I Really Do Not Like Surgery. Aarghh!
I am not sure exactly when my dislike for surgery started, how it sprouted and at what exact moment I was able to identify and define it. But I am certain I must have endured a lot of things that eventually accumulated to what it is today.
Back to the beginning
Let us start from medical school and the times we had to rotate through the surgery department.
I think the first part of surgery I do not like is the theater. We went through medical school recognized only as necessary fixtures in the setting of any ‘respectable’ Nigerian medical school theatre. We were to be seen and heard but kept at a safe distance from the sterile area. I remember the periop nurses shouting, “stay away from my sterile tray“. We were useful for intraoperative and post operative errands like, “one of you should tear/cut plaster”, “Who will get us red pen?”, “Label the specimen bottle”, “The men among you should go and bring the patient’s trolley”, “Surgeon is sweating!!! mop please.”
Quite rib cracking
That last one was just too funny. God then help you the surgeon is a male Muslim and all of you in your group are females or the person uses glasses and the sweat is right under the glasses or you are not tall enough to reach za surgeons face. Another one that has me in stitches every time is when mid operation, power goes off. “Where are your torch-lights?” Of course they don’t expect us to carry solar or rechargeable lamps to theatre. (The day we start that ehn, someone should please just shutdown Nigeria. For realz.)
They mean the torch-lights on our phones. Same phones they tell us we are addicted to. Same phones some of them seize all in the name of you’re pressing it too much. When power then goes off, all of us would be expected to ‘contribute’ light and somehow focus them on the operating field. First time I experienced power outage in the operating room, I actually laughed out loud and almost got into trouble. In summary, we actually do not do much surgery stuff, yet, if we are absent, ‘we are die.’
Ego also play a role
The next thing that makes surgery mega not cool for me is the way most surgeons walk around with what seems like a huge chip on their shoulders. God! They actually think they are close to gods and it oozes out from them every time. There are those ones that would ask for a red carpet if possible on their every path. There are those who if possible would want us to address them by every degree they have earned. There are still those who believe they can never be wrong. With that kind of mindset, please, how can people work with you? Oh, there are those who think no female should be in surgery and this does not come from a place of concern or care for the females but from a mindset that thinks them below the prestige of surgery. Talk about some ego trip???
‘Biopsychosocial’, so we were thought!
Lastly (actually not the last but I don’t think I should say too much), I am not pleased with the interactive skills of most surgeons with their patients. They rarely take time to explain the situation to their patients. They would rather go straight to ,”ehn, mama, surgery ni o. surgery nikan lo le se.” of course, we acknowledge the power of cutting and chopping things off and patients getting better instantly. But, the psycho-social aspect of illness is rarely addressed. Do you know the trepidation most patients go through once they hear the word ‘surgery’ or ‘operation’? They feel that their chances of coming out of that operating room is less than 50% and they don’t get any reassurance from the stern looks the surgeons are always carrying around. I am not advocating unnecessary mushiness. No. I am only saying, surgeons need to see their patients beyond the body part their scalpel is about to shave off.
I’ve had patients come in for surgeries they know nothing about. I’ve seen patients who had masses removed and have no clue what was removed or why.
A young woman, barely 35years has a breast lump. From the appearances, it is cancerous. The best option in our region is a Modified Radical Mastectomy (which is a complex word for cutting off the breast, a bit of muscle and lymph nodes), yes. But did you take just a minute to sympathize with her about losing an important part of her body and vital part of her sexuality? Have you not seen the Twitter wars on which rounded contour of a woman is most cherished? The upper anterior twins or the lower posterior twins? All you’re interested in is cut, chop, shave. Someone would say, but surgeons need to be that harsh because time is of essence. Okay oh, Mr. Essential, get abroad first and get sued for not carrying your patient along with compassion. Or how about you put yourself or a close relative in that shoe first?
And so, it began!
You can imagine how much ‘excited’ I was to be starting surgery.
The only consolation I really had was that I was starting with Pediatric surgery. Consolation only because it meant still being with the little children and still working around the same wards. Apart from that, I was in for WORK.
During my time (‘cos, apparently, things changed just as I left), the way things worked then was that houseofficers were on call for one straight week, free the next week and then on call the next week again. Just imagine it ; being on call for a whole week… Monday to the next Monday. One would have to pack all the clothing, underwear, toiletteries and necessities to be used in that time period, because, well, there really was no allowance to go home and get things again once the call began.
Lounge for call room
I did not emphasize that in paediatrics, there were proper call rooms situated along with the core paediatric wards and bathrooms/toilets such that in answering nature’s call and preparing for the next day’s work, little or no stress was involved. However, other departments had no such things and we were left at the mercy of the residents’ lounge. This lounge has eight rooms which are supposed to be used per department or unit but are generally used by anybody at anytime. They are not gender specific, so, you could be sleeping and next thing, a guy comes in to sleep on the other bed. Of course, the rooms can not cater to the needs of the more than 100 houseofficers and another large number of resident doctors. Sometimes, people have to sleep two on a bed and God help you if the fellow you are sharing a bed with is a snorer or intending Ronaldo who plays intense matches while asleep… probably using your head as the ball.
I remember the morning after my first call in surgery/PSU, I went to the bathroom to have my bath. (no, the taps were not running but there was water in the drum). I then , as if I was in my own house, went back to dress up in the room. Biggest mistake. Did I mention that these rooms don’t lock? Was I pulling on my skirt or shirt when the door opened? And trust your village people to ensure it was a male coming in. And trust them to ensure it was someone who did not know he was meant to quickly dash back and slam the door shut and go ask God for forgiveness for beholding what his eyes were not meant to.
Guy was still asking me should he close the door? No sir. Hug the door. In fact, come inside and help me zip up my skirt. Mortified does not do justice. Really!
So, for a week, on alternate weeks, I was subjected to having my bath and dressing up in the bathroom to save the remaining bride price. If I start talking of the days that lounge stank to the high heavens due to concentrated and accumulated urine, you would weep for me. And what of the days when Red Town came in more than all its glory and I did not take enough sanitary pads? Or we were at a departmental meeting so long I could not go change early enough? I remember one time like that we had just finished the meeting and I asked another lady to help assess how much of the ‘blood of Jesus’ I was soaked in. My lady had initially said, “nah, none”. And then as I moved further, she pulled me back down and whispered that the edge of my ward coat was stained. I removed the ward coat and was hiding it behind my back because I was not sure if the cloth underneath was spared either. Sometimes, we really paint the town red. I took excuse from my consultant to go change and he somehow understood only for another consultant to see me without ward coat and start badgering me. My consultant was right there and he was not complaining about my ward coat being off. But no, this other consultant wanted to prove whatever. I just kept a straight face. Sir, you wee soon mop blood, just kwontinu, atink you hia me?
Pediatrics and pediatric surgery
Let’s talk about the beef between pediatrics and pediatric surgery. It is funny to me that such a thing should exist at all but as we say, “wetin Musa no go see for gate?” Apparently, the PSU is of the opinion that the pediatrics team tends to send them consults anyhow. Thing is, most of the consults would of course come from them because it is after initial evaluation by the pediatric team reveals that what ails the child is more of a surgical thing that the PSU would be invited.
I think both teams have to find a place for each other in their hearts, at least for the sake of the children.
Now, this initial evaluation has to be thorough with the final exclusion of all medical possibilities. If this is not done, an unnecessary consult is written and sent and proper care is actually delayed. When the PSU gets such consults, and the diagnosis ends up being medical, the PSU reg is definitely not pleased at the time wasted. The other thing is the issue of then transferring the patient back to the pediatric team. Sometimes, that thing is a struggle. This is especially so when the exact diagnosis is vague. But you know surgeons, once there is nothing to cut, divert, anastomose, it really is not there bukata.
Best registrar ever!
While at PSU, I had the best reg ever!!! I remember the first time I noticed his handwriting, it was around that time an ‘unfortunate’ fellow told his female interviewer that she smelt nice and the rather immature interviewer came to the social media space to ridicule him. My reg’s handwriting could melt hearts. Very burriful something. And he isn’t the type to clerk with half a page and jump to diagnosis. Anytime we went to see a consult, I would straight up ask the nurses on the ward for three or more continuation sheets because… he would exhaust them. I learnt comprehensive clerking and proper documentation from him. He could write five updates on one patient in the space of an hour. It was not easy walking round in circles almost every minute but I discovered how much those documentations could be life saving.
I wondered if I should tell him his handwriting was superb but I decided to keep my mouth shut tori, I cannot be you smell nice part 2. Woman, save yourself. Kindly ‘unlook’
Apart from his handwriting, this my reg is a fine man. Forget. There was a time I commented on the picture of his son he put up and my reg was like, “his father was fairer and finer than this at his age..” I guess that one was settled; no point telling him what he already knew. Apart from his physical fineness, he has such a fine heart. Gosh! This man took care of me like he was obliged to. We… or he… talked non stop while we saw patients, amidst stories, he would explain why he was doing whatever he was doing at that time. He knew when I was tired and would try to hasten up the work (although, he rarely spent less than an hour ) and when I was tired, he would get me drinks, snacks, food. It was amazing. We would be walking back to the lounge after the day’s work and he’d just say, “Eunice, jẹ́ ká lọ si ọdọ iya Bash.” On the way there, he would stop at ventures to get me a drink and meatpie or doughnut. Or the days of, “Oladeji, I made three different soups yesterday with big big meat, which one should I bring for you?” And all these… with no strings attached. Not once did he ever cross the line.
And you know the best part? He still did this for me even months after I had left PSU and I was in another unit. I don’t know about you but having a thoughtful reg is like heaven on earth.
But, I think he was not well appreciated by the consultants. At some point, he was the only reg answering to three consultant with different patients, different demands and deadlines, different approaches and many times, they just wanted results not minding how he went about it. I get that they expected him to get along well enough but there is only so much one soul can handle day in, day out. This reg took the initiative to commence care for most of the patients we saw and most of the time the consultants only had to add a few things to his plan. He is that good. And even though some may think, “But isn’t that what residency is all about?”, if it were some other reg in his shoes, we might have had even more issues to deal with. I think I must have told him times without number that I didn’t know how he was doing it and doing so well in handling all the pressure to keep sane. The smooth running of that unit hinged a lot on the pro-activeness of my reg towards patient care. And this also reduced the workload for houseofficers to some extent…well, minus the hours of seeing one patient and the seemingly endless back and forth.
I saw an evil under the sun during housejob which was not limited to PSU but was first experienced there.
A Little Note
1. Blessed be God who gave me a loyal readership. Thanks to you all for your data, time, concentration and comments. Means a whole lot to me.
2. I’m setting the bar to 250 views today. Prove yourselves, guys. ???.
3. Special thanks to Moyosoreoluwa and Adewusi Ope. They interact with me on these posts so much and never slack in following the posts. Love you guys.