Sunday, April 17, 2011

covert operations

the consultants didn't always need to know what was happening on the floor. but sometimes keeping things away from them became downright clandestine.

i was a senior registrar at kalafong (hell). an old friend of mine had just taken up a post as consultant in the department of internal medicine. one day he approached me.

"bongi, what are the chances you can do the occasional open lung biopsy for me?" now there was no thoracic department in kalafong so it seemed to me to be a reasonable request. in fact i was quite excited. it would give me a chance to do a few thoracotomies, something us general surgeons don't do all that regularly.

"sure! anytime. just let me know and i'll book them on my list."

"uhmmm, there is just one small problem," he continued, "i've already asked your consultant when the previous registrar was here and he bluntly refused, so i suppose you would need to convince him." this was no small problem. my consultant tended to be a bit hard headed and i knew if he had already decided, then there would be no convincing him. if i were to ask his permission he would refuse and that would be the end of it. if i just went ahead at least i could claim ignorance, that is until he catches me out. there was only one thing for it.

"ok, i'll do it on one condition. at no point must you discuss the matter again with my consultant. everything must go through me." and so it was arranged.

a short while later the internist approached me with the first patient he wanted a piece of lung from. i took her name down and booked her on the back of my list. i then re-wrote the list, carefully omitting her name and took it to my consultant. we went through the somewhat abbreviated list together. he was happy. i didn't want to be the one to erode that fragile joy.

halfway through the theater list, as was his habit, my consultant asked me if i'd be able to handle the rest and went back to his office. i assured him i had everything under control and sent him on his way.

the thoracotomy went well and the hiding of the patient from the consultant in the ward for the next few days also went well. i was feeling good. i suppose i knew it couldn't last.

two more thoracotomies were pulled off in similar fashion. and then we prepared for the whole charade for the next one. again i put the patient on the list and again i discussed the abbreviated list with my consultant the day before. again everything looked good. i went home, looking forward to a great list culminating in a nice thoracotomy to obtain a piece of lung for my internist friend. but this time something went wrong.

how was i to know that my consultant decided to pass by theater that evening before he went home to check something on the list? how was i to know that he discovered my thoracotomy that until then he knew nothing about? how was i to know that when i walked into the morning meeting i was walking into a fire fight?

the consultant was clearly angry. before the meeting he called me over and asked me why there was a thoracotomy on the list that he knew nothing about. i told him the internist had asked for a lung biopsy and i had added the patient because we had some extra time on the list. he went mad (or slightly more mad). leaving no room for any misunderstanding he informed me, with much frothing at the mouth, that there would be no thoracotomies on his list....not now....not ever. i apologized. i thought that was the end of it. i was wrong.

after the meeting the prof asked if there were any announcements. my consultant raised his hand. it was so unusual for him to say anything during the morning meeting because of a certain amount of animosity between him and the prof that everyone sat up and paid attention. he then moved to the front of the room.

"it has come to my attention that bongi has been doing thoracotomies on my lists." he started. "now if this ever happens again i give you my word that i will personally see to it that the guilty party is put up against the wall in front of a firing squad and he will be executed! we will reinstate public executions here in kalafong. we will make it compulsory for all the registrars to attend so they can see what will happen to them if they step out of line. if he wants he can have a blindfold, or he can go without, but he will be executed. the registrars watching will not be permitted to use blindfolds."

i considered the question of the blindfold, but in the end i decided to rather stop doing the thoracotomies.


Renate said...

Sheesh, that's kinda harsh! He really said that? With a straight face?

Linda Pourmassina, MD said...

Thanks for another interesting story and for more insight into YOUR world of medicine, which is dramatically different from mine (in the U.S.).

Question: What would happen to patients who "needed" lung biopsies if thoracic surgeons were unavailable and you weren't allowed to do them?

Danger Boy said...

Wow, that's a heck of a temper on that guy. Glad you made it out of there in one piece!

Rathskeller said...

... but, why?

Was this all ego? Why would he care so intensely?

Wreckless Euroafrican said...

Not being in the medical field, i have no idea why ths=is procedure would be done? Even less can I understand why it would not be allowed/ I am South African, and know and understand the difficulties of medicine in our country, and as far as i am concerned, if the time and facilities allow for it, any / all surgical operations should be conducted in the best interests of the patients.
But then that's just me.
Thanks for the excellent write ups!