“Old is gold” A prof once sang to us when discussing laparoscopic(minimally invasive) cholecystectomy(removing gall bladder). He emphasised on how he hated laparoscopic surgery at every chance he got and didnt get. Despite being less invasive, less pain, less wound care, it requires a great amount of skill that old surgeons may not have found the need to acquire. After all surgeons are creatures of habit (read: stubborn).
Most of the older generation prefer the good old fashioned way of making a large incision and hacking the gall bladder off, just as effective but with more pain and a bigger scar. An unnecessary simplicity.
The art of operating without actually slicing open an abdomen has been a game changer in surgery. Using micro cameras and micro instruments which are manouvered through 1cm holes in the abdomen is revolutionary. Much of the open surgery is now being converted into the graceful and delicate laparoscopic methods, to the disdain of some older surgeons. Aged surgeons meet the young ones, a clash I had noted very early in this career. One particular incident remains fresh in my waning memory.
Some background information is that, For some reason people have engraved a certain picture in their mind of what a doctor should look like. Male. Big and tall, usually white with a sharp nose and wrinkled forehead. And old. Not old enough to be senile but old enough to have been around the surgical block to have acquired enough knowledge deemed to be adaquate by their standards.
Im not sure if the thought of “new blood” in the medicine game equates with less experience and therefore less knowledge and that’s why some people prefer the older generation? Personally I never could grasp that concept as I find the contrary to be true.
If I’d ever have to find myself in the unfortunate situation of being on the other end of the scalpel, I’d have peace of mind knowing my doctor was enthusiastically up to date with new knowledge and has kept their surgical skill crisp and fresh.
That’s why I admired her so much. She was barely over 1.6m tall and had what patients called a “young baby face”, an unconventional combination for a surgeon. She found herself unfortunately drawn to general surgery. I say unfortunately because anyone who knows anything about general surgery knows it’s a man’s club.
I had the privilege of being on call with her in rkk(hell) on a rainy Tuesday evening. We found ourselves face to face with ofcourse, an anal abscess (these cases tended to gravitate toward me), which was beginning to invade the man’s back and thigh. The indian gentleman wore a grim expression probably embarrassed by us invading his rear. So when she mentioned surgery, he looked completely confused.
“What do you mean I’ll need surgery? By whom? And When? ” his confusion turned into annoyance when she began explaining that she is the surgeon on call. “Sir this pus is beginning to encroach on your skin of your thigh and back, it needs to be drained and debrided now, the last thing you want is for the pus to leak into your blood and cause a septic shock”.
He indeed was shocked. He demanded ,”If you are the surgeon, I’d like to speak to the manager or the boss , and I’d like him to come here directly, NOW” . it seemed as if she expected the response and I watched her face for any signs of anger, i found none.
She moved closer to his face. “Sir this is not KFC, I am the manager and I am the boss, so if you feel unhappy with my gender, please proceed out with your anal abscess” with her gaze strung at the door, she said calmly. I swallowed my laughter.
He sat deep in thought before realising he had little to ponder as he had no other options so he signed the consent form reluctantly.
Pretty soon we found ourselves surrounded by pus as predicted, perched up on makeshift stools, maneuvering around the theatre table. The anaethetist questioned her every surgical move as if he knew any better. All I heard was blatant patronization obviously from an anti – feminist. Baby face seemed unphased which bothered me even more. Was she so accustomed to this treatment?
After 2 hours of digging and probing, she announced she needed the consultant on the phone. The anaethetist grinned and looked pleased as if her incompetence as a surgeon had been proved. He jumped to the phone and conversed with the consultant in Afrikaans while We waited patiently for the consultant to arrive.
He stormed in as if her incompetence was a given muttering Afrikaans phrases beneath his morning breath whilst the anaethetist agreed bobbing his head up and down. “Diverting colostomy” he announced, I cringed. Even during the pre-don era, I had hated the diverting Colo- the ultimate diginiity stripper.
The consultant refused to address Baby face directly and used the theatre nurse to convey the message to she who was perched directly across his face. I was really in utter amazement at the level of disrespect Baby face was receiving with such valor.
She continued to teach me whilst the consultant conducted an awkward surgery through a third person. If i wasn’t confused by this dynamic, maybe I would have actually learnt something that day.
The surgery ended and the consultant left as abruptly as he entered. We were left behind to tidy the mess and complete the surgery. Whilst unscrubbing I watched the soap drip off baby faces petite but capable hands and I wondered how she felt. “So that was awkward” i announced quietly.
She grinned. “Moosa you haven’t seen awkward yet” and she was right.
Some weeks later i found myself in the same operating room with the awkward duo and I seriously considered faking a fainting spell. I decided I didnt have the acting capability and stayed. This time however, the tables had turned.
The patient had requested a laparoscopic cholecystectomy at the last minute after consulting with her Google guide. Rightly so with her co morbidities, deserved one.
The consultant shifted uncomfortably whilst the instruments were prepared. Baby face noted his anguish and came to the realisation that he wasn’t all that familiar with performing one. She smiled.
She said in fluent Afrikaans ,” prof , ek moet asseblief oefen my lap chole, kan jy toesig hou?” The consultant shuffled his feet and rushed to step down, “ja ja jy kan” he looked relieved.
Baby face performed the lap chole with ease and confidence, I gleemed with pride. I respected her all the more for the kindness she showed the consultants ego that day, and he did too.
From that day on, he addressed her to her face without using a 3rd person, a great improvement indeed.