The Golden Rule

Anyone who has spent just a minute in any surgical department can safely vouch for this statement : surgeons have fragile egos. Quick to plummet. And even faster to rise.

This was brought to my attention during a Perfectly good comical Sunday call whilst in the surgery department. The one absolute pet peeve of a surgeon is, obviously a gynecologist. You see surgeons are selfish creatures by nature and yet are forced to share their prized posession, the abdomen.

Any female with an acute abdomen that walks through a surgeons door has to be thoroughly examined for a gynecological acute abdomen such as a ruptured ectopic pregnancy or a torsion of an ovary. Which of course, surgeons don’t really know how to do. Pretty often if the surgeon isn’t convinced enough, he turfs the patient the gynaes way for a quick ultrasound scan and waits either to be turfed back or never heard from again.

I’d like to think the ultimate compensation and silver lining of having to share his prized abdomen is one little organ that can really bark up the gynecology tree; The Bladder. Renound for causing sweat drenching palpitations in any gynecology or obstetric surgery. And the reason for insurmountable Ego inflation in a surgeon.

The way i see it, any gynecology surgery basically entails opening the abdomen, then tip toeing around the bladder and ureters hoping some abnormality magically reveals itself so you can close and breathe easy. Or it can go horribly wrong and you are forced to, against all natural fibres of your being, to call a surgeon. You could however send the patient to urology but that would risk an even bigger smack down from the urologists in their ivory towers of a tertiary hospital, along with the technical difficulties like begging for an ambulance while the bladder bleeds quietly.

Im convinced that although surgeons openly display heaps of dread about the call from a gynecologist, they secretly indulge in it. Even wait for it.

My registrars call came on the very same Sunday morning. He tried his level best to look annoyed yet all I spotted was excitement and urgency. We had just admitted a bowel obstruction when his phone rang.

“Uh. I’m calling from OT1. I think we’ve injured the bladder”. my registrar sported a wide grin while trying to disguise his to tone. “Oh that’s sad. Dont worry, I won’t be long”. You see gynaecologists and surgeons have a love-hate relationship, frenemies if you will. So asking a surgeon for help is quite a big chip of your block especially if you had err’d. It was an opportunity for the surgeon to flaunt his expertise at the expense of your already deflated ego.

He galloped along with an extra bounce in his step, he summoned me along. I was confused as there were more than enough hands to assist. “Moosa they’ve injured the bladder. Poked the dragon. Who knows if they can hold a retractor?”

I secretly knew he only required my presence to add to his greys anatomy style entourage. We entered the theatre dramatically , slamming each door wide open, attracting the much wanted attention. If we had a back round track music setting the tone, I’d imagine it would be Eye of the tiger.

We found the gynecologist and his assistant huddled around the pelvis, nervously staring at the blood stained wine red catheter bag. This seemed to push my registrar into 6th gear. “Moosa scrub , now! We have work to do!” I didn’t hesitate.

Whilst i scrubbed I heard the registrar making a call, probably to rub salt into the already wounded gynecologist. He screamed on top of his voice “Prof, theres a bladder injury sent our way from the gynaes, but dont worry I have it under control. Im on my way into the deep end”

We could all hear Prof on the other end of the phone scream “bastards! Go mop up the mess.keep me posted”. My registrar was perky as could be. “Just updating my consultant” he announced to the theatre to avoid looking like a complete ass.

He hummed a chirpy tone while scrubbing and vervently awaited the gynae to step down as lead surgeon and proudly took his place. Looked like pre-school playground antics to me but ofcourse I was silent. He seemed too prepared for this moment , he quickly went into stealth mode and identified the leak. He repaired and announced, bring the gentian violet. The dye was injected into the catheter and we all peered into the pelvis waiting to see if the repair would leak bright purple. A technique I often admired.

My registrar eyed the bladder almost instructing it not to leak. My arms ached from retracting but i wouldn’t dare loosen my grip during his five minutes of fame.

“The bladder is repaired” my registrar noted the obvious. Waiting for an applause and a medal of honour and maybe a picture with his repaired bladder. He got none.

The gynecologist thanked my registrar with a tinge of bitterness in his voice. “You know how bladder injuries can leak post op , so to be safe ill send her for a CT scan tomorrow” mumbled the gynecologist, somehow trying to redeem his ego laying in shambles.

My registrar was beaming during the monday morning meeting where he explained in detail how he had saved the day. “That bladder was in pieces, I basically did a reconstruction” he obviously overstated. He gained bragging rights for a week straight and fist bumps all around.

Surgeons and their egos.