Old Shakey

Doogie Howser2

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

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

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

When am I going to see the real doctor?

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

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

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

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

You are too young to understand my problems

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

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

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

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

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

I want a doctor who is at least my age.

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

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

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

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

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

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

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

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

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

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

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

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

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

 

 

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.

Speech to the Wannabes

Good evening. Thank you for giving me the opportunity to speak. I remember sitting in those very seats you are in now, back in the days when I was a medical student like yourselves.

I was asked two weeks ago, by your faculty Dean to give a talk to you all, on why I chose to do Surgery.

I thought very hard about it, maybe too hard. I thought of all the clichés I should throw in, like it’s satisfying, it’s challenging, it’s interesting. But what field in Medicine isn’t? Somedays, I catch myself envying my colleagues in their jobs, and somedays I walk away from a problem, glad I didn’t have to deal with it.  There are days I am appreciated by others for what I do, and there are days when I am belittled and teased about what I can’t comprehend as a surgeon.

So I have decided that, today, I will tell you why I chose not to do anything else.

I don’t think I could ever be a radiologist. I am afraid of the dark. In surgery, I am always working in a well-lit room. In fact, people around me will always move the light so that it is directed at me and my work. The operative lights are powerful, and for someone who loves being the centre of attention, I am constantly in the spot light.

I could never be a pathologist. They deal with dead people, or bits of tissue (which are also dead) removed from the body. I like to work with living people and living tissue. I also like the skills I possess to revive them under certain circumstances. I am sure findng the cause of death or disease is satisfying for the pathologists, but I figured that finding the cause and being able to fix it, is even more gratifying.

I would find it hard to be an anaesthestist, because then I would end up spending the majority of my time with people who are asleep. I already do that when I get home late from work, although occasionally I do get a grunt or two when I tell my husband about my day while he is slumbering. I am not very good at crosswords and sudoku either. I think if I had to sit there, listening to the steady beep, beep, beep for hours, staring at the squiggly lines on the screen, I’d find it hard to stay awake. Worse still, if I was an anaesthetist, I will have to stand there and be a spectator while the really exciting gory stuff is happening on the other side of the drapes. That’s just not me. I’d rather be the loud conquering hero, elbow deep in blood, than the quiet achiever behind the scenes.

I might have be tempted to become an Emergency physician. TV dramas always project them as exciting heroes, with challenges where they can save lives.  But when I did my ED term as an intern, I realised that these dramatic moments come rarely (which I guess is actualy a good thing). I spent plenty of my time in ED admitting little old ladies with pneumonia and falls, stitching up aftermath of drunken brawls, and sedating IV drug users whilst trying not to get spat at. Sometimes I think it’s awesome that the emergency doctors do shifts. That when they leave work, they don’t really carry further clnical responsbilities because they have ‘handed-over’ to the next doctor. I also found it frustrating, because I never found out what really happened to that 40 year-old man who came with babushka dolls in his rectum, as seen on his abodminal x-ray (because he fell on them, so he said). I felt like a traffic director because the responsibility ended when the patient has been referred on to the appropriate speciality for further management. So I never knew what was done to treat them, or if I even got the diagnosis right in the first place.

I don’t have the strength to be an Oncologist. It is probably one of the very few specialties where the doctor deliberately harm the patient with poisons, in the hope that it will treat or hold their cancers at bay. For the few that are saved, many benefit from prolonged lives, which sometimes, are accompanied by suffering. I think if I was an oncologist, I will have to be comfortable with the concept of Death. This would be hard, because in many fields of Medicine, death is viewed as a failure of the doctor’s abilities, even when we know there is nothing that can be done. I like successes, and I take failures too personally. I would not last in Oncology.

I love Paediatrics. It’s the parents I can’t deal with. There were days when I did paediatrics that I was tempted to prescribe sedatives for the parents, and gave my little patients vitamin C pills (also known as placebo for children), just so that the parents felt that I was doing something for their child. Dealing with babies, is like vetenary medicine. If the child doesn’t bark (cry), play, eat or poop, one had to figure out what is wrong with it, sometimes with almost no lead to follow. I am not that smart, I like my patients to tell me what’s wrong and what they want. And I need clues like sledgehammers.

I am a planner – my life is planned down to 15-minute blocks. Obstetrics would wreck havoc with my mental stability. Babies never book an appointment to appear. They come when they are ready, or sometimes, even when they are not ready. They also don’t book the length of their appointments, some want only half an hour and the others take their sweet time in getting to the point. Getting up at 2am to extract inconsiderate babies and performing an emergency caesarean to facilitate their wish to exit via the sun-roof, does not sit well with my planning tendencies. No, obstetrics would definitely antagonise the control freak in me.

I think General Practictioners are important. Family doctors are the crux of all communities and health systems, and they are family to many patients. They deal anything from simple cough and colds to complex medical dilemmas. Their knowledge has to be so broad as to include all possibilities in medicine. They also have to think about their patient’s social situations, and almost take on the role of a social worker. I have neither the acumen for broad general knowledge (I am always the weakest link on quiz nights) or the patience for complex social situations (I have serious foot-in-the-mouth syndrome), so I think I would score an epic fail in family medicine.  I know just about everything in my little specialty corner amongst the big wide world of medicine – so I think I will stick to what I know.

I can deal with a lot of gory things, like chopped off fingers, haemorrhage and fungating tumours, but there are a few things that make me gag. Phlegm and Mucous. I guess that ruled out respiratory medicine for me. Collecting and looking at gooey bubbly mucous in collecting pots brought bile to my throat. Subconsciously, whenever I hear a very fruity cough, I hold my breath to push down my gag reflex. I admire those who deliberately seek out rattling mucous in patient’s lungs with their stethoscopes. Ergh.

Physicians are smart. Like Sheldon in Big Bang Theory. Comprehending complex medical problems, working out multiple drug-interactions and ordering the right tests to solve confusing symptoms seem like second nature to them. They can’t fathom why anyone else haven’t worked it out yet and the looks of incredulous disbelief (or disdain) when a question is asked, is part of their usual demeanor. And yet, for all that incredible intellect, they are pathetic mechanics. They don’t seem to be able to grasp the physical aspects of the human body nor the common sense of surgically removing the cause of a problem.  Don’t ever try to quiz a physician on anatomy. They do know a lung, stomach or the brain when they see one, and they do know the rough whereabouts these organs lie, but they’d be hard pressed to know the origin and route of every blood and nerve supplies. Some even turn pale at the sight of blood, and becomes completely useless when anything remotely looking like a surgical instrument is placed in their hands. My mind is not geared like a physicist or mathematician. I cannot think like a physician. I don’t have the patience to wait and see whether a drug I have prescribed is going to work or not. I would much rather do something active about it. Even then, after surgery, I usually can’t wait for the patients to wake up and let me know if they feel better.

By now, you might think if I wasn’t committed to the world of insane, I would make a good psychiatrist. Wrong. I have lots of time for shrinks. In fact, I have spent a lot of time with mine. I remember thinking, as I went on and on about the stresses of my work and how pathetic I feel, painfully dragging it out into a full hour, why anyone would spend day after day listen to people whine about their problems. In fact, what was even more frustrating, was the fact that there was nothing he could do about my situation. He couldn’t make my bullying colleague stay away from me; he couldn’t tell the crazy patient to stop hassling me; he couldn’t give me two months’ worth of salary so I could take a holiday; nor could he try and change my husband into a domestic goddess. He was a sounding board, someone to make me see a different perspective of my life, and occasionally, fiddle with my medication. He has always told me that I would not get better, or cope with life, until I have decided that I can and  I will. I would find being a shrink so frustrating, because I cannot control how my patient feels, change their situations and be able to actively do something to help. For this one, I think I’d rather stick to my role as a patient.

Please don’t think I am bashing other specialities. In fact, I admire all my colleagues, and at times, I envy them. Because I know I can’t do what they do. But if you want a straight answer to why I chose surgery, here it is.

It is because I love it. I can make a difference in people’s lives, I find what I do exciting, and I know I can do it well.

But this is what every doctor will tell you about their specialty.

Don’t just chose surgery when you grow up, chose something that excites you and something that you are passionate about.

And if that happens to be Surgery. Then you have great taste. Like me.