Your father was captain of a starship for 12 minutes. He saved 800 lives, including your mother’s. And yours. I dare you to do better.
Christopher Pike, Star Trek (2009)
Many people interact with us only once, or a few times at most, and only on a rare occasion are they remembered and even more rarely do they leave an impression or change us. Today’s blog was inspired by reading the death notices in the Bulletin of the Royal College of Surgeons (RCS England). I get this magazine because I’m a Fellow of the Dental Surgery faculty at RCS, but that’s only a small part of that the college does so most of the magazine is to do with matters of general interest to all sorts of surgeons, most of them not the dental variety.
Accordingly, I don’t always read it thoroughly, but I was tidying up my inbox after the Swords Orthodontics Christmas lunch before closing the practice for the year and flicked through an old edition before consigning it to the recycle bin.
One name jumped off the page. I hadn’t heard it spoken aloud in decades. A consultant I worked for, years before I became an orthodontist
He wasn’t my regular boss. There was a squad of junior staff and three consultants that covered a few hospitals in the area and when holidays and rotas required we might find ourselves on the same session. I guess our paths crossed five times, although we only met on three of them.
And I remember each of them and learned something each time.
ONE
There was an emergency call to one of the hospitals I covered after a serious road traffic accident. It was about 20 miles away from my base hospital and I set off and on my way there was stopped by police because the road had been closed due to weather conditions and a truck had been blown over. I had to re-route to get in to the hospital – presumably to attend to the driver of that truck. He had multiple lacerations, and more worryingly a bleed underneath his scalp that was hard to locate. My consultant had been called in directly by the A+E team which was unusual but they couldn’t be certain when I’d get there or whether I’d be able to deal with it and didn’t want to delay the driver’s treatment. It was impressive to watch him suture so accurately at rapid rate.
TWO and THREE
I only did two scheduled operating lists with him. Since he wasn’t my regular consultant he had less of a idea of my limitations than his colleagues and handed the scalpel to me to remove a skin lesion on one list and cyst on the other. I’d done neither procedure before or since. He had to show me the incision for the skin lesion and the next time when I went to repeat it, he immediately showed me that that incision wouldn’t be the right one for the cyst.
The next time I was working on his list wasn’t with him, it was instead of him.
FOUR
“Stephen, where are you?” It was my regular consultant. I was in my regular hospital, probably about to go to the ward to check on some patients. “Mr X won’t be in this afternoon, we need you to go over to (one of the other hospitals) and do his operating list. The patients have all been clerked in, the staff there are all set up, they just need someone to do the operations.”
“Shouldn’t that be one of the other consultants?”
“You’ll be fine.”
So off I went. Not unlike the guy in Star Trek, this was a field promotion, albeit temporary, only for an afternoon. I wouldn’t do as well as George Kirk, but I did survive it. I would have to cease being an observer or assistant and actually perform. I had no idea what the theatre crew’s understanding of the situation was or why some Irish guy they’d never seen before had rocked up to do the list, so I didn’t mention the background story. I was able to carry out the procedures but only at a fraction of the speed of the person who was meant to be doing them.
This had happened on a few emergency cases I’d been called to do at various units that I’d worked in, but allowances are generally made because they’d be done in the middle of the night and no one was going anywhere else and most of the staff at that hour are junior ranks and when I’d get asked “how much longer to you finish?”, regardless of my own underestimates, I’d get a reply like “and are maxillo-facial minutes like plastics minutes?” Which gave me some comfort as I realised it wasn’t just me.
This wasn’t the case on my elective list that afternoon though. I can’t exactly remember the procedure – I’m fairly sure it was the enucleation of a cyst in a jaw and it was tricky to get all the lining out as it was stuck to the roots of a tooth in a hollow cavity of the upper jawbone – but I was asked how much longer I’d be. I reckoned about 20 minutes. One of the theatre crew told me that I’d already been at this for half an hour and the time that was scheduled for it was only 20 minutes. I replied that I hadn’t written the schedule for the list. At this, the person who had drawn up the schedule for the list walked out of the operating theatre, never to be seen again. They were on the consultant's regular team, and I have no idea what pressure they had been put under that day or the days leading up to it. So I learnt to take responsibility for things a bit better and defend my colleagues a bit better and give some leeway to people doing unfamiliar things in adverse circumstances. So even in his absence, this guy was giving me a lesson.
FIVE
The last time I saw him was about 25 years ago, as an anonymised silhouette on a current affairs programme dealing with addiction in medical personnel. I can’t remember if it was Panorama or World in Action. I was about to change channel but I recognised his voice as soon as he started speaking. Obviously it was connected to my experience on that day when I stood in on his list.
“….and what did you do when you were told you weren’t allowed to practise?”
“I went and opened another bottle.”
Though the problem remains with the profession and is more readily addressed and engaged with, I don’t know if things are better or worse on the wider scale of the profession at large. The documentary wasn’t particularly sensationalist, as I remember. If you’d asked me a couple of years ago, I think they would treat the individuals a bit more sympathetically if they were making the same programme now – but in the current times, I wouldn’t count on that as I’m sure there is a bit of mileage to be had, and an audience to be found, in drawing attention to the shortcomings of individual practitioners and undermining the credibility of the professions rather than looking at shortcomings of an entire system of provision. Watching the response to the nurses’ strike (and possible junior doctor industrial action) in the UK, I see us entering an era where the struggles of modern life are redirected towards, or into, antagonism between people regardless of how they depend on each other in normal times – and medicine in its widest reach will be part of that. I see no benefit in this for individuals providing care or the public in general that they provide it for.
I remembered a man that was competent in his work, but obviously his problem had got him to a stage where he couldn’t be depended to continue it safely and he had to stop working. I don't know how easily he accepted this. As far as I know, he turned that around and returned to work to some extent. It was a tremendous waste of human potential that he wasn’t able to maximise his skills for the benefit of patients. I have no idea of the circumstances of his personal life, but can’t imagine it was as good as it could have been. The only positive thing is that he was able to deal with it to a point where he could return to practice
I’m sure we’ll see this played out again in our friends and colleagues and the abiding lesson is one of the need for support and a bit of vigilance and constructive management of problems when they arise.
Photo by Kajetan Sumila on Unsplash