. But Emma is a loyal, protective friend who, for all her bitching, will not say a bad word about those who stuck by her, and looks out for her friends at every turn. She once said to me, ‘You are just too nice, Tiff. You need a friend like me to tell people to f$@# off when they try to pile shit on you.’ And she does. She takes patients who give me grief off my clinic list, and then proceed tell them as it is when she sees them. She rings and tells me to sleep in because she has seen all my preops for the next morning and will get the operating list started for me. When my lists are overbooked, she will take off cases onto her list so that I would finish on time. For all her tough talk and party-girl image, Emma has a marshmellow heart. She lives alone with her dog whom has been lavished wth more luxuries than a baby, including a handmade dog collar, custom-made bed and matching cushions.

‘Where’s Lizzy?’ Emma asked. I frowned. It was not like Lizzy* to be late. She is often the first one to arrive. Lizzy is a surgical assistant with a nursing background, who assists several surgeons in town. She is the one exception I have made about having friends as employees. She works for me once a week as my assistant. Lizzy is the goody-two-shoes in our group. She is conscentious, hardworking and punctual. Although lately, there was a shift in her focus from work to a recent addition in her love-life. Lizzy has been single for many years. She had been quite an overweight girl who was intermittently on various unsuccessful miracle diets. Four years ago, she started personal training, and lost over 20 kg. She admitted to me months afterwards that the impetus which finally made her serious about losing weight was my wedding. The day before the wedding, all four of us were lying on the beach, reading magazines, enjoying cool drinks and having our final BMW club meeting before I was to become the only married woman in the group. Lizzy told me that it was the most disconcerting day for her. Sharon, Emma and I were all confidently lounging around in our bikinis, and according to Lizzy – we looked hot. It made her feel very self-conscious of her own body. It wasn’t that we said anything – in fact – we were all fairly comfortable with Lizzy, as we have always known her to be a big girl. It was then she realised that no one cared if she was fat or skinny, that if she wanted to lose the weight, she needed to do it for herself.

Lizzy started seeing someone 6 months ago. It sounded serious, with lots of sleepovers and talks of buying cars, furniture, looking at properties. Instead of being so focussed on her work, it was good to see her flourish in confidence and love. Lizzy herself will tell you she leads a very ‘boring’ life. She gets up early every morning to train at the gym, goes to work, grocery shops in the afternoon, hangs out at her boyfriend’s apartment most nights watching TV, visits her parents on the weekends and is usually asleep in bed well before 9 o’clock every nights. She is not naive, but she has led a very sheltered life. Although she is easily shocked and grimaces at some of the details we discuss, she always remain non-judgemental, and seemed to be more interested than horrified, especially when Emma starts going off on a tangent with one of her latest ‘adventures’.

Lizzy is a girl who valued friendships. She is the one who always make an effort to keep in touch. She remembers everyone’s birthdays, anniversaries, and anything that you have ever mentioned in conversation. She would ring to check if everything was alright if she knew you were sick, and text to find out if your dentist’s appointment went well. She brought over hot soups when you have a running nose, and offers to help you clean out your garage on weekends.

‘There she is,’Sharon groaned, ‘about bloody time, I am starving.’

On a lower income bracket than the rest of us, Lizzy’s wardrobe consisted mainly of pieces from Zara, H&M, and Cue. She was the queen of coordination, if it wasn’t matching earrings with bracets/necklaces, it was matching shoes, clutch or belt. The colours were always impeccably organised in her outfits. She never wore heels higher than 8 mm, although the youngest, she is also the tallest of the group. Lizzy is also rather well-endowed, and despite her weight loss, nothing shrunk from her chest wall, much to her disgust. Unfortuntely, being surrounded by three others who rely heavily on padded push-up bras, Lizzy’s bosom, at times, was fair game amongst us less fortunate.

‘Sorry, girls.’ Lizzy smiled. She had large sparkling brown eyes framed by sinfully long eyelashes. ‘I got held up.’ She blushed. We all gave her a knowing look.

As it is always the case when we are with Emma, a waiter appeared out of thin air as soon as she raised her hand. The waiter lead us towards the dining room, and sat us down. Champagne glasses were filled and raised.

The glasses clinked as our laughter echoed around the table.

‘Let’s start this meeting.’

 

*names were changed to protect pesonal privacy of individuals