The Myth of being Plastic Fantastic

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

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

*Insert eyeroll*

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

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

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

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

Scenario one:

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

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

Scenario two:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Myth #5 We date our patients

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

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

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

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

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

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

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

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

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

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

What glamorous night life?

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

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

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

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

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

Myth #9 Our practice staff are picked for their looks

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

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

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

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

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

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

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

So here’s my spill:

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

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

 

 

Old Shakey

Doogie Howser2

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

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

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

When am I going to see the real doctor?

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

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

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

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

You are too young to understand my problems

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

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

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

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

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

I want a doctor who is at least my age.

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

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

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

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

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

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

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

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

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

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

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

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

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

 

 

Hospital Fashion

 

*The latest fashion on the hospital corridor catwalk*

The latest fashion on the hospital corridor catwalk

Am I getting old? Am I becoming a prude? Am I behind in the fashion trends? Or am I just jealous? I am totally appalled at the attire of the female interns and medical students these days because I have had enough of skimpy dresses, mini-skirts and porn-star platform stilettos in my clinic and ward rounds. I think it is time for me to be a bitchy old female surgeon and write a fashion rule book for my young novices.

Rule # 1 Cover up

There are many reasons why short skirts and low cut tops are just not very practical when you are a doctor. Basically, there is a lot of bending over to do. In clinics, when you have to examine patients, you are constantly bending over. Now, there’s nothing more humiliating than having your undies on display or having your boobs pop out when you are crouched down to look into a patient’s throat. On the ward, when you are taking blood or putting IV cannulae in, again, you are flexing those hips and putting your bum into the air. Don’t forget, usually there’s somebody right behind you, either it be the person accompanying the patient, another doctor, a nurse or even one of your colleagues to enjoy the view of your derrière hanging out under the hems. As for those puppies in front, it is awfully distracting for everyone concerned not to stare at the deep canyons of your v-neck, or the shadows behind an unbuttoned blouse. Imagination of lies beyond those valleys has an uncanny ability to lure one’s attention. Similarly if you are sitting at the desk, short skirts ride up, and a crotch on view is particularly attention-seeking. If you cross your legs to avoid that scenario, the skirt will move up more, displaying the milky-white flesh of your naked thighs, which have a visually enticing power of their own. You want your patient to actually listen to what you are saying? It would be best if you redirect their captivated interest away from your exposed flesh.

So girls, button up, cover up and let those hems down. You don’t want to give your elderly patients a heart attack or the disinhibited psychiatric client a stiffy. Don’t be surprised if one of the 90-year-old’s in the Dementia ward sneaks his hand up your backside, or a 30-year-old in the trauma unit talk to your boobs. The only place where you are safe to prance around half-naked is in the intensive care unit, where the majority of your patients are unconscious.

Oh, and see-through clothing does not equate to covering up, especially when you wear hot pink lacy bras and thongs under a thin white dress. That’s called beach-wear.

Rule #2 Lycra is not attractive

What is the story these days with squeezing your body into clothes two sizes too small a-la-Kardashian style? Trust me, you can look amazing in fitted, tailored clothing that allows you room to move without having to suck it all in with a rigid sheath that makes you look like the Michelin man when you bend over (see? there’s the bending over again).

Tight clothing doesn’t let you move. You would be surprised at some of the positions you may have to be in when you are a doctor. Contortionists only have to hold a position, but doctors not only have to coil into positions that require expertise in a game of twister, but also perform medical feats at the same time. I had to dress a patient’s foot wound once, squatting on the floor with my head upside down. If you are ever involved in chest compressions on a patient who has collapsed on the floor, those tube skirts may not hold when you kneel over the patient with your legs apart, and the bum-hugging pants may split if you have to hunker down to secure an airway.

Also – trust me on this one – tight clothing does not constitute covering up. It can be rather revealing in faithfully outlining certain parts of your anatomy; visible thong lines, beaming headlights and camel toes are just a few things that come to mind; all of which are seriously distracting in life-and-death conversations.

And if you really think that tight clothing flatters your figure, the names whispered behind your back are usually not as complimentary. Health workers love to give each other nicknames, and I really don’t think you would want to be stuck with Dr Bootylicious in a place where you may want to advance your career in the future.

"You will not be going to clinic in that outfit, young lady!"

“You are NOT going to clinic in that outfit, young lady!”

Rule #3 Wear shoes that will save your feet and your patient’s lives

Tottering on 10 inch heels on a surgical ward round is not attractive, especially when you are trying to balance files, clipboards, gloves and your phone. Unlike physician rounds, surgeons don’t round with file-trolleys that you can lean on, and we also walk really fast, as most of us have to get to the operating theatre or clinic by 8am. So if you can’t keep up in those ridiculous shoes, no one will be slowing down for you.

A survey was done to show that 15-20km was the average distance an intern or resident has to walk during a working day. You will soon learn that one of your jobs is being able to be at 3 places at the same time. When they build hospitals, they usually try to put all the surgical clinics, preadmission clinics, surgical wards, and the operating theatres as far away from each other as possible. They also put in ultra-slow lifts that fits no more than 10 people, so you will find yourself racing up and down the stairs out of necessity. The moral of the story, wear shoes that will save your feet, because you still have a long long long way to walk for the rest of your medical career.

Wear something covered. I know some men have feet fetish and find pedicures irresistible, but having glamorous open sandals will not protect your pretty toes. Imagine walking around with vomit between your toes all day or even slipping on pee as you walk. As doctor, you will also be handling a lot of sharps, and having one of your tootsies stabbed with a fallen needle or nail ripped off by a drug trolley may just make it a rather bad day at work that you could do without.

Most of all, if there is a Code Blue (cardiac arrest), you need to run. Murphy’s Law dictates that the area where your patient has collapsed would be the furthermost place from where you are when it goes off and none of the lifts will be working. So, if you are teetering on your heels, you might as well start making your way straight to the morgue. Because by the time you have staggered down there in your stilettos, the patient would have been declared dead and bundled up into a trolley on his way for a coroner’s review.

*This is what happens when you run on stilettos*

This is what happens when you run on stilettos

Rule #4 Hospital lighting is not kind to heavy makeup

Unlike the romantic, flattering illumination of disco and restaurants, the hospital is brightly lit night and day. Hospital fluorescent bulbs do not give a warm soft glow; instead, they paint your skin in a starkly pale blue shade. It is exceptional for clear vision when one is perusing pages and pages of patient charts and examining every abnormality on a patient’s body. It is also particularly revealing for showing up every imperfection of your skin and each granule of make-up. The thicker you lay it on, the harsher it looks, until those dark eye-shadows and red lipsticks become a portrait of Alice Cooper.

alice cooper

The other thing you will learn is that lengthy days are detrimental to your facial palette. What may begin as seductive thick mascara on eyelashes and carefully layered blue shadows on eyelids will become the makings of a vacant racoon stare after 48 hours on-call. The blush would make its way down from the cheekbones to your nose, so you’ll look like you have a runny nose. While the lipstick will either be completely chewed off or will have migrated onto your teeth. Half of your powder and foundation would have rubbed off, so your forehead will be particularly shiny in the brilliant lighting. Overall, the picture becomes rather unappealing even in a horror movie.

Rule #5 There is a reason why we got rid of white coats

White is a colour reserved for dinners without Spaghetti Bolognese and Chilli Crab. White is suitable if you don’t plan to land on the ground while playing tennis, and it is definitely suitable for your wedding unless you have very clumsy relatives.

If you wear white to the hospital, be prepared for it to be used as a virginal canvas for body-fluid-art. Most colours of organic liquids go very well with white. Poo-brown is an earthy contrast to a pale background, although there can be unpredictability to the exact shade and texture depending on the source. While blood-red is always visually stunning when splashed generously, although the colour does turn coppery if left for long periods. Sputum-Green has just enough shade to make a warm pastel base whereas bile from projectile vomiting tends to veer towards turquoise; Pus-yellow can be used to enhance the warm tone of the overall canvas. The sanguine stain of Urine-gold can be a bit tricky to see on white, but sometimes when there is bleeding in the bladder, hues of Haematuria-rosé are a little bit more noticeable. These are often complimented by regular ink-blots made by the leaking pen that never leaves your hand. The beauty of this art-work is that it is eternal; no amount of scrubbing, baking soda, washing powder or dry cleaning will completely removed these physical mementos of how you acquired them.

"I told you not to wear white if you wanted to shoot people."

“I told you not to wear white if you wanted to go out and shoot people.”

Rule #6 More bling, more bugs

I do understand that these days, fashion is all about accessories. Style is almost entirely judged on how people decorate their outfits, rather than the actual garbs. Well, all I can say that you will just have to accept that doctors cannot be part of the current ‘trend’.

Some hospitals have banned ties for men – as it was found to be the main source of cross-contamination between patients. It was not uncommon to see these ties taking a swipe at patient’s groins, or a dip into a pus-filled wound. Nurses can’t wear bangles, bracelets, and rings, because no amount of hand washing will disinfect these as potential bacterial-carrying vehicles.

So, young female doctors and students, I would advise that you leave your blings, danglies, chains and scarves at home – unless you like being a free taxi for bacteria, or keen to bring your work home, literally.

Rule #7 You are not auditioning for a Shampoo commercial

Meredith Grey drives me nuts. I just don’t understand how anyone could see what they are doing with that mousy hair floating around her face constantly. You might think flicking those luxurious locks on ward rounds is eye-catching, until you accidentally smack it into your senior registrar’s face. Long hair has a lot of perils in hospitals. Like the tie, it can take a dunk into cavities where you may not want it to go. You could inadvertently tickle your patient when you are bending over the patient (there it is again!). It could get caught on bed rails, IV poles, monitoring lines and plaster saws (yep, seen that happen). When you are doing a procedure, hours of preparing a sterile field can be instantly swept away with your hair. Bangs and hair in the eyes can also be detrimental to your vision, which may not be so helpful when you are placing fine stitches or handling fragile body parts.

Tie those loose alluring locks away from your face, ladies – you may find it disadvantageous to your modelling career, but at least it will save your day job.

"Maybe if I cut my hair, people will think I am a real doctor."

“Maybe if I cut my hair, people will think I am a real doctor.”

Now I know these rules are harsh, and I am not aversed keeping up with what’s in vogue. I am as much into the latest trends as the next fashion-conscious female. I am not advocating dressing-down either, as crack-showing skater jeans and ripped off-shoulder T shirts are not exactly confidence-inducing attire for the sick and injured. There are ways to look beautiful without being inappropriate, it is about retaining your individuality in the role you have picked to play in society. You have chosen to become a doctor, not a model, not a tart, and definitely not a hooker.

Just remember, the hospital is not a night-club. You are not going on a date (and if you are, it is rather sad you are having it in a hospital, so get a life!), neither are you selling your ‘wares’, and advertising your ‘goods’. If you are dressing up to snare a rich doctor husband, you would be setting your trap for the wrong kind of men. There are plenty of playboys in the medical faculty, as there is definitely no shortage of male doctors who think they are God’s gift to women. These ‘hot’ charismatic egomaniacs are more interested in the junk in your trunk and the boobies in your bra than your personality. They are more concerned in accumulating notches on their belts, and having available booty-calls on speed-dial, than learning about your aspirations. You would be mistaken if you think by attracting their attention, they will be willing to marry you/help you get the job you want/get you out of trouble/recommend you for a promotion.

I am not suggesting that we should masculinise our appearance, but there are ways of being feminine without flaunting ‘sexuality’, and being gorgeous without over-embellishment. Dressing elegantly in appropriate attire will go a long way to instil confidence in your patients. Your seniors will take you seriously and be more than willing to share their knowledge with you. It will not upset the nurses (who are stuck in unflattering uniforms with colours that make them look like tampon packages), and draw attention away from those higher up the ladder than yourself. And believe it or not, professional dressing will actually make you sound smarter than you really are. You want the men to stop ogling at you; you want them to look at you in awe.

So, Ladies, save your reputation, your career, your feet and your patient’s lives. Next time you pick your apparel for work, channel classics such as Jackie Onassis, Audrey Hepburn and Grace Kelly.

JackieOnassisAudrey HepburnGraceKelly

 

Watch out girls, Dr McDreamy is in Town

A few nights ago, I attended a dinner gala event held for a surgical conference. I sat at a table with a group of surgeons I knew very well, many of whom I have either gone to med school with, or gone through training with. We are a miscellaneous group, with each of us in different surgical specialities. When I went through surgical training, there were very few females, so my table was filled with men, except for two other women who were the wives. Two of my closest friends, Daniel* and Rohan*, sat on each side of me. My husband also sat at the same table, and he knew that back in the days before I met him, Rohan and I had a very brief relationship. Dan was Rohan’s best friend, so he treated me like his baby sister – that was, until he and I started dating when Rohan left me to chase someone else in skirts (yes, yes, it was all a bit complicated). Fortunately, for our friendship, Dan and I realised it was a mistake before it got untidy. My relationships with them made me the envy of other girls in med school. If Grey’s Anatomy was around at the time, these two would have been the epitome of Dr McDreamy and Dr McSteamy.

mcdreamymcsteamy4

Now, most people would have considered our current dinner seating to be an awkward situation, but this is the funny thing about the medical fraternity. A lot of doctors have relationships with each other, some turned out well, some not so well. At some point in our careers, all of us will end up having to work or deal with each other in our profession. And that is the price you pay for having a relationship with another colleague – apart from the wagging tongues of nurses, other doctors and whoever else thinks it’s their business. You learn very quickly, if you are dating colleagues, to separate personal life from working life. Majority of break-ups between doctors end amicably, and being fairly intelligent people, we get over it pretty quickly, because the only way to be professional at work is to clear the air and get on with what’s important.

I have been lucky. Rohan and Daniel patched up their friendship after Dan and I went our separate ways. Although there were some awkwardness moments for couple of months, we all became very close friends, especially after I entered surgical training. When my husband entered the scene as my boyfriend, they also became good friends, so it was not unusual for the boys to hang around our place to watch a football together or for all three of them to go out for a drink after work. Daniel got married four years ago, and his wife is expecting a second baby.

Rohan, on the other hand, is another story altogether.

Rohan was a new cardiothoracic surgical trainee at the time when I was an easily impressionable naïve 2nd year med student. Tall, dark and handsome with startling turquoise eyes, he was pretty much irresistible to women. And he knew it. I was flattered that he paid me any attention, but I was forewarned by the nurses on the ward of his predatory ways. They said he targeted young medical students and interns, and there was not a single young female surgical intern who had been able to resist his charm. He left a trail of broken hearts in every department.

I was determined that I wasn’t to be his next victim. I kept my distance and laughed his invitations off. I pretended not to be affected by his flattery, and concentrated on being diligent with my studies. I tried to impress the seniors on the team with my hard work and knowledge. I stayed in the operating room later than others to watch procedures. One night after a long case, he invited me to share a burger with him downstairs at MacDonald’s. Thinking it was just a casual ‘lets-grab-a-bite’, I agreed. I don’t know whether it was the fatigue or just plain stupidity, the rest was history after that.

The relationship lasted 3 months. Two weeks after I changed from a surgical rotation to a medical one, and left Rohan’s team, he announced that he wanted to date other people. It was a statement, not an invitation for a discussion. Even though I had always known it was coming. I was hurt. I cried on Dan’s shoulder. They were nice broad shoulders and Dan, a neurosurgical trainee, was also tall dark and handsome. And so the story went.

Anyway, back to the dinner. While we were walking towards our table earlier in the evening, my husband commented on the increasing number of female doctors in surgery and how young they looked. He got a jab in the rib from me for his efforts. He teased Rohan that there’ll be plenty of girls for him to chose from during the conference. Dan commented on how short and tight the mini dresses were these days, and I joked that he was not supposed to notice these things now that he was married with 2nd baby on the way. Rohan then mourned the fact that the majority of the girls in short tight sheaths are not of the correct BMI to wear those outfits. My husband chuckled and shook his head as another one in tight short dress wobbled by in her platform heels or ‘stripper heels’ as he fondly called them.

Once we sat down for dinner, we did our usual catch up of what each of us has been up to. Rohan couldn’t resist firing a few digs about Dan’s marital status, as he had always viewed Dan’s marriage as the ultimate betrayal of his loyal wingman. In the meantime, Dan made a few comments about Rohan’s womanising ways, which he now viewed as a one-way dead end to self-destruction. Then both them started launching an avalanche of abuse at my husband across the table for taking the best woman off the ‘meat-market’. (Yes, that would be me preening at the compliment and attention). He returned fire with a friendly retort, ‘hey, you guys had your chance and screwed it up.’

It wasn’t long after we had our entrees before various young female doctors started to approach our table. They stopped by ‘just to say hi’ to Rohan. He, of course, lapped it up like a cat with a bowl of fresh cream. Daniel was getting his share, but he knew better than to misbehave since his wife (who was back at hotel with the baby) is an anaesthetist. For those who are unfamiliar with the socialisation of the surgical fraternity, anaesthetists have nothing to do during the operation except talk, or surf the net (apart from keeping the patients alive, of course), so they are like the accelerators on the gossip grapevine. The best source of juicy updates on any surgeon’s personal life came from the anaesthetists; they often work with several surgeons, so the sources are usually reliable.  Dan knew if he was up to no good, she would be the first to know. Meanwhile, I was busy watching these young nubile things walk around the table to stop by my husband’s seat and his oh-so-friendly smile at their sweet-talking.

‘Stop snarling, Tiff.’ Dan chuckled next me. He only laughed harder when I denied it. ‘If looks can burn, those girls would be needing skin grafts by now.’ I reluctant looked away and tried to stop grinding my teeth. To distract myself, I started watching Rohan’s interactions with his swarm of admirers. Dan and I started a commentary on each.

‘Nah, too short,’ I said. ‘Look at how high those heels are.’ I really was just jealous at the fact that she could actually walk in them.

‘He doesn’t mind the short ones.’ Dan said, ‘Not one of his rules.’

Oh Yes. Rohan’s rules. We knew them well.

Rule Number One: Don’t sleep with nurses. According to Rohan, sleeping with nurses is like sleeping with the enemy. Once you do it, you will fall under their influence and rule. It was not to be done.

Rule Number Two: Don’t sleep with anyone in your own department. This is pretty self-explanatory, according to Rohan, it’s like shitting in your own backyard. Break-ups can make your life hell and one should never mix business with pleasure.

Rule Number Three: The size of her butt must fit the bum scale. So, he is discriminating against large girls. The bum scale is basically the width of two hand-spans (his hands of course). Sometimes I catch him holding up his hands – spreaded to check the width of some random girl’s butt size. Luckily, he has very big hands that wear size 8 gloves, so there was a good deal of girls who fit the bill.

Rule Number Four: No older women and anyone within 5 years of his age. Mature women want relationships, marriages and babies. It wasn’t for him, and he hated expectations. He wasn’t into mature women (which I pointed out meant he wasn’t mature enough to handle them.) He blithely agreed and continued on.

Rule Number Five: The younger the better. I asked him once if there was a limit (apart from the legal one of course). He said that the youngest ethically acceptable age would be his age divided by 2 plus 7. So basically (he’s 40), the youngest for him would be 27. I have no idea where he got that from, but I shudder to think that when he is 60, he’ll be chatting up 37 year olds! His response to my skepticism was ‘You are only as old as the woman you feel.’

I know he sounds despicable and is obviously an incorrigible womaniser, but Rohan is not a bad person. He has a good heart and goes out of his way for others. He is always clear to the girls he dated that he was not into relationships of any sort. He never lies, and doesn’t mistreat women. He always lavishes affection and attention on the girl of the moment. He is loving and generous, and never holds a grudge. He is kind and loyal to his friends. He makes people laugh, and is surprisingly dependable in times of need. I have watched him stand up for a bullied upset junior doctor against another surgeon once. The junior doctor was one of his many past conquests.

I once asked him why he asked me out when I was a med student, since I didn’t fit all the rules. I had always suspected it was because I turned him down so many times. He said that truthfully, he didn’t know, but he was in awe of my work ethic and intrigued by the fact that he enjoyed having long conversations with me. I guess he had never dated girls for their conversation skills before me. He told me: ‘You were my one exception.’ Awwww.

‘Oh Shit,’ Dan tapped me on the shoulder. ‘He is going in for the kill.’

I realised suddenly that Rohan had his head bent down way too close to a young lady crouched beside his chair. His hand had moved up to her shoulder. He complimented her on her outfit, a tight sheath which enhanced her perfectly athletic BMI. I sighed in resignation. Dan leaned over me, trying to catch their conversation.

‘If you are not doing anything after the dinner, can I take you out for a drink?’

Dan and I burst into laughter. At the confused look on the young girl’s face and Rohan’s warning growl, we both put on our most innocent butter-won’t-melt-in-our-mouth smiles on, and directed our attention back to the baked red grouper in lemon sauce and mango salsa.

Watch out girls, Dr McDreamy is in town.

Just a bit more eye candy for my readers.

Just a bit more eye candy for my readers.

* names have been changed to protect privacy of individuals