Thursday, July 19, 2007

in the deep end

when i started surgery it was just after the government's unfreezing of training posts. (they put a hold on things they thought weren't so important, like training surgeons). the result was there weren't too many senior guys. i was thrown in at the deep end. i have already sort of discussed this in m&m earlier this year. but suffice to say i got used to going for it and hoping for the best. when there is no backup, then you are the best chance the patient has. no use whining. get on with the job. i also tended to throw my juniors in the deep end. the one difference is i was always available to bail them out.

i had been consulted by the physicians to do a lymph node biopsy. one of my students, who showed incredible surgical acumen, came with me. i held his hand through the procedure. it was straight forward and all went well. at this point let me mention that it is pretty unusual for students to do these types of procedures. in fact, this particular student was the only one in all my years of training that did an appendisectomy, with my assistance of course.

about a week later, again i get consulted to take out a lymph node. i tell the same student to do it and sommer (afrikaans word not easily translated here) teach his colleague how to do it. i say i'll be in the tea room, so they can call. off they go. my plan was to give them time to get into it and check up on them anyway. thus they would be able to feel a certain amount of confidence but i would still make sure everything worked out.

about half an hour later, the phone rings. someone answers and says it's for me. without answering the phone i jump up and start running for the ward where they are working, as i charge up the stairs, a colleague and i almost collide, he stops me.
"do you know your students are taking out a lymph node up there?"
"yes." i reply, "i told them to!" i was trying to sound in charge, but wondering if all hell had already broken loose. i would be the one to take final responsibility. a strolled on until my colleague was out of sight. then i bolted again.

i came into the ward. there were two students, both white as sheets. there was a modest puddle of blood on the bed. bearing in mind how pale the students were i wondered if it was their blood and not the patients. the one was picking away at a very superficial cut in the neck. i asked the one i'd taught the previous week how things were going. his face was a picture of terror. his eyes were pleeding for me to bail him out, yet in a clear steady voice (remembering the patient was awake) he calmly said,
"we're struggeling a bit. i wonder if you could maybe help?" i wanted to laugh.
"sure!" i replied. " slightly more difficult than the previous one?"
"decidedly!!" was his response. yet his eyes and his body language made me realise that that was the mother of all euphamisms. then i nearly did laugh.

i realised what had happened. they had been going at it to the best of their ability. my colleague had walked in. he is the prototypical surgeon. thus and therefore he had let them have it, cutting into them with his sharp tongue. the one i had taught the previous week admirably stood his ground, using my name in his defence. my colleague had come rushing down to confront me. this exchange more than surgical trouble had made them phone for backup. the confidence that i was trying to instill in the student that he could handle any situation had been shot to blazes by my bombastic colleague.

still, it made for a pretty good laugh.

i understand the student in question went into anaesthetics.


Anonymous said...

The student was lucky to have you for a mentor, even if it was only for a short while.

Are most surgeons as puffed up as your colleague?

Bongi said...

surgeons are typically bombastic and arrogant. often they are aloof etc. probably something to do with their type a personalities. also possibly due to dealing with people dying so often or a general feeling of superiority. whatever the reason, there is no excuse in my opinion for elevating yourself above another human being or treating someone with anything less than the respect you would like.

Anonymous said...

Hi Bongi,
This is my first visit to your blog and I enjoyed reading your posts. :-) I'm adding you to my blog roll. Thanks! All the best!

Bongi said...

thank you story.

Anonymous said...

LOL, I'd have been pale like that (maybe even fainted) at the first site of blood.

I really admire you guys who fix the others up again, coz its gotta be hard!

Jeffrey Parks MD FACS said...

Nothing prepares you for the first time you do a case without the reassuring presence of an experienced attending looking over your shoulder. The simplest cases turn into complicated, harrowing moments of chaos as you try to keep your cool. The little things, how to place a retractor, finding the right tissue plane, can't be taught. I always admired attendings who allowed trainees a little leeway, let you progress to the point where you can't go any further. And then a little further the next case.

Bongi said...

buckeye, some day i think i should blog about our training. i was seldom taught anything by a consultant (attendant). i was taught almost everything from seniour registrars (kliniese assistente) or i sort of figured it out on my own. maybe i'll blog about it some time to keep this comment short.

Jane said...

I know 3 surgeons, none are my friends and all think they're diplomas gives them some kind of God-given power.

None to say that they all have close to no life and are happy with themselves; I completely agree with what you have to say.

Will come back.

make mine trauma said...

What an exhilerating and terrifying way to learn how to operate! I'm guessing that in the end, you have become a better surgeon for it.

Bongi said...

makeminetrauma, yes.
i always used to say to people considering studying surgery at our university that the bad thing about studying there is they throw you in the deep end and you must swim. the good thing about it is they throw you in the deep end and you must swim.

DrCris said...

One of my first supervising surgeons let me do a bowel resection on a crumbly patient with liver disease, who eventually died (under his supervision). He got so much grief from other surgeons, but always defended his decision to let me do it. I always appreciated it, and I remember that case and its lessons forever - I will never underestimate liver disease again.

As to surgeons being arrogant, I think it comes down to the fact that there is no right and wrong (to a degree) in surgery. Everyone just ahs to depend what they choose to do, and the technique they use. It makes you focus a lot more on your own abilities, and choices. And if you have issue with a colleague it becomes "I wouldn't do it like that" instead of "That is the wrong thing to do." It automoatically makes you seem arrogant.

Mind you, some surgeons are simply arrogant.