Saturday, November 05, 2011

gatekeeper



i am somewhat known for not knowing when to keep my mouth shut. but, fortunately for me i once managed to put a watch in front of my mouth, but only just in time.

i was on rotation just before intermediate exams. this was a difficult time when generally you had to make sure you didn't make enemies in other departments. you always ran the risk that the guys you irritated would be in the exam or write a scathing report to your own prof. then, no matter how well you knew your work, you would not get through. it's just the way things were.

interestingly enough the obstetric and gynaecology department stood apart from all other surgical disciplines. for many years they had not done the rotation and therefore did not write the intermediate exams common to all the rest of us. other than the fact that this meant that they didn't share with us the burden of running the icu department (which they did use, however) it also meant that they could be very narrow minded. they didn't have an overall knowledge of physiology and the management of acutely sick patients. to them a patient was simply a vagina and a uterus of varying size, with or without a bun in the oven. in short, the rest of us thought of them as lazy and stupid.

i was on call in the icu at kalafong (hell). the way things worked there is we all knew all the patients in the finest detail. on a call day that knowledge was absolute. we could recite the finest details of any patient under our care in an instant. so late that afternoon when i walked into icu and saw the prof of obstetrics standing at the bed of one of my patients who we were treating with severe pre-eclampsia and hellp syndrome with his entire entourage i immediately walked towards them to answer any questions they might have.

as i approached i remembered that prof from my pre-grad days. we used to call him red beard which was some sort of a reference to a scary pirate, but more a comment on his interesting choice of facial hair. he always seemed to try to intimidate and to be honest i think we were all scared of him. looking at him now i couldn't understand that anyone could be scared of an obstetric prof. thinking back it seemed to me that his so called intimidation tactics were no more than posturing. he must have been trying to hide something. i walked up the the group of gynaecologists milling around my patient.

"hello prof." i greeted.

"oh, are you in charge here?" he asked looking up at me. i could see his underlings shifting uneasily. maybe he still had the power to intimidate them.

"yes prof, i am." i smiled in what i thought was a friendly, disarming way. i readied myself to help them with any and all questions they might have. after all there was absolutely nothing about the patient that was not at the tip of my fingers.

"good, because we are trying to make head or tail of what is going on here." simultaneously a few things happened. firstly i realized he was not going to lower himself to the point of actually asking me anything in front of his hordes. secondly, right there i decided that i would not be intimidated by what i now saw as the posturings of an old sad man. i stepped, back and folded my arms. secretly i enjoyed watching him struggle and flounder as he went through the patient notes. lastly the perfect sentence popped into my mind. by some miracle i actually kept my mouth shut and did not actually say.

"of course you are prof. after all the only thing more stupid than a gynaecologist is an obstetrician."


9 comments:

Ruth said...

Thanks for starting my day off with a laugh! I know how difficult your job is, yet you manage to find humor in almost every situation. Thank you!

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Tony

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DA said...

Bongi,

I must say, I have been reading your blog intermittently over the last couple of years and find it both well written and highly entertaining. However, I find this post somewhat offensive. As a gynecologist, during my training, I heard this all before from "real" surgeons. Unfortunately, your comments hold true for some in our specialty; however, you shouldn't generalize as others of us do manage our ICU patients and perform a wide variety of surgeries (bowel, bladder, pelvic reconstruction, upper abdominal, etc).

Just wanted to throw in my two cents...otherwise, keep up the entertaining posts.

Bongi said...

da, i am very happy you commented because you are right. like all generalisations this is only partly true. these days i work with very competent gynaes.

the post speaks of a time during training when we did despise the gynaes, specifically of our university (not all gynaes worldwide). it had a lot to do with the arrogance filtering down from their stupid (yet technically brilliant) prof. the fact that their prof refused to let his underlings rotate, thereby robbing from them the opportunity to better their knowledge, with specific reference to icu, did nothing to improve our opinion of them.

in the end i acknowledge that this post does generalise more than it should and thank you for giving balance with your comment. but at that time in my career that is what i felt (since then my opinions have changed quite a bit) and the incident that i describe happened, even if it does paint me in a somewhat unflattering light. i do try to be true to what goes on even if it does reflect badly on me.

i hope my reply finds you well. thank you for your compliments reguarding my writings.

DA said...

Bongi,

Thanks for the reply. No worries. Unfortunately, most gyn training programs do not offer the opportunity to rotate through the ICU which, as you appropriately commented, is definitely an opportunity missed. And even more unfortunate, this is generally accepted as OK or preferred by trainees. I assume gyn training is similar in South Africa as in the US where ob/gyn is joined together. For someone who plans to do absolutely zero (at at least very limited) obstetrics (such as gyn oncologists), it would be nice to have the option to do rotations with other surgical services.

Thanks again for your reply. Looking forward to reading more of your posts.