Friday, May 29, 2009

suboptimal


recently i did a submandibular gland excision. i always find them challenging. i think i know why though.

i was no longer a junior registrar but i still had a long way to go. i had just been rotated to kalafong and it was my first theater list, a list that had been booked by my predecessor and one i therefore did not know. my consultant knew me from a few years before when i had worked in his firm as a junior registrar. as much as he was able to actually have human feelings, i think he almost liked me.

i assisted the first case with the consultant operating. it annoyed me a bit but i assumed he hadn't worked with me for a while and wanted me to get my eye in before he entrusted the knife to me. when he once again took the prime position in the second operation i started wondering if i was to get any operating time in his firm. what could i do?

after the second operation my boss turned to me.
"just a mastectomy and a submandibular gland excision left. have you ever done a submandibular gland?"
"no." i answered truthfully.
"have you ever seen one done?"
"only once when i was a fifth year medical student, so it hardly counts."
"i'll give you a very good article describing the technique."
and with that he turned and left.

it was kalafong so he returned long before we got the mastectomy patient on the table. he handed me the article, which he had fetched from his study, told me i'd be fine, and left.

great. i had to somehow quickly read the article between the mastectomy and the submandibular gland and then do the operation with only theoretical backing. i tried to swallow hard, but, in sympathy with the patient's soon to be excised salivary gland, my own salivary glands had simply stopped working. my mouth was suddenly very dry.

so i did the only thing i could. i cut out the offending gland, more or less how the article suggested i should. but somehow to this day, whenever i am asked to do a submandibular gland, my adrenal glands tend to contract a little bit when i think back to my first one.

7 comments:

rlbates said...

I'm sure you did well though as you are a good surgeon. You had the basic skills needed, just got thrown in .......

amanzimtoti said...

I really respect the no fear/ tread-where-angels-fear-to-tread attitude you have. It's inspiring.

The Hippocratic Oaf said...

Whoa, thrown in the deep end there?!

elaz said...

Yeah, the first and most important rule I ever learnt in med school was: "anything can be faked".

Travis said...

Hi Dr Bongi.
I must say I always thoroughly enjoy reading your blogs, I have been doing so for the past few weeks. I've been reading a lot of your older blogs too and I must say they quite addictive!

I'm currently in matric and planning on studying medicine next year and hopefully later specialising in some form of surgery. Your blogs give me great insight into the profession and I really admire your selflessness. You are truly a role-model to me and any other aspiring doctors! Keep up the great work!

Bongi said...

oaf, standard for our type of training.

travis, thanks for your kind words.

Anonymous said...

Your narrative gave me a tickle at 1am...;)

-rsefel