The heart of surgery

I won’t write about smoking flesh, the straight needle suturing technique, the suffocating mask, my inability to open the gown the right way. Neither will I write about the few inpatients, the conflicts with nurses, the angry stream of people coming through clinic after waiting for a long time in the waiting room, the multiple multidisciplinary meetings, or the terrible accidents that brought in some of those under the trauma unit. I won’t even write about the early starts, and long days without daylight. But I will write about the heart and soul of surgery.

It was the most formal mid term assessment any of us has had so far. It’s touching really, the attention they pay to the intern group. But the most significant comment to be made, is that -gasp- I didn’t know specific sub-unit the Prof, the head of surgery worked in?

The only time I’ve come across this man was in general outpatients, attended by a mix of interns, residents, registrars and consultants from several units. I presented a few cases to him, he helped form the management plan, and that was fine. One day he came across the corridor, and asked whether we could run an errand? It was actually for the trauma team, but could I do it? Yes, okay.

“Of course you would, wouldn’t you? Or else I wouldn’t write you a good assessment,” he said, half jokingly – or then again maybe he wasn’t. “Oh, I didn’t know you were doing our assessments, are you on (this unit) too?” The other people in the room, supposedly working, hold their breath in horror. Ooooooo. It’s not a small group of consultants. I hadn’t worked or been a student there prior to that week, and evidently, I don’t gossip about registars and consultants enough to be in the know. After running the errand and letting him know the happenings of his private patient, I thought, just in case he was offended, I will apologise for the earlier incident. And I did.

But weeks later I still hear about it, mentioned in a roundabout way, at a feedback session given by another consultant. Later, we are at coffee with our temporary registrar, and in a well meaning way he tells us about the sort of things that matter on these teams. About titles – first names, or Doctor or Miss, or Mister or Prof, and what about the ever confusing title of A/Prof? About conversations, and what conversations not to have in theatre. About how an emergency group meeting was going to be held with the interns across surgery, as across the units (so not specifically on our unit) the consultants felt that we were “overfamiliar” with them. What is that even supposed to mean.

I agree, we should of course be respectful. And careful not to talk or address in a way that offends. But the amount of attention paid to this is far far far more than any other aspect of the job – maybe we can get some useful feedback too, about our patient assessment and management, our case presentations, what about working as a team with co-interns, what about the surgeon’s favourite “medical school these days don’t teach any anatomy”? Is the most important quality you look for in your prospective trainees, the ability to slavishly suck up to you and reinforce your status as king of this old and prestigous castle? I’m not saying all in the field are like this, I’m not even saying the head of department is so (to be truthful, on most occasions he seems to be a pleasant and reasonable man), but ego is a big thing in surgery. Perhaps we need to remember that somewhere out there, there is a world beyond that of this institution, beyond these hospital walls. Perhaps we need to know, each of us no matter how high or low on this hospital heirarchy, are accountable to God who is above all.

Slaves, obey your earthly masters with respect and fear, and with sincerity of heart, just as you would obey Christ. Obey them not only to win their favor when their eye is on you, but as slaves of Christ, doing the will of God from your heart. Serve wholeheartedly, as if you were serving the Lord, not people, because you know that the Lord will reward each one for whatever good they do, whether they are slave or free. And masters, treat your slaves in the same way. Do not threaten them, since you know that he who is both their Master and yours is in heaven, and there is no favoritism with him. – Ephesians 6:5-9


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