Wednesday, June 16, 2010


as a registrar i made sure there was no one in my firm who worked harder than me. i would arrive early and leave late and would generally see everyone myself, not leaving it to the house doctor or students. that way when they complained about how hard you had to work in surgery i could justifiably tell them to suck it up and get on with the job. i say generally because there was one glaring and even shocking exception to this rule.

the vascular rotation was the busiest, bar none. there were two of us in the firm so we ended up on call every second night and the calls could get quite tough. one single vascular emergency could destroy your circadian rhythm. yet if there was only one we would boast about the three hours sleep we had managed to get. in that time we considered that more rest than we knew what to do with. the other problem was we had no house doctor so our days tended to get quite busy with all the administrative tasks that were needed to get things running smoothly. so after being there for a few months my enthusiasm for long hours had somewhat diminished.

then suddenly there was an extra house doctor in the department and in a moment of weakness the boss allocated him to vascular (he would often rather put two house doctors in his own firm than send one to vascular). we were ecstatic, especially after the first day when it became obvious the guy was not afraid of work and he also clearly knew what he was doing. we had been given a gem. on his second day on the job he asked us about how the calls worked and what his after hours duties would be. i was just about to tell him that his calls were going to be quite light because we handled pretty much everything, but my colleague spoke first.

"well, you are the only house doctor, so you'll have to handle all the stuff primarily and call us if there is a problem or if someone needs to go to theater." it was so clearly a joke i thought at any moment one of them was going to start laughing. then we would send him home to his new wife and we would continue to slave through the night. but they both nodded. the house doctor seemed to accept this as simply one of the hardships associated with where he had been allocated in surgery. it was my colleague's call that night so once the day's activities had ended i made my way home.

the next morning my colleague told me he had had a great call. the amazingly competent house doctor had handled everything and he had spent the night at home. i was intrigued. i wondered what it was like to spend a vascular call at home. i decided not to tell the house doctor yet that the story of him being on call every night was just ridiculous and let him do another call. the next day he would probably complain so much we would have to inform him that it was just a joke and then life would settle back into its usual rhythm.

my call was wonderful. unlike my colleague i did come out to operate, but all the other peripheral irritations were completely handled by the house doctor. the guy was good. and still he hadn't complained. i spent post call in theater and went home well after the sun had set. i didn't see the house doctor that day and just assumed he was also at home. yet the next morning i discovered he had done another call and once again my colleague had spent the night at home. i started wondering how much of this the house doctor could take. it was clear he was tough, but the question was how tough was he.

and so we sort of never really told him that it had been a bit of a joke and he just kept on working, day and night and night and day. i think we also fell into the luxury of not doing the hard yards during a call and we got used to it. also we knew he was only going to be with us for three weeks and then we would be alone again so i suppose we saw it as a rest in the eye of the storm before the reality of vascular returned in full force.

after nearly two weeks of being on call every single night the house doctor started to hint that he might need a break. they were just hints so we did what any normal male does with hints. we ignored them and hoped they would go away. they didn't. after another few nights he told us he needed to speak to us about the call situation. by this time he was looking a bit worse for wear. who could blame him? he had done a solid two weeks of call on the trot and that in vascular. that was enough to break most people, but he seemed to be at least partially alive still. we agreed to discuss it.

the house doctor explained that he had done more than his fair share and had in fact done much more than the other house doctors in surgery who were doing about one call a week. he went on to say that it wasn't that he was lazy but he just needed a break. he also told us that he was fairly recently married and although his wife was understanding there was only so much a young wife could take of this sort of lifestyle. he told us that he needed to give some attention to his marriage too and couldn't just work constantly. we knew he had a point. he had proven himself beyond our wildest expectations and he did need a break. also secretly we knew that we had expected him to do far more than what was actually required of him. he was well within his rights. we had to relent.

we gave him one night off and told him to be back at work the next day, ready for another weeks call.


HMS said...

Hum. Wonder how it ended.

That the 'sucker' snapped and you guys jeered, or
that his marriage fell apart and you guys regret playing such prank.

Anyone who has gone through the residency knows how the game goes.

The question is whether we would hand down such 'tradition' to the next round of 'suckers.'

No wonder medical professionals are increasingly cynical/disillusioned from one generation to the next.

Bongi said...

rickover, the guy survived. his marriage also did. at the time he was starting a business which later became successful and he went out of clinical medicine which was his plan all along.

like pretty much all my posts, this one is a story based to a large extent on an incident that did happen. but it remains a story. it is supposed to illustrate what life was like back then and to do that honestly i must occasionally also post the stories i'm not overly proud of. yet it is still a pretty good story, i thought.

i think there are so many other reasons medical professionals are increasingly cynical/disillusioned from one generation to the next that my single incident probably had no effect on the trend.

also of all the students and house doctors that i worked with there were very few who experienced it as bad. actually some decided to pursue surgery and told me that i had a direct influence in their decision. i feel that the true error i tended to make was that i maybe made some people who in the long run won't enjoy surgery tend to want to study surgery, this incident excluded.

still, just a story.

HMS said...

That is good to hear.

ophelia balls said...

i dont believe its a story. so many older surgeons have problems with their hearts or with ETOH and marriages. its a direct result of overwork. they burn out young.

Bongi said...

ophelia, you are right. we as a group are overworked and we do burn out. this does often reflect in the rest of our lives. maybe this guy had it right. after all he wasn't studying surgery and in the end left medicine altogether and pursued another line.

the burnout issue is maybe a topic for another post some time.

rlbates said...

I'm surprised he lasted as 2 wks before "suggesting" he needed a night off. :)

Zamalek said...

Imagine this guy did go on to do surgery? He would have quite a successful surgeon I believe.

arsfona bumgardardner said...

is that poor lady really called
ophelia balls?

Anonymous said...

our actions shape things and change people.

of course, you know that. nice story, dr bongi.

Greg P said...

There are some people so gullible you feel almost compelled to do things like this. One hopes that at some point he understood what was going on and felt appropriately and incredibly stupid, but OTOH, he might have just never "got" it.

Anonymous said...

Greg P,

Sounds like you were chewed up pretty bad while you were a trainee and decades later you are still on your 'revenge' mode.

That is so, well, adolescent.

Bongi said...

in the end what this post actually is about is how that time changed me as a person. i often said i lost myself then and luckily found at least parts of myself later on. this is one of the things i was a party to that i'm not wildly proud of.

anonymous june 17, yes we have an influence on those around us. i try to have a good influence. this was noe time i didn't.

anonymous june 21, i'm not sure i agree with you. that is a bit of an assumption. actually this post shows that i'm the one that passed off what happened to me onto others, not greg p. i think your sentiments would better have been directed at me and not greg p.

anyway i have repented of this somewhat not-so-minor lapse in what i usually was like. it didn't happen before nor after this one time.

Anonymous said...

Hat tip to you, Dr. Bongi.

It takes a noble soul to write what you wrote just now. We all have our high and low, proud and humbled moments.

Respectfully, an anonymous reader

dr. bean said...

Kudos, Bongi; the humility you are showing to admit and renounce your behavior is necessary to breaking the cycle of abuse. And it's a good story.

Re overwork and burnout,
I had an uncle who was a thoracic surgeon. He worked like a slave, smoked like a chimney, and drank like a fish. He dropped dead at 44 while shouting at his wife. It sounds like a cliche but sadly is true. Now that I am a physician I no longer wonder why he acted this way. However I believe we are ultimately responsible for how we behave even under provocation.

ophelia bumm said...

"an uncle who was a thoracic surgeon. He worked like a slave, smoked like a chimney, and drank like a fish. He dropped dead at 44 while shouting at his wife"

What a wonderful description: i loved it. bet he was a Fab surgeon. pity there wasnt a defib around or he might still be ranting on today.

All Over said...

So a long time ago you did a miserable thing to an innocent person. Not cool, but it doesn't make you a demon either. At least you're honest.

I think Philip Larkin said it best:

Man hands on misery to man.
It deepens like a coastal shelf.
Get out as early as you can,
And don't have any kids yourself.

Mindful of this, I do want kids though... and am not planning an early exit either. :)

oluwatosin said...

For what you did you have no other option but to live for ever.