Seasons of Surgery

Three months of my Surgery rotation are almost entirely behind me. Today I was on the ward jubilantly dancing to my own personal rendition of “Two and a Half Days Left” – if you haven’t heard it yet, don’t worry. It’s on my mixtape. Have a listen.

While a nurse wondered aloud whether I needed loading with Dilantin for my seizure-like activity, I blithely one-man-partied on.

This afternoon I had an epiphany: medicine is all about people.

But what about those five years of complicated biochemistry and endlessly detailed anatomy? Those reminders about evidence-based management and peer-reviewed research? All still relevant. But at the end of the day, what the delivery of health care is about is people.

Effective health care delivery means knowing what what people want.

We have to know what the patient expects from us. “to get better” is not a specific enough answer. It can mean keeping a limb or losing one. It can mean an IV line that never stops dripping, never mind that it’s only infusing normal saline. We have to know our patients.

Radiographers and radiologists are overworked. They know how we warp medical histories in our desperate attempt to get our patients’ done first, they know that sometimes we flat out lie. Yes, sometimes they send back really bad xrays and don’t bother to do the ultrasound for days because the porter only just now got sent for the patient, but getting angry has never solved any problems. They know we need their help, and we have to know when to pull back from all the pushing.

We have to know people.

Pharmacists are understaffed. They wield a lot of power behind their glass windows – second to laughter, medicines are the best medicine. They don’t have a lot of stock to work with either. Half the time, we’re out of this antibiotic or that painkiller. Now we have proton pump inhibitors, now we don’t. It’s like playing peek-a-boo only instead of a friendly face, what pops up is a stomach ulcer.

When we’re frustrated because the patient with a blood clot up the entire length of his leg hasn’t gotten his heparin because it wasn’t sent to the ward, it doesn’t do to yell. Yelling only makes pharmacists crawl behind their glass windows and give us a glass stare. I’m learning to bite back retorts and swallow anger because all it does is take me two steps back. Hopefully PPIs will be in stock by the time I get my stomach ulcer (which should be any day now).

We have to know people like porters. Have to know how to get them to work for you, instead of making them put you to work. Today, I got a patient down to the radiology department without having to accompany them personally for the first time. It was a red letter day, lemme tell you. It took me a dozen phone calls, endless cajoling and three months of saying hi and being friendly for it to happen. (In return, of course, I got a metric tonne of attitude, one “you owe me lunch, doc” and, AND, the results of my patient’s xray and ultrasound thankyouverymuch).

Working in a public hospital is about knowing how to tread around toes and egos, knowing how and who to bribe (always have candy) and knowing how to keep your head down and work hard. There’s a lot of humility and swallowing of pride and a little bit of knowing your limits. (there needs to be more knowing of limits).

It’s great to have someone you can learn from, even if that someone is sometimes yourself and your own mistakes because internship is one hell of a learning experience.

The Biting Wit, the Bitter Cold

It was a laparoscopic hernia repair (bilateral Lichtenstein, if you’re interested) in theatre seven at the UHWI. Late morning in what could be called the winter months but which was really a sunny day in February. The hum of air conditioning set the scene.

When you step into operating theatre, you’re greeted by a temperature drop. That’s fine. Equipment might overheat.

You change into scrubs, grab your shoe covers, cap and mask and trod down to the very last theatre at the end of the drab concrete-coloured row. The paint perks up a little when you hit theatre six but so does the AC.

The AC.

Dante’s Inferno should be rewritten with Frozen’s Elsa in the starring role, because you cannot imagine any kind of hell more intolerable than a cold one. Like the nine circles, you descend through seven unforgiving levels of frigidity. (Theatres one and two are out, you know. Electricity problem. Which puts the recovery room/anaesthesia headquarters a step above purgatory, uncomfortably playing into their established superiority complexes).

You sit on your hands, stick them up your armpits, fail to cover them with your scrub top because there’s always a bit of skin sticking out with hair sticking up. Your fingernails turn blue. You lose focus of the screen with its graspers and scissors and capillaries. At the same time you realize you’re hungry, you realize there are probably a million students in the room and no one will notice if one of you goes missing. One does.

You buy coffee. And a biscuit. You stick your hand out of the change room window to grab at sunlight and get snickered at by a passing porter.

You go back. It’s more tolerable. Minutes pass. Your boyfriend retracts his arms into the body of his shirt straight-jacket style and the short sleeves flap around comically. He keeps offering handshakes. Your bare arms have goosebumps. More time passes. They’re unrolling the mesh now. Then tacking it in. Then suturing the umbilical incision (finally).

“Meet me in the classroom,” says your wavy-haired consultant.

After two tries you all find the classroom and open windows to let the sun in despite the plexiglass that cuts you off from the outside. You stretch your palm out along its transparency but it just feels cold.

When a nurse comes in to turn the AC on, a dozen seniors and half as many juniors screech NO.

“You guys are cold?”

Yes we’re cold.”

“But Dr. Wavy-Hair is hot.”

On cue, Dr. Wavy-Hair walks in. “Your students are cold,” the nurse tells him archly. He surveys you all for a moment over rimless lenses then quips, “Too bad.”

You survive the next hour by sitting on your hands and fantasizing about arson. When you’re finally released you step into the nearest patch of sunlight and press your palms to glass that is actually warm and shiver a bit when a strong breeze passes. You stand there in the sun and you wait and wait and wait for the warmth to reach your bones.

Opining OT

Does anyone else hate OT as much as I do?

We're the guy in the back.
Med students observing in the operating theatre.

I think the operating theatre is one of the worst places to be. As a medical student. Who doesn’t scrub in. (Scrubbing in makes a teensy bit of a difference; you’re too busy retracting to see anything but at least you’re doing something). You can’t see, your feet hurt, your back hurts and you can’t hear a thing the consultant is muttering sotto voce to the scrubbed-and-gowned assistants. (Do they really have to speak so softly? Really?)

To make matters worse, I’m not the least bit interested in surgery. The thought of standing on my feet for hours at a time, elbow deep in some 80 year-olds intestines does not appeal to me. Neither does orthopaedics nor head and neck surgery. Nor cardiothoracic. I do not feel a thrill from excising a ruptured appendix, or resecting a tumour. All I am seeing is backs of heads and patients’ toes while the surgical nurse gives me dirty looks for standing too close to her sterile trolley. Calm down and pass the instruments, would you?

Not everyone’s cut out to be a surgeon, anyway. Some people just like to poke you once or twice and write prescriptions. That’s me: professional poker and prescription writer. It’ll look great on my résumé.