la mancha

the man was an enigma. those who knew him soon realised he was the only person in kalafong (hell) that cared anymore. somehow that terrible place hadn't eroded his soul to such an extent that he no longer gave a damn about his patients. yet to those who only had a fleeting acquaintance with him, he seemed course and even harsh. he didn't fit into kalafong (hell), yet he would not have fitted into any other place quite as well as he fitted into kalafong (hell). yes, he was an enigma.

my consultant in kalafong (hell), the enigma, had a certain way of bringing his point across (here and here). on the face of it it was never pretty but it was always funny in some twisted sort of way, despite that never being his intention. he also had a knack of going off on some wild tangent for seemingly no reason. what we may have thought was normal would more often than not set our own don quixote off on some wild quest chasing what seemed to us to be little more than windmills. but who were we to argue? he was after all the consultant.

so on that particular morning, when the house doctor showed the don the official consultation form from the internal department requesting us to drain an abscess on one of their patients there really was no way for him to know that this would cause the old man to fly into a frenzy and charge off towards the wards of the unsuspecting internal medicine department, his entire entourage, myself included, in tow. i was a very junior medical officer so i kept to the back and just observed.

"where are the doctors?" he bellowed at no one in particular as he stormed through the doors. "are you all deaf? i said where are your doctors? i want them here right now!" from behind a few curtains here and there the house doctors of that department peered, eyes wide, like frightened rabbits. still they froze and moved no closer.

"i said come here!" he shouted pointing directly at the closest one. "you! are you a doctor?" it seemed like a silly question. of course he was a doctor. but our master continued, "i said are you a doctor?"

"yes sir." wrong choice of words.

"don't call me sir!! do i look like i've been smacked on the shoulder by some foreign queen?"

"no, professor."

"don't call me professor!" his face went red with rage and despite it seeming impossible, the volume of his rantings increased. "i am not one of those academic professors in that ivory tower on the other side of town who operate by remote control from the comfort of their large chairs in their studies! i am a real surgeon!"

"sorry doctor."

"that's better." his voice dropped down back to jet plane decibels. "i asked you a question. are you a doctor?" the poor guy's lip quivered as he carefully and deliberately chose his words.

"yes doctor."

"what degree do you have?" we all cowered out of the direct line of sight of the man just in case he asked us the same seemingly easy question. at least we now knew not to call him sir or professor. but the poor internal house doctor had no such privilege.

"i have an mbchb, doctor." he almost whispered.

"yes you do. and do you know what that means?" before the confused victim could answer this next seemingly easy question our consultant blundered forth. "bring me a blade and show me where this patient is with the abscess.

a few moments later we were all standing around the patient wondering what was going to happen next. the house doctor was visibly shaking.

"i asked you a question?" continued our mentor, toying with the knife in his hand that the doctor had fetched for him "what does mbchb mean? or what does the chb part mean? the mb part is easy. that means you can give pills out. any old monkey can give pills out, but now i want you to tell me what the chb means"

"i'm not sure sir, i mean doctor!"

"if you call me sir again i will have you thrown up against the wall and i will bring a firing squad in here and have you summarily shot!" our consultant believed a firing squad covered a multitude of sins. "well let me tell you what it means. you see this sharp shiny thing in my hand? this is a blade. chb means you are trained to use one of these. it means you have a bachelors degree in surgery and it means you can lance an abscess. now watch me." he turned towards the unsuspecting patient. "you see now. this is the blade and this is the abscess. and this is the blade draining the abscess." with that he sunk the blade deep into the abscess. the patient winced, but, surprisingly made no other objection. i assumed he felt the threat of the firing squad may have been a general threat and that it was not limited to the poor house doctor. also once the thick stream of puss came out, there even seemed to be relief on the patient's face.

"there you go, mb and chb. now never consult us to drain an abscess again!" he turned and strode out. we had to follow. i was right at the back so i think i was the only one who heard the quiet and slightly bewildered voice of the house doctor as he said;

"i didn't consult you. that isn't even my patient."

strategy

while i'm on the topic of how to handle consultants i was reminded of another consultant who was somewhat peculiar. also while in prague one of my old colleagues from the old days who actually reads this blog asked why i never wrote about this very interesting individual. so here goes. lets just call him doctor d.

doctor d had dogmatic views on pretty much everything and his views were usually fairly odd. he had developed a way of discussing one or other of his views during operations. he could time a discussion about a given topic to last just long enough that as he placed the last stitch he would wrap up his talk. so with a short operation he would just launch into his theories, but with a longer operation he would start by asking each person in theater what they thought of whatever topic he had chosen for that specific operation. i used to enjoy listening to him during operations and sometimes even felt disappointment when the last stitch would be placed while he said,
"and that is why you should not send your children to school but should home school them." or "and that is why you should always wear long sleeved shirts" or "and that is why cremation is wrong" or some such statement.

but on ward rounds my feelings about these discussions were completely different. an operation had a predetermined end, but ward rounds could go on indefinitely. with this in mind i'd instructed the students how to respond to doctor d so as to shorten the discussion as much as possible. i explained to them that if he asks their opinion about anything not related to surgery he is not asking because he wants to know their opinion, but rather that he wants to expound his own theories. if they gave their opinions he would first take time, a lot of time, to debunk their theories before explaining his own. they were under strict instructions to make sure they didn't give their opinion but rather just immediately ask doctor d what he thought. and then after he had expounded his often bizarre theories the students were not permitted to question him on the rounds. if they wanted to argue some point they could do it in their own time when the rest of us would not be forced to stand there, often post call, and listen too.

generally this approach worked quite well and ward rounds usually didn't drag on more than a half hour after seeing the last patient while we heard why a contraception was wrong etc. that was until one day.

we had just seen the last patient on our post call rounds and ward rounds were as good as over. the students were a new group but i had already orientated them about what to do when asked questions unrelated to surgery. so i didn't worry too much when doctor d started.
"what do you think of rugby?" he asked each student. they dutifully were non committal and quickly turned the question back on him. i was smiling inwardly. we could wrap this up in about 5 minutes if no one questioned him afterwards and he still would be none the wiser i was sabotaging his beloved so called philosophical discussions. he continued.
"rugby is a homosexual game and anyone that plays it must be homosexual." i could almost hear my bed calling. we just had to nod and soon we'd be on our way. and then things went south.

one of the students seemed to be turning slightly red. he also seemed to be bouncing up and down on the spot.he seemed disturbed. i realised he was going to go against my instructions and ask something or worse, challenge doctor d. i started recalculating how long it would take for the rounds to end. but what happened then i hadn't expected.

suddenly the student jumped forward with index finger extended, first towards me;
"i know you forbade us from questioning doctor d about any of his crazy theories, but this i just can't take!" and then towards doctor d:
"doctor d how the hell can you say rugby is for homosexuals? do you really think all the springboks are homosexual?"

i wanted to cry. not only were we forced to endure the full length explanation of doctor d as to why rugby was indeed a homosexual sport, but afterwards i was personally taken to task for instructing the students as to how they were to ensure the good doctor d's talks did not go on for quite as long as he liked them to. worse still, the good doctor d adjusted his way of discussing his theories on ward rounds to bypass my influence on the students. never again did we have a short discussion after rounds, whether the students asked questions or not. doctor d also i think trusted me much less after that episode.