Food, glorious food

When you’re on call, you’re in control of so little.

You can’t control how busy the call will be- like cats and Donald Trump, calls do just whatever the hell they please. You can’t control what’s going to roll through the doors- just because vascular emergencies have kept you up until the wee hours on your last three calls, doesn’t mean you’re exempt on this call. You can’t control who will be on your team- the universe may gift you that intern who thinks the management of hypoglycaemia includes ‘like…uh…10 units of insulin stat, dude’ or the pregnant intern who looks like she is mere moments from rupturing membranes, whom you take pity on and send home, and you end up doing the shift without any help. A derailed train could flood your ER with mass casualties, a patient could bite you, you could develop diarrhoea (a distinct possibility if your call takes you within a 1 mile radius of the paediatric ward, those kiddie viruses don’t mess around), and on, and on.

The only thing you DO have control over…

is your lunchbox.

When it’s all going to pot around you, at least you have that Snickers you’ve been saving up. When you’re so fatigued you feel like you need to prop your eyes open with matchsticks, that cup of coffee and packet of Jammie dodgers will come through for you. I have on occasion averted imminent mutiny in the emergency room by ordering in vast amounts of pizza for the team. It’s an essential component of boosting / maintaining morale.

I’ll be the first to admit: falling face- first into an angina burger with a side of LDL fries EVERY day is not a great coping strategy.

But once in a blue moon, when the going gets really tough, only bringing out the big guns will work. Napoleon Bonaparte famously stated that an army marches on its stomach, and these calorie bomb exceptions to our usual sensible nutritional rules may give us the courage we need to grab our metaphorical rifles and charge over the parapet of the metaphorical trench, to once again enter the fray.

The menu options at the Heart Attack Grill in Las Vegas. Surprisingly enough not endorsed by the American Heart Association.
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Surgemoji

I don’t really use emoji. I reckon it’s because I’m not down with the kids as they say, and because it doesn’t really fit with the curmudgeon vibe I’m trying so hard to cultivate.

There is however one emoji that I will break my rule for. If there is one emoticon that is hugely underrated it’s the laughing shit. The exuberant excrement. The carefree crap. The sunny stool. The merry manure.

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Delighted diarrhoea

General surgeons are of course obsessed with stools. We get that warm and fuzzy feeling when a patient passes a proper stool after a bowel anastomosis and we damn near pop the corks when that paediatric faecal impaction starts passing little bits of concrete and plastic action figures.

My only complaint regarding the jolly jobbie is that it is a tad one-dimensional. All the other emoji are now available in a range of colours and shapes, so wouldn’t it be great if the pleasant poo followed suit? A black melaena stool emoji for bleeding peptic ulcers, white acholic stool for the jaundiced patient, green for traveller’s diarrhoea or mucoid stools, red for hematochezia… the possibilities are endless!

And while academics have been speculating for ages regarding what Mona Lisa is smiling about, the real question, in my opinion, is what is that laughing poo emoji laughing about??!?

Eulogy

We received the news on a Sunday evening. Word spread incredibly quickly, as these things do.

A colleague, an anaesthetist, a friend, had committed suicide.

We all expressed our disbelief- how could this happen?

And yet it does happen, and with alarming frequency amongst medical professionals.

I thought of this colleague, and of other colleagues lost to suicide. I thought of my last interaction with each of them. I didn’t try to answer the why, because these things are beyond answers- they involve situations and emotions and circumstances weaved into a pattern too intricate for me to pick apart. But was there some sign, some tell-tale indication that things would end like this? And if there had been, does that mean we lacked the insight to do something, anything, to prevent it?

Not many of the others could see it, because you had just started your training at our hospital. But we knew you from before, from internship. We knew enough about your optimistic, fun-loving, joyful personality to know that this doppelganger wasn’t you. Your ready smile was gone.

But your work never suffered. When we would run into each other on the ward, we would have the same conversation one seems to have at least ten times with ten different people every day when you’re a trainee:

 

‘So how are things going at orthopaedics / gynaecology / anaesthetics?’

‘Pretty crappy, I have had 3 calls in six days. I’m so tired I feel like I can’t even lift my arms. I’m so sleep deprived, I feel like I’m hallucinating.’

‘Tell me about it. And are you getting any studying done, cause I’m not? I can’t afford to bloody fail this exam and it’s in like 4 weeks. I still have 5 calls to do before then.’

‘Same here. And I complained to the head of department, but he’s not doing much about it. Meanwhile Emma, Josh AND Jason are all on leave at the same time and I have to cover their rounds as well. So sick of this shit!’

‘That’s insane. (Laughs) Why the hell are we doing this to ourselves?!’

‘I know, right? Hey, we should go out for a drink some time, catch up.’

‘Yeah, that sounds great…’

 

But we never did go out for that drink. Because rounds and exams and life gets in the way. And when you did fail that exam and you went off on leave afterwards, we all thought that it was perfectly normal and perfectly understandable- we would be upset too. Only after the fact did we piece together that it was a lot more serious than that, that the ‘leave’ was just one of many admissions to a psychiatric care facility for depression and anxiety. You never told us- because for all the whining and complaining we do when we run into each other on the wards, the unspoken rule is to suffer valiantly and NEVER to admit to any form of weakness.

When you qualified, we imagined that it would all be smooth sailing from there- the exam was out of the way, you were ready to embark on the career that you had been training for for more than a decade. We didn’t know that the admissions continued. We didn’t know that threats of suicide had become so commonplace that those closest to you were watching you very carefully. We didn’t know that you had started combining alcohol with your psych meds to cope. We didn’t know that your employer had noticed the slurred speech and trembling hands that we had dismissed, and they had approached you about it. We didn’t notice that things had been spiraling out of control, ever faster.

I am sorry that you felt like this was the only way out. I hope that you are at peace.

 

The person described in this post is a composite of many colleagues- in order to honour the privacy of the individuals involved.

Plastic Fantastic

Plastic surgery consultant, pointing to vessel in the surgical field: ‘So that’s the vascular pedicle right there. That vessel is keeping the whole flap alive.’

You: ‘Oh, amazing!’

Your internal dialogue: ‘Holy guacamole, I wanted to grab that with a Gillies to burn it into oblivion a minute ago!!!

 

Abstract art

When you need to prune the abstract of your research to meet the word-count criteria of a congress and it starts looking like…

‘Retrospective files. Patients included open laparoscopic hernia Midlands 2010 – 2016. Data recorded demographics, ALOS, complications. Descriptive statistics and chi-squared test. P < o.o5 significant. Open good. Laparoscopic great. Further research needed.’

Might as well use smoke signals.

Snap, Crackle & Pop

Usually, I try to be in the operating room as the patient is put to sleep, but sometimes stuff happens and I just can’t. So not too long ago, I barged into the operating room convinced that I was late for an elective inguinal hernia repair… only to come upon a scene that almost defies description.

The patient was already asleep and intubated,  but the anaesthetist was hovering over my patient… well on the way to popping a pimple on the patient’s face.

‘WHAT ARE YOU DOING?!?’ (Scalpelista in banshee mode)

The anaesthetist looked up guiltily, bringing to mind the family Labrador after it had licked the Christmas roast.

‘Erm, if you were the patient, wouldn’t you want that taken care of?’ The ‘that’ in question being the pustule and a couple of rather large blackheads on the patient’s face.

I told the anaesthetist with the itchy fingers that the patient never signed consent to have the living daylights squeezed out of his face under anaesthesia. We do what’s on the consent and nothing more. Cue unhappy muttering from beyond the drape- every now and then the anaesthetist would mumble to herself, while staring wistfully at the blemish, now bringing to mind Gollum with his preciousssss. But in the end, my patient had his hernia repair and arrived in the recovery unit with his face unmolested.

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To be perfectly honest, I didn’t want my patient waking up looking like I’d taken a sledgehammer to his face- and I would be the prime suspect, as our colleagues at anaesthesia conveniently wave goodbye to groggy patients from the operating room exit, never to be seen nor heard from again. And suppose this impromptu extraction leaves a scar? And if you want to get all deep and analyze this like in those weird medical ethics courses they made us take back in med school- if we start popping zits under anaesthesia without consent, what other ‘procedures’ will we be performing without consent?

Pimple popping videos have a huge following, you can confirm this with a simple search. I have also worked with many interns who volunteer for the abscess drainage slate, not because they want to gain surgical experience and realize that as interns they have to start at the bottom and do some simple procedures that they consider to be ‘beneath them’, but because they derive intense erm… satisfaction from draining these super-charged zits. (By the way, this is me rolling on the floor, laughing hysterically- I used ‘intern’ and the concept of volunteering for work in the same sentence!!!) I specifically recall a dainty blonde intern with high heels and even higher hair explaining to me how much she loves it when the pus comes a-gushing out of an abscess… what can I say, weekend surgical calls be cray cray.

I decided to look into the psychology behind this fascination with extracting other people’s pus. Explanations range from it supplying a rush similar to riding a rollercoaster to being akin to the grooming behaviour observed in primates.

Not sure what that says about my colleague.

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Do the voodoo

Everybody has one. Even you.

I’m referring to a surgical superstition. You know, the totally irrational little voodoo-mojo-juju things you need to do (or avoid) because you just know it makes your operations go well.

It’s not the sensible things, like placing your sutures well or not slashing through that ureter. It’s the stuff that’s about as sane, rational and well-balanced as a season of Keeping Up With The Kardashians. It’s the surgeon’s version of not walking under ladders and avoiding black cats.

Erm, not that we believe in that stuff anyway…

but we totally do.

For some people it’s saying a phrase before starting (‘Let’s rock and roll!’), for  others an object (‘I’m wearing my lucky cystoscopy boots’).

The brilliant fellow in our unit is an extreme example. Before we can begin any surgical procedure she has a host of seemingly random objects to touch and mantras to repeat. This person has become quite infamous for her compulsive presurgical routine and all the scrub nurses know not to interrupt her when she is in the thick of it, as it throws her completely off balance. No harm has ever come to any of her patients because of it and we all accept it as her quirk. In a way, I can understand her need to create a kind of order out of what she perceives as utter chaos (and let’s be real, the minutes before the start of surgery can sometimes be chaotic!)

My little superstition is sartorial. I CANNOT DEAL with a scrub cap that doesn’t match or complement my scrubs. I’m not going to tear the offending item off and burn it in the theatre passage, but when my cap is black and my scrubs are navy I just bloody know this isn’t going to be a good day. Perfectly rational, no?

After I have scrubbed, I plant myself next to the table and I always ALWAYS test the Bovie by holding in each of the buttons on the handset. Once I’ve heard that satisfying beeeep-BOOOOOP sound of a Bovie functioning correctly, we may start. And then, all hell can break loose for all I care- at least I know I’m well dressed and my lightning stick is functional.

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Beeeeeeeep – BOOOOOOOOP!!!

What’s your superstition? Please share!

The Working Dead

 

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From Cafe Press

You may think it’s a zombie, but it’s probably the senior surgical trainee. I’ll tell you why:

1. The eyes of a zombie are glazed over and may appear hazy. Zombies do not blink.

After a few rough calls, any surgical trainee will tell you that they rock that glazed look. Good old eye drops may become your very best friend. And who has time to blink, I need to check that ?appendicitis’ blood results, book stab abdomen guy for a laparotomy, finish my ward rounds and insert the central line that the intern couldn’t manage. I’ll blink later, damnit!

2. The tissue of a zombie continues to decay and produces a distinctive odour. New zombies may have little or no odour.

I didn’t have time to blink, so where did you think I’d find time to shower? Anyway, it might not be my own erm… distinctive odour you’re getting- that bowel obstruction in 6F really does have projectile vomiting…

3. The skin of a zombie will appear pale…

Surgical trainees generally don’t see the sun (or the tanning bed) often enough to give their skins the Donald Trump treatment. If it’s any consolation, hopefully that will culminate in a decreased melanoma risk in the long run.

4. Zombies walk in an unstable, shambling pattern…

Shift’s over… Must make it to car… Hot shower…. Warm bed…

5. A bite mark may or may not be apparent…

Yes, patients do bite. Especially inebriated ones and children. (Ask me how I know!)

Surgeons on the other hand, don’t bite. Unless you’re consulting me, trying to sell the patient as a GIT bleed but you haven’t actually done the rectal exam to check for melaena. Or you haven’t checked the pulses in that fractured limb. Or you’re the radiologist refusing to scan my patient when we both know that my request is reasonable.

Or if you’re that ham & cheese sandwich that I’ve been having daydreams about since before we went to theatre this morning.

Braaaaaaaains…

GP matters

I wanted to call this post ‘why GP’s need to be on top of their shit’, but ended up not doing that.

Every kind of doctor has to be on top of things. The first rule of Fight Club may be not to talk about Fight Club, but the first rule of medicine is to avoid causing harm to your patient. This is super important in surgery, because when things go wrong in the operating room they do so rapidly and spectacularly. Malpractice suits are expensive.

But this post is about why General Practitioners need to be on top of things.

For many patients, their GP is their first point of contact with the healthcare system. Patients bond with their GP’s over many years and they trust them implicitly. This GP splinted their broken arm, took their tonsils out and delivered their babies. If the GP tells a patient that while her breast cancer is very small, it is probably better to have a RADICAL mastectomy or that she is too old or too ill to have a general anaesthetic, the patient will treat this as gospel. Patients are often unwilling to consider the other options offered by specialists, because they have already had their minds made up by the (well intentioned) advice given by their GP.

So in a nutshell- being a GP is a position that comes with great responsibility. Use it wisely.

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Marvel Comics

Damn straight, Spidey.