Saturday, October 25, 2008
i'm not the brightest. pregrad took a lot of studying just to scrape by. surgery nearly caused pressure sores on my butt. so i always assumed i was fairly low down on the surgical iq pecking order. we at pretoria knew we could operate better than most of the other universities, but how could we compare to a place like uct (cape town). those guys we knew didn't nearly get our operative exposure. we just assumed they used all that extra time cracking the books.
i remember a registrar's symposium i went to where they presented. at some stage a zim registrar asked a pretty poor question. the uct guys answered, but the zimbo wouldn't accept their answer (mugabe-like???). the uct guy calmly pulled the mike forward and said,
"i suggest you go back to your books!" i was impressed. i knew the zim guy was clueless but i couldn't quote chapter and page to allow me to throw the book at him like that. i really thought that the uct guys were super clever.
a few years later the international surgery conference was held in durban, south africa. we all went. i decided i'd try to get to know the uct guys better. it's always good to make friends. but i also wanted to get a chance to grade them myself.
as could be expected from capetownians, they weren't too keen on this pretoria boy in their presence and they made it pretty hard for me to get to know them. at a stage, as surgeons tend to do, some of them were sharing surgical stories. i noticed they all ended in 'and then i phoned the consultant.' well i had stories and mine didn't end like that. so i told one.
it was a midnight blunt abdominal trauma that ended in a liver resection. (truth be told the impact with the truck out there on the street had pretty much handled the resection. i just needed to tidy up a bit.) they were astounded. no consultant? i did it alone? we do that sort of thing in pretoria? and such questions.
i felt better. even if i wasn't as clever as they were i could at least operate. i had been trained to make the crucial decision at the crucial moment without needing to rely on backup.
a few days later they were once again telling their stories, but this time they had one of their consultants there. it seems one of them opened an abdomen because his junior had put the patient on the list and the diagnosis turned out to be something unexpected. my first thought was that where i come from there is no way the primary surgeon wouldn't have made the decision to operate himself. i admit i felt superior.
the uct registrar described his shock at discovering the actual diagnosis, something that is first approached non-operatively. only when this fails is surgery considered. he phoned his consultant, the guy sitting with us.
the consultant advised closing and reverting to the non-operative management. i piped in.
"but you had the abdomen open. i agree with the non-operative approach, but you're there with the abdomen already open. fix the problem with a knife." they all looked at me. the consultant asked,
"how?" i was a bit surprised. but i told him how. the registrar who was telling the story said that he didn't know how to do what i'd just said. again i was surprised.
"you do know how now. i've just told you how. you just need to do it."
they all shifted uneasily in their chairs. they didn't have the charge-in-where-angels-fear-to-tread attitude that the pretoria guys had. to argue the practicalities of an operation with a pretoria guy was not going to work. it was time for plan b.
"well i've never seen that operation in my books. maybe you should go back to the books." it was the same line that i'd heard them use years before. i was a bit confused because i had read this operation in a book. i'd actually seen it in a few books. but they were uct registrars and i doubted myself suddenly. i knew we could out operate them, but if they said that it was not in the books in the presence of a consultant and he agreed, then maybe i was wrong. i kept quiet.
that night i opened my book, the latest sabiston and sure enough, my operation was there described just as i had said.
i didn't go back to them to point out that i was right. it seemed too petty and vindictive. i just reminded myself that despite the way i felt about my spartan-type training, it was actually good and academically sound. i would never feel inferior to the uct guys again.