Why I love my job

Today is Thanksgiving Day in the US. Between this morning’s cases I had some moments to ponder on a consultation I had with a patient a few days ago. One of those conversations that is like a glitch in the matrix, seared into my conscience.


Here I am In Canada, far away on the other side of the hemisphere from where I used to be in Australia. I sat with a patient in clinic. People were speaking French behind the door and there was snow falling outside. The view through the window is magical. This gentleman in his 70s sitting in front of me is 5 years away from his treatment of mucosal melanoma of the oral cavity. For a head and neck surgeon, that is significant. Mucosal melanoma is an invariably fatal disease. It’s rare and it gets less media attention compared to its deadly cousin, skin melanoma. The survival statistics is bad. The five year survival rate is about 20%, that is, four in five patients will not be alive 5 years from diagnosis. After his diagnosis, he underwent a major head and neck resection. This was a major deforming surgery that often last 6-10 hours. Some doctors call operations like these ‘horrendoplasties”. Often the question is asked if the treatment is worse than the disease. With such a poor outlook, why, bring someone through such a massive surgery? He has a bigger chance of being dead than alive in a few months.


Because this week he sat in front of me and said, “I am thankful to be alive.”


Like a ton of bricks, it hit me again. This is why I do what I do. This is why I love my job. This is why I devote so much of my time learning to treat head and neck cancer. This is why I train so long and hard. This is why I do the late nights, the incessant oncalls, the long trips to conferences. This is why I stand for 6-10 hours sometimes to finish the job in the operating room. This is why I rely on a team of head and neck cancer nurses, radiation oncologists, medical oncologists, anaesthetists, speech pathologists, dietitians, etc.


It is an incredibly awesome privilege to hear my patients say, “I am thankful to be alive.”


Happy Thanksgiving Day.


Be thankful.

Christmas Wish For My Patients

Here’s what I’m wishing for my patients:



Waterproof hearing aids that do not rely on batteries.

A tablet taken in the first trimester that would eliminate the development of congenital ear malformation.

A percutaneous, image guided insertion of a cochlear implant under local anaesthesia.

A pill to eradicate otosclerosis and acoustic neuroma.

A trans tympanic suction device that would extract cholesteatoma.

A fibreoptic trans tympanic device to microscopically inspect the middle ear.

An ultrasonic lithotripsy device to eliminate otoliths and BPPV.

A once off nasal spray to cure Meniere’s.

Tissue engineered ear drum.



A once off injection to desensitize the nasal mucosa and ablate polyposis.

A nasal spray that would shrink the inferior turbinate.

A microscopic robotic fibreoptic device for sinus surgery, transsphenoidal pituitary and anterior cranial fossa surgery.

A small cream application to expand and stiffen the nasal aperture and eliminate nasal obstruction.



A once off inhaled medication to prevent tonsillitis, pharyngitis, laryngitis.

A tablet to reduce the size of tonsils and base of tongue to reduce OSA.

An inhaled medication to eradicate vocal cord polyps.

An antiviral tablet to eradicate laryngeal papilloma.

Stem cell and tissue engineered vocal cords.


Head & Neck

An antiviral medication to eradicate Human Papilloma Virus.

A blood test to screen for and diagnose, thyroid and head and neck cancer.

A stem cell application to re-grow a resected tongue, floor of mouth and palate.

A sculptured implantable larynx, maxilla and mandible.

Endoscopic parotidectomy.

A handheld robotic fibreoptic device for transoral tumour removal.

Injections that would kill malignant cells in the lymph nodes.

A tablet that would kill melanoma cells.


Paediatric ENT

A nasal spray to stiffen the larynx and eliminate laryngomalacia.

A perfectly designed and implantable laryngotracheooesophageal complex to treat airway stenosis, laryngeal clefts and tracheooesophageal fistula.

A cream to eliminate arteriovenous malformation.

An inhaled medication to eradicate upper respiratory tract infection and otitis media.


And many other wishes.


But most of all,

That the whole world would stop smoking.


What are your Christmas wish for your patients?

Why did I choose ENT?

Easy. It is the most beautiful of all the surgical specialties. I know, I’m biased. Let me tell you why (and I am about to have a word diarrhea here)

It’s true that ENT does not get a lot of fanfare in Medical Schools. Most medical schools may spend 1-2 weeks on ENT teaching. ENT is often out of sight and out of mind in many curricula. That is, until a doctor does a term in Emergency, Family Medicine, general medical ward or critical care. Suddenly ENT problems are appearing everywhere: nosebleeds, headaches, dizziness, tinnitus, ear infection, hearing loss, sore throat, sinusitis, airway emergency, thyroid problems, sleep apnoea, hoarse voice, tongue lesions, parotitis, dry mouth, etc.

In ENT, we get to deal with the most urgent of all conditions (airway emergency), to the least (facial plastics and cosmetics). We deal with the most common of all surgical operations (tonsils, adenoids, middle ear tubes) and the least (open craniofacial resection, orbital exenteration, tracheal reconstruction, brain stem auditory implants). We deal with newborns (EXIT procedure, choanal atresia repair, laryngotracheal reconstructions) and the elderly (skin cancer, etc.) We deal with medical conditions (headaches, dizziness, ear infections) and surgical conditions (facial trauma, head and neck cancer). We have short ops (middle ear tubes, botox injections) and long ones (head and neck reconstruction, acoustic neuroma excision, skull base resection). We do things beyond our traditional territories: CSF leak repair, middle cranial fossa approach, pituitary tumour, orbital decompression, scapula and fibula free flap. We do some really fine procedures (vocal cord laser, stapedectomy) and some big knife ones (maxillectomy, mandibulectomy, facial reconstruction). We cure quickly (Epley’s maneuver, tonsillectomy) or we care slowly (chronic rhinosinusitis, vestibular migraine). We do old procedures (tonsillectomy) and new ones (bionic ear, transoral robotic surgery). In essence, we do way more than most people think.

And we like it that way. The variety is interesting for us, and no one else knows what we do. We keep it kinda like a magician’s secrets.

Let me list some of the exciting things we do to give you a sample:

Otology (Ears)

Otoplasty, exostosis drillout, canal atresia repair, microtia reconstruction, myringoplasty, tympanoplasty, ossicular chain reconstruction, mastoidectomy, stapedectomy, endoscopic ear surgery, facial nerve decompression, semicircular canal plugging, superior canal dehiscence repair, meningioma, CSF leak repair, acoustic neuroma (transmastoid, middle cranial fossa, restrosigmoid), etc.

Rhinology (Nose)

Rhinoplasty, Septoplasty, turbinectomy, sinus surgery, endoscopic maxillectomy, transsphenoidal pituitary resection, endoscopic dacrocystorhinostomy, sphenopalatine artery ligation, orbital decompression, endoscopic craniofacial reconstruction, nasopharyngectomy, oesteoma drillout, meningioma, CSF repair, orbital abscess drainage, etc.

Laryngology (voice)

Vocal cord microsurgery, vocal cord injection, botox, laser vocal cord surgery, papilloma shave, vocal cord medialisation and lateralisation etc.

Head and Neck Cancer

Skin excision, lip reconstruction, glossectomy, pharyngectomy, laryngectomy, laryngopharyngectomy, maxillectomy, mandibulectomy, neck dissection, tracheostomy, craniofacial resection, rhinectomy, microsurgical reconstruction, thyroid, parathyroid, sialendoscopy, parotidectomy, etc.


Tonsils, adenoids, ear tubes, airway reconstruction, choanal atresia repair, microtia repair, mandibular distraction, laryngolamacia supraglottoplasty, vascular malformation, bionic ears, bone anchored hearing aid, drooling surgery, etc

Facial plastics

Rhinoplasty, mentoplasty, facelift, blepharoplasty, brow lifts, fillers, TCA peels, botox, liposuction, implants, fat transfer, etc


Head and neck trauma, skull base trauma., etc

And those are the surgical cases. There are plenty more non-surgical fun to be had in ENT.

I love ENT because of the variety that I see everyday. A good mix of acute and chronic, medicine and surgery, kids and adults., rare and common conditions, routine and creative procedures, quick and complex cases, and lots more.

We’ve found gold, and that’s a secret that we hide from the rest of the world. Best of all, we get to help some people! Every specialty within medicine and surgery is fascinating. I happened to have found something I dearly love and enjoy.

The Martian: What’s a MacGill’s Forceps Doing on Mars?

the-martian-matt-damon I’ve just watched The Martian. Brilliant movie! Geez, I love geeky space movies based on some real science! Rotten Tomatoes’ Tomatometer gave it a 94%, and I concur. The movie was well acted and well directed. More importantly it was built on some good science, the non-Hollywood kind. The Martian is based on a book by the same name written by Andy Weir. Quoting from the receptacle of all wisdom that is Wikipedia: “Andy Weir, the son of a particle physicist, has a background in computer science. He began writing the book in 2009, researching related material so that it would be as realistic as possible and based on existing technology. Weir studied orbital mechanics, astronomy, and the history of manned spaceflight.”

The publishing story itself is amazing. He got rejected by publishers. So he released it free on a website chapter by chapter. Fans wanted it published in a book form. He put it up on kindle for 99c. Bought by thousands. Publishers smelled money. Signed him up for copyrights. The rest is history.

A geek wrote a geeky science story for geeks. Nerds rule. Science is amazing. One of the most quotable lines from the book/movie: “I’m going to have to science the s#*t out of this”.

I digress.

Without giving too much of the story away, let’s just say that early in the movie, Mark Watney, the stranded astronaut, had to remove something from his abdomen by performing self-surgery. The way he applied local anaesthesia was brilliant. Worth us considering that kind of technology for our patients. But unfortunately the local anaesthesia didn’t work because there was tense music playing in the background and he was still in pain. Next he pulled out an instrument to extricate the foreign object. This is where I got a little nervy. Now I’m sure thousands of dollars was spent on validating the aerospatial, astronomical and botanical science behind the movie. They missed out on a simple phonecall to a surgeon for medical advice on the movie.


You see, Mark Watney pulled out a MacGill’s forceps to extricate the foreign body. What? I know. Pick yourselves up from the floor now. I was as surprised as you are. You see, a MacGill’s is not a surgical instrument. It is an anaesthetic instrument designed to assist in introducing the endotracheal tube into the larynx & trachea. No surgeon would pull out a foreign object with a MacGill’s. And unless you were planning to intubate someone on Mars (I suspect not, because they will have to remain intubated for the trip back to earth which would take months), then a MacGill’s should not be in the standard NASA package for survival on Mars. Much easier to pack smaller and more useful forceps like Adson’s, Gillies’, or Bonnie’

Anyways. At least he stapled the wound closure well, though I hope by then on Mars that we would do away with staples and simply spray on some skin glue that closes the skin and reduces scar formation.

What do you think? If you are a scientist of any sorts, was there any other inaccuracies in the movie?

Five People You Will Meet on Social Media

Twitter is a communication platform, and therefore, it is a neutral medium. It’s not the medium itself, but how you use the medium that makes Twitter ‘good’ or ‘bad’. In my 5 years of being an anonymous and 5 months of being a named individual on Twitter, I have come to realise that different people use Twitter for different purposes. In general, these are the 5 people (or doctors) I have met on Twitter. They have enriched my experience on Social Media and taught me much about life and doctoring.

  1. The Knowledge Distributor

These are the ones who frequently tweet and retweet various information, news, latest studies, guidelines and opinions. Following a few of these people will add to your knowledge base. They often have tens of thousands of followers and they usually have tens of thousands of tweets. They are good at disseminating information. Their timeline is full of information. The downside? They read like a newsfeed and therefore often lack the personal and social engagement that is an enjoyable part of Twitter. But they serve their purpose well. I learn lots of new things from them.

  1. The Court Jester

The Court Jester is the one who entertains, enlightens and yet educates at the same time. They’re the ones who put up a mirror to our faces. They poke fun at important issues, sometimes even taboos, and bring up a very important message. They are often the ones behind the mask who would tell the truth when no one else would. They provide the behind-the-scenes look at the medical industry (or any industry) and challenge the status quo. As you can guess, they’re often anonymous. They’re the ones the lawyers and administrators warn you about. But I see great value in following them. Because they tell the truth behind their masks, I reckon every industry needs some of these, with respect of course. I can think of a few doctors who are anonymous who make a massive impact through their Tweets and blogs.

  1. The Social Collaborator

They are fun to hang out with. They are one of the main reasons for joining social media. It is social after all. There are lots of conversations about life. Lots of food photos and baby photos. And cat photos, of course. One must never forget the abundance of cat photos on Twitter. Sometimes, in their eminently sociable space, the line between public and personal lives get crisscrossed. Raw emotions, anger, bitterness and hurts make their way into their tweets. It can be painful to watch. Sometimes downright unprofessional. But I love following them, because at the end of the day, we’re human. I need to always be in touch with the raw and unpredictable nature of human emotions and relationships.

  1. The Relentless Commentator

The devil’s advocate. They seem to have an opinion on and a comment for anything and everything. Some of them good, some of them very critical and negative. They always provide a contrasting view and they’re happy to let loose with their opinions. You’ll find them debating certain issues with passion and their timeline reads like an angry verbal joust. It’s good to follow them because there are always many sides to any story and you get to learn from them. However the line between respectful difference versus discourteous disagreement can be very thin at times. First rule of Twitter: be respectful of others.

  1. The Thought Leader

Here’s the one everyone wants to be. The person who leads the world with contemporary ideas and tweets their sophisticated perspective to everyone. Twitter truly adds to their impact and in some immeasurable ways, they are truly changing the world. They are examples of what’s good on Twitter. The synthesis and harnessing of people and expertise. There are not too many of them around, true thought leaders. When you’ve found them, they’re a treasure to follow as they enrich your days with colourful thoughts and perspectives. I’m certain that they would be as amazing in real life as they are on Twitter.

It would be great to follow a few of these different kinds of tweeps to challenge your thinking and enhance your perspective. What about yourself? What kind of a twitter person are you? My guess is that most of us would be a bit of all of them. Who we are on Twitter is probably defined by who we are in real life and what our purposes are in joining social media.

My Twitter Experiment: From Anonymity to Community

I was once Australia’s most followed surgeon on Twitter, according to dear wife. She was probably right, as always. I had more than 3700 followers on my account, but very few people knew who I was behind that necktie avi. You see, I was an anonymous, or more correctly, a pseudonymous. There were 3 reasons why I chose to start off life on Twitter as an anonymous surgeon:

  1. Who wanted to hear my voice anyway? I was a young trainee surgeon at the time. There were more important people and celebrities to follow. Who wants to follow me? Well apparently, as this twitter experiment rolled out, quite a few.
  1. Is it really safe to be a doctor on Twitter? Australia was grappling with the legalities of doctoring and tweeting. No one was sure if it was safe to be a doctor on social media. I think we’re a little wiser now.
  1. How do you use this Twitter thing? Twitter was new. It didn’t come with a manual. I haven’t found my voice. I didn’t know what works and what doesn’t.

So, over 5 years and more than 22000 tweets, I learned a few things from Twitter:

  1. People are inherently interested in other people’s lives. So somehow, as I shared my victories and struggles through my surgical training, people listened and friendships were built.
  2. Twitter is the great equalizer and collaborator. On twitter I can speak to a Professor, Astronaut and Miss Universe at the same time. We’re each individuals with a voice and the chance to collaborate on multiple issues affecting individuals and the great public.
  3. The rules of real life applied to Twitter. Respect, kindness and authenticity are valued as much on Twitter as in real life. If you’re not a likeable person in real life, chances are, you won’t be likeable on Twitter.

After having found my voice and learned the good and bad of Twitter, I decided to lock the account, come out and start afresh with a new personal account. I’ve learned now the difference between the effectiveness of an anonymous, and that of a named account. I learned that these are the strengths of an anonymous:

  1. People were happy to treat the anonymous as a sounding board of their issues. I had lots of DMs and private conversations with people from around the world. I suppose, it’s like talking to a bartender or cab driver. People were happy to spill out their guts to someone they don’t really know by name.
  2. As an anonymous, I was the court jester or stand-up comedian who could point out issues in real life and poke fun at it with the hope of bringing a serious message. There are many effective anonymous accounts that do this very well. As a named person, however, I tend to be a lot more careful with my words as it can now be contextualized and locked to a person, time and place. The generality of the issues discussed suddenly become specifics.
  3. Being an anonymous was for me a safe way to learn, observe and discover what twitter was all about. I learned the strengths and limitations of twitter. I have regretted a handful of tweets. Who wouldn’t? I have learned some good lessons.

Twitter is a powerful medium of communication and collaboration. I would encourage all physicians and surgeons to consider being on Twitter to extend your reach and impact. If however, you are concerned and hesitant about it, I would suggest a gentle progression from Twitter anonymity to community.

Why I love twitter but need to let it go.

I wrote this on 27th December 2013 on my ‘anonymous’ blog. Interesting reading one and a half years later.

I joined twitter 3 years and 4 months ago. I did it twice. The first time as an observer-explorer, but gave up on it. The second time, with a friend’s encouragement I tried it again. Like any new technology, medium of expression, or tools, there were trials and errors. I didn’t know how to use twitter at first, but well, none of us did. People got into trouble for their tweets, and I did too. There have been doctors out there ready to crucify me and my tweets as it did not fit their brand of professionalism. The legal boundaries formed around tweeting doctors were blurred and there was a period when we doctors were forced to ‘come out’. All these anonymous witch-doctors were being pulled kicking and screaming out into the open.

Why did I join twitter?

  1. Enjoyment (Social)

It’s social media after all. Twitter is mostly fun, encouraging and funny. There are a few out there for negative reasons, but it’s a mostly safe social arena. I have met many wonderful, interesting, fascinating people who are now dear friends to me. These are not friends I’d ever meet through ‘traditional’ social methods, frankly because I have no time to socialize in parties or pubs anymore. Remember that for every tweet, there are plenty of personal DMs not seen by the public. Some of those DMs from close twitter friends have pulled me together during difficult times. Hey, I even got Canadian socks from an awesome Twitter friend who I’ve never met before. It’s like pen pals in the past. The sharing of words and lives is an inherently human experience.

  1. Education (Learning)

I’m on twitter to learn a bit of medicine, surgery and life skills in general. Some of the studies that have changed the way I practice surgery I first read on twitter. Some life wisdom that has encouraged me to live a better life I first read on twitter. Funny one liners, trivia, awesome pictures, random information, latest news and all sorts of beautiful things that colour my day all gets delivered through twitter. I have learned much through twitter. I’m usually the first on my unit to hear about a breaking news, new ideas, interesting studies, etc.  Twitter adds colour to my days.

  1. Engagement (Teaching)

Yes, if you haven’t figured that out already, I’m an ENT surgeon in training. It means that one aspect of my calling as a doctor is to teach others how to live better lives and help them through their ENT problems. I also freely give out life advice that I’ve found helpful. Take it or leave it. More importantly, I want people to laugh or smile when they read my tweet. I want people to enjoy my tweet, not get a PhD in ENT.

What else have I learned through twitter?

  1. Twitter is here to stay.

Just like moving from snail mail to e-mail, from phone landlines to mobile phones, from desktop computer to portable personal computing, Twitter is a new medium of communication that is here to stay. When I’m looking up another doctor, I not only look up their addresses, emails or phone numbers up, I also look up their twitter handle. Twitter is a new address, a new email, a new phone number, a new contact point in this increasingly interconnected society we live in. It almost does not matter if we live on different continents, as long as you’ve got twitter, you can contact/DM/interrupt my day any time, as if you’re a colleague working in the next operating theatre.

  1. Twitter helps me express my thoughts.

I used to journal my thoughts. I still do. The word is my medium of self-expression. I find that I feel better if I can articulate my convoluted mind using a few well-chosen words. Not that I’m a poet or anything. Twitter is like a toothbrush. It keeps my brains clean and free from thought sediments. My wife knows this and although she hates me for spending too much time on twitter, she also knows that it is my medium of expression. It’s a way of me clearing up my thoughts as I go through my stressful surgical days. That’s why I hope to continue tweeting to keep my mind active.

  1. Get a shorter twitter handle next time.
  2. 3,700 followers mean nothing if you’ve added nothing into their lives.

There are celebrities with millions of followers. I don’t want to be that. But I do want to be an inspiration to a few. I want to help if I can. Twitter is a unique method of getting into people’s lives. When I’m followed, it means that I’ve been invited to enter into the lives and thoughts of someone, and I need to respect that. I cannot be putting up garbage on their timeline. I want people to laugh, or be inspired, or learn something from my tweets because they have allowed me the privilege of allowing my words to enter into their conscious minds.

  1. The timeline is the appetizer.  The DMs is where the public becomes personal.

I’ve seen your hurts on your DMs (Direct Messages). I want to reach out and help. Words, even mere words, can be an incredible powerful agent of change. Tell me your pain, and I will do what I can to share in your struggles. It’s like being in a busy train, sometimes you strike up a good conversation and tell your story to a total stranger who can share your pain even if only briefly.

  1. People are inherently interested in other people’s lives.

The common bond amongst us all: life. We have lives to live, stories to tell. I’m interested in your life and thoughts. And I know that many people are interested in what it’s like to be training as a surgeon. I tell you my story. I allow you to see the raw emotions I feel when I’ve been on call non-stop for 10days. I tell you my struggles with family, work, dying patients, etc. And I’m interested in your stories too. It’s like sitting around a campfire, trading stories, enriching lives.

  1. Don’t judge a tweep by a single tweet. See the whole timeline.

Lots of bad twitter fights happen because of this error in misinterpreting a single tweet. In life as in twitter, there is no point winning an argument but losing the friendship.

  1. Everyone is equal and accessible on Twitter.

I can speak to a professor, an astronaut and a Miss Universe contestant on Twitter. And I get to discover that they are all down to earth people, happy to live out their ordinary lives. It’s inspiring like that. Similarly, I hope people can just tweet me up and I can help them in whatever way I can.

  1. There are different uses for twitter.

Some are on twitter for commercial reasons. Some for clinical reasons. Some for political reasons. Others like me, are here for fun. Just like in any social gathering, don’t assume that everyone is here for serious purposes. For example, my lighthearted comments about medicine and surgery have been mistaken for serious criticisms. The funny thing is I never meant for any of my tweets to be a serious opinion. I liken myself some times to the court jester who performs and cracks jokes to provide a lighthearted alternative at looking at this serous business of life and surgery. The Surgical News, which is the monthly magazine of The Royal Australasian College of Surgeons, read by thousands of Aussie and New Zealand surgeons routinely include several articles written by anonymous Prof R U Kidding, Dr BB Gloved and Dr IMA Trainee. They are anonymous articles meant to poke fun at the serious business of surgery. Sometimes being told directly about an issue has a negative effect compared to being told a funny story by an anonymous. The effect is the same though: laughter, enlightenment and behavior change. I hope my tweets do that. If you’re looking for medical information, there are plenty of doctors on twitter who do that better than me.

  1. It’s ok to be an anonymous doctor.

I know some would not agree with that. This is how I see it: being a doctor is who I am. I cannot separate who I am in real life and who I am on twitter. But I’m not here on twitter as your doctor, so I’m not going to offer you personal medical advice. Also, I’m not here as a professional entity, although I will remain professional and courteous. I’m not here marketing my surgical practice. I’m here as me, myself and I, who happened to be a doctor and tweet doctorish thoughts. If I can help you in any way, does it matter if you don’t know my full name? I’m not endorsing any special treatment, surgery or thoughts. You don’t really need my name.

Sometimes I share the raw emotions, the confusions,  the frustrations, the anger, the uncertainties, the inexactness of the science and practice of surgery. All those things are real. Real patients and real doctors know that. Medicine is not a sterile, perfect, exacting practice. I don’t think I’m painting a bad picture of medicine and surgery when I share some of those raw experiences. I don’t think I’m being unprofessional when I’m questioning my own and my hospital practice. I don’t think I’m being unprofessional when I’m sharing the human side of medicine and surgery – the blame game, the politics, the money, the administration, the ego clashes. And I don’t think that I’m hiding behind my anonymity when I do that. I’m sharing the real story behind doctoring that does not need to be hidden. One day I will come out. But at the moment I still feel that I am effective being an anonymous. And yes, I am accountable for every tweet I have tweeted. I’m fine with that.

Twitter has become a routine part of my daily life. I’ve had so much fun with it. I’ve learned much, and I love it. It has given me so much needed support during odd hours of my nights. It has been a real enjoyment, education and engagement tool. I hope to have inspired some lives out there during the process.

But I need to let it go.

Why? Because it has taken up so much of my thoughts and my time. I need to focus on something else of immense importance in the next 3 months, and I need to be single-mindedly preparing for this and this alone: FRACS Fellowship Exam. It’s like taking a sabbatical. I need to focus on studying and training myself up to be the best I can be, so that hopefully I can return as a fully trained surgeon and be even more helpful for the people around me and my friends on twitter.

So farewell, my friends. While I fall in love with ENT, will you keep a space for me when I return.

5 Reasons Why Surgeons are better at Tweeting

I wrote this on 20th November 2011 on my previous anonymous blog. This was meant to poke fun at surgeons and Twitter. what do you think today?

A/Prof Katherine Chretien and team has recently published a landmark study on Twitter Physicians. It was aptly titled “Physicians on Twitter”, published in The Journal of The American Medical Association, February 9, 2011—Vol 305, No. 6, pg 566-568. There are some very interesting statistics there. Definitely an article worth a read particularly if you’re interested in the use of Social Media in Health Care.

There have been many correspondences and blog posts written in response to the article. Most of them have indicated the good progress that doctors and medical professionals are making in utilising tools such as Twitter, Facebook and the like.

When the article detailed the profile of doctors on Twitter, there were a few surprises.

Guess which group of medical specialists Twitter the most?


That’s right! There are more Tweeting Surgeons than other specialties. (Read the article for the rest of the specialties and see how your specialty ranks.) I found this a little interesting because we surgeons often work longer hours and are usually stuck in theatre doing stuff. When do we find the time to Twitter?

So I started to analyse my own tweeting habits, and asked myself why Surgeons tweet more than other specialties.

I think I’ve found 5 reasons why Surgeons are Superior at Tweeting. Here are the reasons:

5. We are always waiting for theatre.

I don’t know how it works in your corner of the world, but here in Australia, taking someone to theatre is like getting a bride to the church altar. We have to book the church, get the certificates signed, get all the equipments, romance the anaesthetists (who are usually the atheists who do not believe the surgery need to happen and withhold their blessings), bla.. bla.. bla… After all the hard work of organising theatre,  we wait till the cows come home or pigs fly. So we surgeons end up having lots of times twiddling our thumbs waiting. We wait, therefore we tweet.

4. We are brief, succinct, and to the point.

We are simple people. We’re not multifactorial. We can’t compute the cosmological reasons why someone should be on omeprazole instead of esomeprazole in some situations. Hence, our simplicity limits our thought processes to 140 characters only. Perfect for twitter.

3. We’re more comfortable speaking out when no one talks back.

The beauty of twitter is that there are so many conversations going on at any one time. It’s like a college party. So many tangential conversations, and in the morning you can’t remember who you’ve talked to last night. Surgeons, being surgeons, love to impress people, and perhaps we like to impress but not really want to be spoken back to. Perfect communication style for twitter. Follow me, and I might follow back, maybe.

2. We are not comfortable socializing with real people.

We like our consults brief,  our operations long, our patients asleep, and our anaesthetists asleep as well. Just like twitter.

And the top reason why Surgeons are More Superior at Tweeting:

1. We have the most outstanding, intelligent and witty one liners.

Perfect for twitter. Some call it sarcasm, others call it irony. We say, witty.

Now if you are a surgeon, any other reasons you are better at Twitter compared to your non-surgical colleagues? If you’re not a surgeon, aren’t we right?

What will greet me this Christmas: ENT Emergencies.

I’ve been told many times, “You’re doing ENT, that’s great. Early Nights and Tennis. Easy life with no emergencies, right?”. I’ve also been asked many times, “Is there such thing as an ENT emergency?”

Well, let me list some of the emergencies I’ve personally been involved with over the last few years. When I’m oncall for 10 days straight over the Christmas & New Year period, these are the emergencies that I will meet at odd hours of the night.

·      Post operative tonsillectomy bleed: a bleed from a branch of the high-pressure external carotid artery into the oral cavity and airway. Picture those horror movies where blood pours out of the nose and mouth. I have had to put my hand in a girl’s mouth and knelt over her body as we got wheeled into the operating room with full on resuscitation.

·      Gunshot wound to the neck. Messy.

·      Gunshot wound to the face. Bloody.

·      Airway obstruction from an invasive thyroid cancer. Emergency awake tracheostomy performed through friable cancer mass. Death stands beside me while the patient in distress stares back at me as I cut her throat awake.

·      Tooth abscess becoming a Ludwig’s angina, compartment syndrome of the floor of mouth. Mouth swollen, can’t be opened.

·      Tongue cancer bleeding into the airway. Cannot intubate through cancer and bleeding tongue the size of cheeseburger in the mouth.

·      Quinsy peritonsillar abscess becoming parapharyngeal abscess and disseminating rapidly inferiorly into the mediastinum. Death.

·      Epiglottitis, cardiac arrest. Emergency specialist and anaesthetist cannot intubate cannot ventilate. Slash tracheostomy in 10 seconds.

·      Massive epistaxis in a haemophilliac, or those on warfarin/Coumadin/aspirin/assasantin/dabegatran, or those with platelet disorders, or arteriovenous malformation.

·      Facial trauma, midface degloving, massive bleeding from ears, noses, eyes, mouth.

·      GCS 5, cerebral abscess and cerebral vein thrombosis from acute otitis media and suppurative mastoiditis.

·      Arteriovenous malformation bleed from an erupted tooth requiring maxillectomy.

·      Airway burns from house fire.

·      10month old child swallowing an opened safety pin, lodged in the larynx next to the carotid arteries.

·      11month old swallowing Christmas ornament, lodged in mid oesophagus.

·      12month old child swallowing a button battery, resulting in perforation of the trachea and oesophagus.

·      Fishbone lodged in the larynx.

·      Lamb bone perforating the oesophagus.

·      Epistaxis from a nasopharyngeal carcinoma, out through the nose, and down into the airway.

·      Lego piece inhaled into the lung.

·      Denture with metal hooks swallowed and lodged between the larynx and oesophagus.

·      GCS7, meningitis due to frontal sinus abscess penetrating into the brain.

·      Eye abscess secondary to bacterial sinusitis. A young lady was blind in 12 hours from a misdiagnosed sinusitis.

·      Acid and alkali ingestion causing airway chemical meltdown.

·      Nasal septal abscess causing bilateral cavernous sinus thrombosis, blindness and death.

·      Carotid artery blowout due to erosion from neck cancer.

·      Relapsing polychondritis and Wagener’s granulomatosis causing cricoid airway obstruction.

·      Kids developing abscesses behind the eye from a bacterial complication of the common cold.

·      Acute mastoiditis from ear infections in young kids, causing facial paralysis and brain abscess.

·      Meningitis and CSF leak from a nasal cancer invading into the brain through the cribiform plate.

·      Retropharyngeal abscess in young kids, causing stiff neck and airway compromise with pus into the airway.

·      Invasive fungal sinusitis/mucormycosis in chemotherapy, transplant and immunosuppressed patients, causing fungal invasion into brain and eyes.

·      Airway obstruction and suffocation in patients with laryngeal cancer.

·      Clothesline injury/hanging injury causing laryngeal fracture and laryngo-tracheal separation.

·      Neonate with airway obstruction from vascular ring, vocal cord paralysis, choanal atresia.

·      Tracheostomy tube eroding into the arch of aorta.

·      Jellybeans, lego, foam in noses that can possibly end up in the lungs.

·      Infected branchial cysts and deep neck space abscess causing airway obstruction.

·      Skullbase fractures, CSF leaks from ears and noses.

·      Sudden deafness and dizziness from brainstem tumour.

·      Airway obstruction from glandular fever.

·      Paradoxical vocal cord movements from whooping cough causing airway obstruction.

·      Neck and airway trauma.

·      And many more.

Season’s greetings!

Wishing you a safe Christmas and praying that none of you would ever need to greet a surgeon this season.

8 Things 8 years of marriage has taught me

Last weekend was our 8th anniversary weekend. Lots of people did not believe that I’ve been married that long. I wonder if it’s because I looked young, or perhaps because people did not think that marriage could last my surgical training that long?

You know the old joke: An elderly couple was asked “Wow, you’ve been married for such a long time. In all these years, has divorce ever crossed your mind?” The old couple replied, “Divorce? Never. Murder, many times.”

Anyway, it’s been such a heaven on earth, and I feel that I have not yet left my honeymoon stage (don’t know if my wife has left the honeymoon stage and thinking of murder at this point). I think it is important for me and for my dear wife (who received a late anniversary present) to know how I feel about our marriage. I thought about it while facebooking the other night, and realised that I have learnt a lot of things about marriage and life in general.

These are the 8 things 8 years of marriage has taught me:

1. Marriage is easy.

Yes, particularly if you married the right person. I don’t know what all the fuss was about ‘surrendering your rights’, ‘putting spouse before me’, ‘loving and serving’, etc. I thought my marriage was relatively easy. I think that’s where I’m extremely lucky. I got myself a good spouse. Well, I had 9 other competitors going for the same girl many years ago, but I won the fight and took the girl trophy home. It’s smooth sailing from then on. So my advice boys: choose your spouse carefully, and fight hard for her!

2. Marriage is costly.

Have you seen the number of gifts I bought for her? Bags no longer used, dresses no longer worn, accessories still in boxes, flowers now decayed. It is costly, but it’s all an investment. “It’s the thought that counts” is a myth, people. It actually is the gift that counts. But that’s ok. To see the smile on her face, that’s priceless. For everything else, there’s mastercard. And all the extra oncall shifts that comes with it.

3. Marriage is safe.

We decided early on to enter the covenant of marriage in a biblical sense and never never never ever consider divorce as an option. It seems almost counter-cultural in this day and age where almost 1 in 2 marriages end in divorce. But we found that this commitment has kept both of us safe. We can count on the other at all times. We face challenges, any challenges, as a team. I feel safe when I’m with her, and so does she.

4. Marriage keeps you humble.

I don’t like to admit this, but I often feel like a real flawed human because I’m living with a flawless angel. Her beauty, compassion and purity of heart keep my cold surgical heart and arrogant attitude in check. Each time I act like the lord of the universe, she reminds me of who I am and keeps me in right perspective. I put away my light sabre yet again.

5. Marriage does not cure loneliness.

It’s interesting to think that many people get into the marriage thing hoping to cure their loneliness. Not quite. What’s worse than being lonely is being locked in relationship with the wrong person and feeling alienated by that person. What some call loneliness, I believe is something else altogether.  Blaise Pascal, a French Mathematician and Physicist said “There is a God shaped vacuum in the heart of every man which cannot be filled by any created thing, but only by God.” I think I understand what he means. Marriage is not that which will absolve all your loneliness. Once that God-filled vacuum is filled, marriage can and will bring out the best in you.

6. Marriage is fun.

Needless to say, my happiest moments in life happen within the context of my marriage. And these joyous times are even better because they are shared with my best friend. Examples of our fun times? Birth of our son, family holidays, getting into our training programs, and well… a few other things that a family-friendly blog cannot include.

7. Marriage hurts sometimes.

As iron sharpens iron, so does one person sharpens another. She makes me a better person. Not easy for her, nor for me. But I realise the emotional pain I feel is for my own good as she always sees the best in me. And because we know each other so well, we are also the one most able to hurt each other with a particular word or two. Marriage opens the darkest parts of me. She knows that, sees that, and still loves me because she can also see the potential good in me. The hurts are necessary so the good will be experienced.

8. Marriage is about the journey.

We agree that we are stronger today than 8 years ago. We haven’t got there yet. We know the road ahead will not always be smooth because we have some very big dreams about what we want to do with life. But we’re safe. Because we’re best friends on the same journey, we can face all of life’s storms together. We do not know our ultimate destination, but because the journey is so enjoyable as it is with her at the moment, it probably does not really matter where we will be.

Now, I need to get approval from dear wife to post this blog… Wish me luck.