Scalpel’s Edge

Fit to be a patient

// June 23rd, 2009 // 3 Comments » // Family, Surgery

For those that follow my twitter feed, it will be no surprise that I have been on a fitness kick. This has extended to 6am group personal training. Do you know how cold it is at 6am in Melbourne at the moment? And how warm it is in bed curled up with one year old, three year old or handsome man?

Without becoming a crying, fat person, I wanted to explain my motivation. It is all related to my work. Operating on someone is one of the more intimate interactions you can have. You get to know what they look like on the inside, and not in some vague, philosophical way. You get to touch their fat. Ewwwhgh.

I work in an affluent western area, so our patients are mostly overweight, especially by the time they get bowel cancer in their sixties or seventies. And operating on a fat person can be really, really difficult. It is physical tiring to manipulate that extra flesh. And the fat is ubiquitous - everywhere and always in the way. The anatomy is harder to see, so the “figuring out where you are” phase of an operation lasts a lot longer.

I have been able to ignore the similarities between my physique and that of my difficult patients. I am young enough that being a surgical patient is unlikely. Then I had an emergency caesarean section, and realised I am at risk of needing surgery.

So I am trying to lose weight so I won’t be the fat anaesthetised person. I want to be the one where the surgeons are amazed at the beautiful anatomy. I know it’s a little wierd, but that is what counts for me.

Image credit

Surgical manners

// June 1st, 2009 // 1 Comment » // Health, Surgery

One of the surgeons I work for has a typical surgeon’s manner. It’s a bit uncommon, now, especially with young fellows. I imagine there used to be a deal made between the surgeon and their society - you revere me and I will allow the hospital and my patients to use up my life. The deal has changed, so the behaviour has, too.

This boss seems to have little empathy for staff. I’m not sure if it is true, as he is really a nice guy, but he certainly gives that impression. You know how some people think that they know how things are meant to work, so get shocked when other people don’t? Like that. I don’t know how he deals with patients, as I never see him outside theatre.

I wanted to share the one thing he has taught me recently. We had a complicated case, and there were a few technical difficulties with the video equipment. Then his favoured instruments weren’t available. Then the staff started to get cranky at him, and the tension started to rise. And this was a complicated case, in a spare theatre, with fill-in staff.

So I learnt that attitude is one of the most important surgical skills. My surgeon expected the best of everyone in difficult circumstances, and got disappointed. Our plan should not be to expect the best and get disappointed. We need to expect the worst and enjoy the relief when people step up.

The other important skill is to plan for hassle-free work. Surgeons are the master of their workplace to some degree, and can manipulate what operations get performed in what situation, especially for elective cases. Especially in the times we expect everyone around us to let us down, we need to keep a margin of safety. Save your regular list, with familiar staff, for tough cases. No one has the right to get miffed if they have planned poorly. Be on time, have a familiar anaesthetist, be honest about the length of the list.

I know this sounds basic, but I have to write it down, because it just keeps bouncing around in my head. A tense workplace with standoffs between staff is unsafe. It’s a long career. Being a donkey at the beginning of a career doesn’t win points.

Image: malia (Flickr)