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.

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.

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.

Bovie.jpg
Beeeeeeeep – BOOOOOOOOP!!!

What’s your superstition? Please share!

Bullying in Medicine

This week, a video by Dr Yumna Moosa exposing the culture of bullying at her institution went viral.

 

The University of Cape Town has since released a statement in support of Dr Moosa.

In the video, a senior colleague advises Dr Moosa to keep quiet- as a complaint would ruin her career and make her “unemployable”. Unfortunately, this colleague may very well be correct: as evidenced by the case of Australian neurosurgeon Dr Caroline Tan.

In 2008, Dr Tan spoke out about the sexual harassment she experienced at the hands of a fellow neurosurgeon. The accused neurosurgeon claimed that Tan had falsified these accusations as a cover up for her poor clinical performance (sounding familiar yet?). Despite the judge finding in Tan’s favour, she faced fierce criticism for speaking out and has been passed over for positions in at least 8 public and private hospitals. Australian vascular surgeon Dr Gabrielle McMullin has even said that she advises her trainees to comply when approached for sex (by senior colleagues), as this is the “safest thing to do in terms of your career”.

Surgery has a reputation for having a formal hierarchy. At surgery, we are often told to “toughen up”. To “put up or shut up”. To “look for another job if you’re not happy with it”. To “keep your head down, don’t rock the boat”. The nail that sticks out will be hammered down – or as Dr Moosa’s senior colleague so eloquently puts it “No fuck off! This department drinks beer at lunch time!”  And so, all the female registrars in the room roar along with laughter when a male colleague bellows out that a woman’s mouth should only be open for one thing nudge nudge, wink wink. The female registrar will then try to tell a cruder joke, swear louder and drink more than her male counterparts – because she doesn’t want to be the old bag who can’t take a joke. The Jewish registrars laugh along with the offensive “jokes”, the Coloured registrars laugh along with the offensive “jokes”… and the world keeps turning.

Others become The Loner referred to in the video, and are often subtly hounded out of the department for being different – as happened to a lovely, soft spoken colleague of mine whose only offense was being a vegetarian?!? (and not subsisting on a diet of coffee, red meat and nicotine). Or perhaps you will be not-so-subtly hounded out of the department, like another colleague who was told by a senior consultant that he would personally see to it that this person never qualifies as a surgeon. This registrar never qualified, by the way. And how do you complain to your boss, if the person who is harassing you IS your boss?

Do I have a solution to the problem? Nope. But there is light at the end of the tunnel. The surgeons in our department are for the most part a friendly, diverse group of people- and we far outnumber the few bigots in our ranks. If we start speaking out against harassment (like Dr Moosa), and lead by example, we just may be able to change surgery’s reputation for the better.