Medicine – Eric Levi

3 Things My 3-year-old Taught Me

27 November 2011

This weekend my darling wife went away interstate for a training conference. Some Infectious Diseases clever doctorish stuff. Things we surgeons just do not understand, or even wanna try to understand. I always think, there are only 3 antibiotics in the world anyway, so why spend a beautiful weekend attending conferences on those 3 antibiotics?

So it was left with the trio of Father, son and the wholly MacDonald’s. (Noooo…. don’t worry, we did not go to MacDonald’s at all this weekend.) Anyway, we both survived the weekend. Mommy was surprised we both maintained healthy weights.

During the weekend, my son taught me 3 little things. I’ve been taught these things in the past, but being the simple surgeon that I am, I always need frequent reminders.

1. The Discipline of Unhurriedness

As a trainee surgeon, time is limited. I’m always in a hurry trying to get things done. I have books to read, jobs to do, patients to cut, research to complete, etc, etc. I often have the problem of bringing home that kind of surgical mindset and applying it to the general running of this household. I need to remind myself that this is not a hospital to run, but a home to enjoy. I need to stop being in a hurry. My plans for a 7am wake up, 7.30am out the door for breakfast and 0815am arrival at the Aquarium were not appreciated by my son. He wanted to chill. He wanted to take time choosing his cereal. He wanted the cereal sprinkled across the kitchen room floor. Then he wanted to run around the house in his nappies expecting me to run after him in my underwear. It didn’t matter what jobs we had to do and how much we had to accomplish by the end of the day. We just needed to play. There wasn’t a list of Reminders and To-dos. There was just me, and him. And I admit I had to fight this surgically-trained urge of goal-oriented time-managed behaviour. I had to let time go. I had to be unhurried. It was not time ‘wasted’. It was time ‘invested’ in my son.

2. HIS Happiness Matters

My workplace is full of sickness, pain, diseases, blood, sputum, saliva, snort, negativities, stress, complaints, anger, frustration, etc. Sounds like I work in a bank. No, hospitals in general aren’t the happiest place on earth. Hospitals are full of the egos of doctors, the pride of nurses, the pain of patients, and the anxieties of families colliding. It is a highly charged environment. So when I spend a weekend with my son who smiles and hugs me and says, “I love you, daddy”, that softens my calloused heart. My son’s happiness detoxifies all the poison that I’ve drunk during the week. My son’s happiness reminds me that all the hard work will one day be worth it as long as I keep my life in balance. My son’s happiness does something to my heart that no amount of fame, fortune, alcohol or even the most successful of operations could ever do. My son’s happiness reminds me to be humble and to strive for the simple things in life.

3. MY happiness matters.

Twice this weekend my son asked me, “Are you happy, daddy?” Almost brought tears to my eyes. He must have known that I am a surgeon. I am always angry, upset, uptight, obsessive-compulsive, and short-tempered. He probably sees me angry more often than happy. He knows that I bring home the stresses and demands of work. This 3 year old just wants his daddy to be happy. How could a 3 year old know that? He does not like being near an angry daddy. He wants me to be happy. My happiness matters to him.

And how often does my happiness matter to my wife, my son, my family, my workmates and my patients. I have been asked many times at the end of an operation by patient’s families if I was happy with the outcome. Patients do rely on a surgeon’s happiness for their sense of hope. Nurses sometimes say at the end of an operation, “you’ve gotta be happy with that.” Even the surgical team takes pride and walks out happy when they see the surgeon walks out of theatre happy.

My happiness matters. Not in a self-centred egoistical way, but in an others-focused way. My happiness does matter for others.

Thanks, my lovely Little E.

Of Phones, Pagers and Positions

8 November 2011

I still remember carrying my first pager as a medical student. It was such an honour. I almost felt like I was finally someone important enough that people need to call me. Funny I felt that way, because the pager was really there just in case our tutors needed to change our tutorial times or locations. But still, I was proud. I fantasised about getting some pages from nurses desperately wanting me to help them resuscitate a patient, or of emergency departments wanting me to attend to a trauma call. Those pages never came. A few pages we did receive asking us why we were late for tutorials.

And then I actually became a doctor. I started getting ‘real pages’. But after a few days of feeling all important, those pages became an annoying interruption to my day to day work life. “Please take blood on bed 5”, “IV re-site in ward 5”, “Drug chart lost, please re-write”, “Patient fell off bed, pls review”, etc, etc. The pager became a constant annoying interruption to my activities. I remembered a day when I was operating and had trouble with a life-threatening bleed while receiving more than 5 pages about scripts, discharge summaries, admission forms, and other menial paperwork tasks. The ward clerk wanted to fax the papers before lunch. The nurses wanted to administer the drugs before morning tea. And I needed to make sure my patient on the operating table wasn’t dying. I couldn’t have answered the pages, but still, the nurses weren’t happy with my late reply.

A study (Westbrook, et al. The impact of interruptions on clinical task completion. Quality and Safety in Health Care, 2010) has shown that doctors are interrupted on the average, 6.6 times per hour. We get interrupted every 9 minutes or so! 11% of all tasks were interrupted, 3.3% more than once. Doctors multitasked for 12.8% of time. The mean time on task was 1:26 min. Interruptions were associated with a significant increase in time on task (We take longer!). And doctors failed to return to 18.5% (95% CI 15.9% to 21.1%) of interrupted tasks. Every 1 in 5 tasks don’t get completed. (We forget to finish the chart, left the tap running, left the sharps on the trolley, zip up pants, tie our scrubs, finish shaving legs, etc.).

And then I started being the registrar on call for the hospital. I did general surgery, plastics, urology, vascular and of course, ENT. When I was on call, the hospital had my mobile number and home phone number. I went home, but was always interrupted by phone calls from the hospital. Dinners were interrupted, TV was interrupted, even vacuuming was interrupted (my wife is laughing cos she has never seen me vacuum). These interruptions came at any hours of the day and night. Getting calls about nose bleeds and ear aches at 4 in the morning is just not nice. But I have to be nice on the phone, don’t I? Otherwise other doctors and patients will complain.

Those who call me at 4 in the morning probably do not realise that I am on call on top of my usual day job. I still have to do my operating despite having been in and out of the hospital 2-3 times overnight. Can you imagine me operating on you with only 2 hours of sleep?

So as I climbed up in my position, my pager and phone became the yoke I have to carry, the cross I have to bear. What started off as an item of status and position has now become a reminder that I am here to serve, help and assist. Yes I am on call. In all honesty, I hate being on call. But it is my duty and my privilege. Yes, I am ready to be interrupted. Despite my tiredness, I shall attempt to help you.

Doctoring isn’t for the weak-hearted. It is also probably not for those who can’t multitask and be easily interrupted. Yes, I am a Surgeon, Interrupted.

Epistaxis: Stop it like a kid.

31 October 2011

What a lovely word! It comes form the Greek word epistazo which means to bleed from the nose (duh!).

Most of us will have nosebleeds at one point in our lifetime (if you haven’t had that experience, try vigorously digging your nose, or call someone ugly). It is said that up to 60% of us will have nosebleeds in our lifetimes, but only 6% will require medical attention, and only a further 6% in that group will require admission to a hospital (and you shall see me!). So rule number 1: not all epistaxis need to be seen by an ENT surgeon (HINT, HINT: ED). However, from an ENT Surgeon’s point of view, it is the most common ENT emergency that gets referred to us.

Let me just mention that big group of nosebleeds to whom medical attention is not required. Guess where is the driest part of the human body? No, not the wallet. It’s the inside of the tip of your nose. The nose is divided left and right by a soft cartilage called the septum. That septum is a narrow passage for air (and dust, and pollen, and grass, and perfumes, and body odours etc). It gets dry very, very easily. (If you don’t believe me, try pinching your nose and breathe through your mouth. See how quickly your mouth dries up.) So to keep the septum from becoming too dry, we set up a massive camp for blood vessels there to warm and humidify the air that gets through the nose past the septum.

That’s a tricky combination isn’t it? To warm the inhaled air, we need lotsa blood vessels under the surface. Yet when it gets too dry and crusty, these vessels bleed easily.

So what should one do when one is epistaxising (nose-bleeding)? Here are some simple tips:

1. Relax. It happens some time. Quickly say sorry to the one you called ugly.

2. Don’t tip your head back. Guess where the blood will go? Swallowed into your belly, which will make you sick. Or inhaled into your lungs, which is not nice, coz you’ll splutter and cough. Tip your head down.

3. Pinch the lower half of the nose, the soft, fleshy cartilage part. You see the top half of your nose is bone, and the bottom half fleshy. No point pressing on the bony part. Well, unless you’ve been punched so badly that the bone is now mush. I suppose you can try pressing on that too.

4. Open your mouth slightly. Take slow deep breath.

5. Point number 4 above is also applicable when giving birth.

6. Suck on ice, or have some cold drinks, preferably non-alcoholic and without a mini umbrella in the cup as it may poke you in the eye. Suck like a kid. Ice cream, icy poles, milkshakes, etc. The cold may help constrict blood vessels and give you a bit of brain freeze too. Have some ice compresses to your forehead or back of neck as well if you like. Call room service if you can’t do this alone.

7. Wait a few minutes. Update your facebook status, tweet, or flush the toilet. Whatever.

8. Most bleeds will settle.

9. Once the bleed settles, remember that inside your nose is a raw area that needs time to heal over a few days. So bungee jumping the next day may result in a repeat bleed. Try not to call anyone bad names in the next few days as well.

10. Moisturise the nose over the next week or so. My recommendation: go to the baby section at your local chemist and grab a baby bottom cream. If it’s good for a baby’s bottom, it must be good for your nose. Just apply a small amount (using your finger, not your baby’s bottom) into your nostrils 2-3 times a day. It should help moisturise the nose while that raw bleeding area crusts over and heal up.

These simple steps will help in managing most bleeds. These are also good advice any doctor can give when managing a patient with epistaxis. But of course, many these often don’t get as far as the doctors or the ENT surgeons (thankfully).

What about the bigger bleeds?

7 Things ENT Surgeons Can Learn From the Hairdressers

27 February 2011

I’ve been to the hairdressers many times in my life time (that’s an indication that I’m not balding, yet). I’m mostly a drive-through type. I go when I have a free 18minutes and 30seconds from my schedule, and make my way to the nearest hairdresser/stylist/barber/butcher, or anyone with a comb and a pair of scissors. No appointments, no fancy styles, no funky hair products. Cut and run, I say. I have accepted the way I look, such that no hairstyle (or lack thereof) could ever make me look better or worse.

The last time I went to my local Vietnamese barber, I pondered about the things that I could learn from them. You see, our art is similar. My barber and I have a mission to eradicate the world of any head and neck (or hairy) disorders. He and I both examine our patients/clients with skilled head and neck assessment, and we employ our ancient art and modern treatments, to ensure our patients/clients go home feeling good above their clavicles.

There are 7 things I learned from my hairdresser. I believe I am a better ENT surgeon because of what they’ve taught me.

1. It’s all about the client.

They called me by name, asked me how I was, and led me to a comfy chair. He then proceeded to ask me what my hairy wishes were. All through diagnosis, treatment and management, I was always ensured of comfort. We talk about life in general and my mind is put at ease. I don’t have to worry about the fact that the way I look in the upcoming 4 weeks is fully dependent on his paying attention to his scissors on my head, while talking to me. That’s great service. I need to know how to employ the Art of Small Talk in my surgical practice. Appropriate small talk will help to ease the anxieties of my patients. It’ll make them feel like they’re being treated as humans, instead of cases, and I also reckon it will add fresh colour to the consultation.

2. Gentleness, gentleness, gentleness.

The way my barber holds and moves my head teaches me that I need to be gentle when I examine my patients. An ENT Head and Neck examination is reasonably intrusive. Patients hold their heads and faces as private properties. People naturally do not like to have their faces held, their heads tilted, their necks palpated, or their facial orifices poked and prodded by total strangers. The good barber knows to be gentle with their clients. So should the good ENT surgeon.

3. Pay attention to details.

That goes without saying isn’t it? The good barber would look at my hair from every angle to ensure perfection, and he won’t stop styling till perfection is achieved. I need to have that perfection mentality too from the time the patient is put to sleep, positioned on the operating table, painted with antiseptic, draped, first incision, dissection, resection, reconstruction, closure, dressing, and to the point of painless wakefulness.

4. Use the right equipment at the right time.

One of the greatest thing about ENT is that we are the specialty with the coolest tools and gadgets. Tools are only tools. But in the master’s hands, tools come alive and become instruments of magic. With the right tools at the right time the science of surgery becomes an art and magic that is pure perfection. Some of the greatest moments in surgery happen when I see an expert hand pick up a simple tool and turns water into wine.

5. Get rid of that BO or smelly breath.

Once in a while, I get a barber or hairstylist who smells. Gosh. No matter how good I look at the end of the service, I’m still left with an olfactory experience I wished I did not have. The most common smell is the disgusting smell of smoke, then BO, then garlic/onion breath, etc. You see, the barber and I spend time in close proximity. So does an ENT surgeon with their patients. It is crucial that the surgeon leaves their patient with a good clinical as well as olfactory experience. When I got onto the ENT program, I swore off garlic and onion, and I always carry mints in my bag, next to ear wax currette.

6. Never whinge, whine or gossip.

Not only bad rhinological olfactory experience, sometimes I get the stylist who leaves me with bad otological acoustic experience too. They are those who whinge and whine and gossip about everything. So sometimes I’m unlucky enough to sit there strapped onto my seat covered in that barber cloak listening to the non-stop negativity that seem like an avalanche of verbal diarrhoea. I don’t know about you, but I don’t like to be around people who whinge. Why? Cause I know I’ll end up whinging too. Whinging is contagious. Happiness, encouragement and compassion are contagious too, but I’ve noticed that they take longer to catch on. Somehow, seeing or hearing an ENT surgeon whinge is just not a professional image I’d like to adopt. I want my patients to be positively impacted by my presence, even if it is only a brief few minutes.

7. Marvel at your surgical training and history.

This perhaps is why I love going to the barber. Barbers are our surgical predecessors. Barbers and surgeons come from the same historical occupational genealogy. We share the same DNA. We are children of the same barber father. You see, a few hundred years ago, barbers were surgeons. If you had an abscess that needed to be lanced, you’d go round the corner to your local barber, and he would lance your abscess. If you had to have your blood drawn to relieve you of disease, stress or any ailments, you also would go to your local barber (“venesection”, drawing of blood, was the treatment of choice for multiple disorders in the past. It still is the treatment for a particular condition today – Which one?). In fact, you’d also go to the local barber if you needed your leg amputated. So the barber was master of the cutting instruments. You probably have seen the old sign of the barbers: red and white striped spirals. That was to signify blood. Now you know.

The first surgeons were called barber-surgeons. Surgeons were not doctors originally. They were barbers. In the beginning, surgeons were not even allowed to enter medical school, because they were dumb barbers. It was only a few hundred years later that doctors started to ‘operate’ and took over from the barbers the procedures which are now called surgical operations.

That’s the reason why surgeons were and are called ‘Mister’ or ‘Miss’ in some parts of the world, even nowadays. Historically, they weren’t doctors. And that tradition of calling surgeons ‘Mister’ or ‘Miss’ persisted to this day. Some doctors today still think that Mr/Miss Surgeon should not have gone through med school anyway, because they are not smart enough.

So when I sit in that barber chair, my mind wanders and reflects on the long glorious history that is surgery. It started off as a basic cutting skill of the common barber, and has now been elevated into a precise art of healing. Knowledege of anatomy, the field of anaesthesia, the development of antisepsis and the advance of technology has caused the science of surgery to become the magic that it is today. I am privileged to be trained as a surgeon. And that barber chair will ground me and remind me of my humble beginnings in many ways.

Yes, mister, a little bit of hair product would be great.

First Impressions: How Do You Introduce Yourself?

27 January 2011

In this world of instant image management and quick intro snippets, your first impressions do last. As a doctor, you are patient-inundated, nurse-interrupted, time-limited, ego-conscious and sociably-challenged. Hence the way you introduce yourself may determine whether or not you start on the right footing with your patients. How do you introduce yourself?

Here are a few options you may consider. We have not yet run a fully randomised control trial, because these have not been put through the ethics committee, and no big pharmaceutical company is willing to sponsor the research. But some of these have been extensively studied and found to be quite effective in leaving a lasting impression:

If you are a Cardiologist:
“Hi. I am a doctor to the broken-hearted.”

If you are an Anaesthetist:
“Hi. I pass gas.”

If you’re a Neurologist:
“Hi. I’m your electrician.”

If you are a Urologist:
“Wee. I’m your plumber.”

If you are an Orthopod:
“You. Bone. Broke. Me. Fix”

If you are a Paediatrician:
“Peekaboo…”

If you are an ENT:
“Hi, I am your waxing specialist. I don’t do legs. I do ear wax.”
Or,
“Hi, people poke their tongues at me.”
Or,
“Hi, I am you otorhinolaryngologist. No, not automatic ventriloquist. Otorhinolaryngologist. Oops, sorry I sprayed some saliva there.”

If you are an Ophthalmologist:
“Hi, I’m your iDoctor. My iPhone app tells me you need an eyePad.”

If you are a Neonatologist:
“Hi, baby.”

If you are a Radiologist:
“Hi, please switch off the light.”

If you are a Colorectal Surgeon:
“Hi. I’m a shit magnet.”

If you are a Plastic Surgeon:
“Hi. I take cash, credit or cheque”

If you are a Psychiatrist:
“Hi. You can hear me. But you can’t see me.”

So how else would you introduce yourself to leave a lasting impression on your patients?

Thanks to Nick Bennett @peds_id_doc
If you are an Infectious Diseases Specialist:
“Hi, you’ve got the bugs, we’ve got the drugs”

7 Reasons Why You Should Be an Anaesthetist (or Anesthesiologist, if you don’t speak proper English)

23 January 2011

WARNING: This post, like the rest of my blogposts, is best enjoyed with a glass of wine and a good sense of humour. THIS IS NOT A SERIOUS BLOGPOST! I love anaesthetists and have family members who are anaesthetists. We laugh at and with each other. So please have a read of my other blogposts and catch the humorous flavour in all of my posts before throwing egg at this one. If you still didn’t like it, feel free to leave your comments.

As surgeons, we work closely with anaesthetists every day. We get to love them, laugh with them and sometimes even look at them. They truly are the quiet heroes behind most of our surgeries. Without them, we wouldn’t be able to do what we surgeons do. Always undisturbed, and unfazed by the happenings, they hide behind their masks and machines. Often I wonder what goes through their mind (I found out it was always food or the stock market).

So, why does one want to become an anesthetist? After an exhaustive research involving multiple sessions of pondering about it while on the toilet, here are some reasons why (well, er… maybe):

1. You get to switch people off from talking by putting them to sleep.
Twitter limits talk to 140 characters. Anesthetist can do that to their patients too. They only need to ask enough pertinent questions, and in goes the milky solution and the tube to whiz them off to sleep. How cool is that? I sometimes wish I could do that to my patients, particularly the non-operative dizzy ones.

2. You are most up to date with the news.
The anaesthetist is always listening to the gossip around town. In one theatre they will hear about the general surgeons’ who’s who. In the next theatre, the orthopod’s who hates who. In the next they listen to the plastic’s who augmented who. Still in the next theatre they hear the neurosurgeon’s who buys who. The talks among the nurses, technicians, surgeons, trainees, etc. They are always up to date with gossip. Or ‘news’ as it is often called in the healthcare industry.

3. You become really, really good at Sudoku.
The anaesthetists have so much ‘leisure’ time sitting down during surgery (they call that ‘work’). Once the patient is asleep, out comes the Sudoku. The speed at which the endotracheal tube goes in is well correlated to the speed at which the Sudoku is extracted form the handbag. I’ve seen some really complex mind boggling sudokus done by anesthetists. Amazing. They get lots of practice at work.

4. You can handover the patient at the end of your shift.
This is one of the beauties of anaesthetics. While we surgeons have nightmares about our patients, anesthetists get to hand over the patient at the end of their shift. The good ones, bad ones, unstable ones, etc.

5. You get to finish reading a novel/newspaper/magazine/tabloids while getting paid.
See reason number 3. Actually, you also get to pay your bills, organise your holiday, bid on eBay, shop on Amazon, purchase a new car, do yoga, eat, drink, sleep, and sometimes even brush your teeth, all while the patient is asleep. Well, in short, you get to do what you do at home in the convenience of work.

6. If you don’t like the surgeon, you just have to lift up the sterile barrier.
It’s always interesting when that happens. I have the luxury of working elbow to elbow or face to face with all types of surgeons. I’ve got no blood/brain barrier I could lift. When they yell at me, well, they yell at me. I have to face the music. And that’s also often when the anaesthetic side suddenly lifts up their barrier and I can almost hear the muffled giggles behind.

7. And this is probably the main reason they do anaesthesia: You get to pass gas at work.
Now who wouldn’t want to be paid for passing gas all day?

And for the Famous Anaesthetists’ Hymn brilliantly done by Amateur Transplants:

[youtube=http://www.youtube.com/watch?v=c1JzCDqt3BM&w=480&h=390]

DISCLAIMER: I am a trainee surgeon. This may be a biased research. No anaesthetists were harmed in the writing of this “Piece of Work!”. In fact, no anaesthetists were present or awake enough to be bothered with this.

10 Things A Surgeon Can’t Say Out Loud

20 January 2011

1. What is that?
2. Does that part go here?
3. Oops.
4. What happens if I cut here?
5. Hmmhh, not sure if I can fit it all back in again.
6. Could you please google up this procedure?
7. Where is my lawyer’s contact details?
8. Who is this and what did I do to him?
9. Sure I’ll be home for dinner, honey.
10. I love herbal tea, scented candles and bubble baths.

An Ode to the Mighty Bloody Surgeons

16 January 2011

When erythrocytes are spilled
Many a surgeon would go “S%$IT!”
But not the Mighty Vascular Surgeon
Who smiles and says “Come on!”

Since young he dreams of balloons
Till old he plays with balloons
Poke, poke here, and pump, pump there
Let’s get those vessels flowing with flair

With a cheeky smile, and a twisted mind
With a thick wallet and a stent behind
The Mighty Vascular Surgeon walks the ward
Thinking everyone’s in awe

The smokers fear him
The diabetics adore him
The multi-toed worship him
And the toe-free pays him

Whether you are ischaemic, or haemorrhagic
Or just plain aneurysmic
Whatever the bloody specific
Fear not, The Vascular Surgeon is here to fix

Aaah… The Mighty Vascular Surgeon
Once they get you, they ain’t letting you go
They start from them toes
And up to those groins, going, going, goes

From A to Z they wield their control
Abdominal Aneurysm to Zenith Endovascular control
They have the power
They have the money

They love to strip
Veins, that is
They love to disimpact
Arteries, that is

The Mighty Vascular Surgeons
No vessels they can’t unblock
If they can’t, they’ll divert
Or to open they’ll convert

The Mighty Vascular Surgeons
Their lives are simple red and blue
If it’s white, they’ll turn them pink
If it’s black, they’ll amputate to nothing

This ‘piece of work!’ is dedicated to my Vascular Surgery friends both tangible and virtual.
No vascular surgeons were harmed in the making of this masterpiece.
Image thanks to Cook Medical,
With whom I am not associated.

7 Reasons Why You Should be a Surgeon

15 January 2011

I’ve been asked many times why I chose the path of surgery. The esoteric, philosophical, mightier-than-thou answer would be “Well, I didn’t choose surgery. Surgery CHOSE me.” Somehow the conversation falls flat after I say things like that. So for practical reasons people can understand, here are some reasons why:

1. No traffic jams.
Yes. That’s right. With surgery, your day begins with 6am (or so) ward rounds, and ends sometime between 8pm and midnight, or you may not even make it home. Which means that you get the joy of driving to work when everyone is still asleep or watching Glee on TV. No traffic jams. No honking. No stressed out road rage. No queues at MacDonald’s drive through. Isn’t that great?

2. No public holiday shopping nightmares.
As a surgical trainee, you get to kiss all your holidays good bye for the duration of your training. That’s great, cause this way you get to avoid the silly seasons of buying things for yourself, or worse, for others. Now who wants to do that?

3. You get to wear pajamas all day and still get paid.
Surgical scrubs are great! There are several good excuses here. Certainly you save a lot of money cause you don’t really need to buy too many shirts, pants, ties or any of those things. Also you save yourself a lot of laundry time. The down side, however, is that you will have to have on at all times a good pair of underwear. It has been noted many times that wardrobe malfunctions do happen with surgical scrubs. An incidental showing of the undergarment occurs not too infrequently around major hospitals, either through a thin scrub material, a slit on the side, a hole on the back, or just because of a poorly tied scrub pants. Depending on the undergarment incidentally revealed, one may end up with a job promotion, or a trip to see the disciplinary board.

4. You get to spend a lot of time with your patient, asleep.
It is a myth that surgeons spend little time with patients. They say physicians and internists spend massive amounts of time really talking to patients, while we surgeon “swing by the bed” (like as if we were chimpanzees or something) and not even talk to patients. They say: “don’t blink, or you’ll miss the surgeon”. Well, I’m here to abolish that myth. We clock up more time with our patients compared to physicians. But our patients are anesthetized when we’re with them, for good reasons. Apparently anesthetists put the patients to sleep for the patients’ benefit so they won’t be exposed to the surgeon too much. Hmm…

5. You get to cut people open and stuff.
Isn’t that the coolest thing in the world? In any other business it’s called ‘assault’. In my cut-throat industry (pardon the pun), it is called ‘craftsmanship’.

6. You’ll always have an excuse to stop a job, a conversation or an article if you’re getting bored (or can’t find reason number 7).

Sorry, gotta go. Hospital called.

Duty, Discipline and Delight

12 January 2011

Surgery should be built on a bedrock of duty and discipline. Otherwise one will not enjoy the delight it offers.

As a trainee surgeon, doing long hours in the hospital is a necessary evil I wil have to endure. There has been many a times when I’ve not been able to reach home at night, or that I hit the doorsteps of the home, only to be called back to the hospital. I’m getting very familiar with the old cranky bed we have in the residents’ quarters.

Particularly in ENT, when our emergencies are true life or death emergencies (such as a potential airway disaster), there are many times when I have had to stay in the hospital to be within 5 minutes of the patient.

We are doing it better than our bosses, who literally used to live in the hospital for weeks. I get to go home every couple of days or so. Still, its not a nice idea to think that I’ll be missing much of my wife and son.

As a trainee surgeon, I need to develop a habit of discipline and a sense of duty. I don’t choose to work hard. I am expected to. It is a minimum standard that a trainee surgeon trains his/her mind, heart, emotion and body to endure tough times.

But this is not unique to surgery. Training hard is a feature of many demanding jobs. Most successful people get to where they are by training hard. We often only see the results broadcast, but not see the gruesome training that leads up to the results. World class athletes, musicians, and leaders, if they’re worth their weight in gold, would have put in years of unseen training and preparation time to get to where they are.

In my pursuit to be a great surgeon, I need to do years of unseen hard work. I need to delay the delight of surgery, because I need to work hard on the discipline and duty of surgery. I need to do it with humility, respect and honor, knowing that if I really want to be useful to my patients in the future, I need to put in the hard work today.

What about you? Duty and discipline will ultimately lead to delight. What unseen work are you doing today in preparation for the delight of results in the future?