Saturday, February 7, 2015

I thought my surgical career was over before it began

I have just read this piece by Dr Rinjana Srivastava and she identifies a problem within the medical profession that only one from within could express with such clarity.

It reminds me of being on the receiving end of bad behaviour from colleagues and I felt that it was about time that I put this down in writing.

When I was a junior doctor, surgical training programmes in Australia were all hospital based. You would be accepted onto a training programme at your hospital and you would work within that system for the duration of your training toward specialisation. You had to keep your head low but not so low that you would not be noticed.  If you upset any surgeon in any specialty, you ran a significant risk of automatic exclusion. The chances of getting onto a training programme outside of your hospital system was low as they tended to be parochial and would appoint from within.

I will never forget seeing the poor treatment of a colleague who was a year or so senior to me. He was an outstanding doctor and it was generally held within the hospital network literally being ‘pick of the draft’ and was going to essentially walk into the next available surgical training position. At about 6 months before the interviews, he inadvertently slept in on his first day of a new rotation, which also happened to be an operating session.  The surgeon took a vindictive dislike of that talented young doctor. He was blackballed from succeeding in his application for the next available training position. That doctor had little choice but to go to another hospital to re-establish himself and it was several years later that he would then enter surgical training. This sent shockwaves through the hospital system and sent a strong message that we needed to do everything within our power to avoid upsetting anybody. 

Now for my story. As a junior doctor, I thought I was going okay. I had been a ‘finalist’ for the best intern award and I had passed my surgical primary examination on first attempt and had not managed to offend anybody. The surgical registrar under whom I was working was particular self confident and very much a larrikin type of individual. His self confidence and decisiveness was something that I had initially felt was something to aspire to. On the morning ward round, we looked a patient who had been operated upon the day before.  The leg was very swollen and the registrar felt that it was within acceptable limits and felt reassured given that there was no blood in the drain. 

A few hours later, I did a further quick ward round of the patients I was most worried about. For the man with swollen leg, it was my impression that the swelling was worse. I called the operating room to speak with the registrar. The phone was placed on loudspeaker and he reiterated that he was happy that all was fine and besides ’the drain had nothing in it’. I went back to the ward with my tail between my legs. An hour later, I reviewed the patient again and felt that things had progressed further.  On this occasion, he came out of the operating theatre to have a look and was again satisfied that all was fine.  A further hour later, I thought things were again worse and I could no longer feel pulses in the foot. On this occasion, I walked over to the vascular ward and got hold of a portable doppler and confirmed that the pulses were barely if at all audible. Apart from becoming increasingly swollen, the leg was now starting to look blue. I called up theatres and was again placed on speaker phone. The eye rolling was palpable and he again affirmed that his assessment of the patient was that everything was fine. With given tone of voice, I felt humiliated.

What was I to do? Keep my head low with the knowledge that I had done what was expected of me or step it up? I then decided to call the consultant surgeon who was nominally in charge of this case - I had to hold the phone away from my ear as he yelled "How dare you call consultant surgeon? The patient is a public patient and is managed by the registrar."

That moment, my only thought was with the patient who was going to lose his leg. I found myself  wandering almost aimlessly in the ward corridors trying to work out what to do next. It just so happened that a consultant vascular surgeon walked around the corner and I dared to approach him.  He wasn't even on call for emergencies but given the gravity of the situation, I asked if he could please come and look at this patient - he agreed and the moment he set eyes on the patient, I could almost see him mouth the words "Oh F**K"

We had the patient in the operating room within an hour. I scrubbed in to give a hand. The moment the leg was cut into, blood burst out and splashed all over the theatre light and ceiling. The blood in the thigh was under such pressure that it was compressing the flow of blood to his leg. The registrar dropped by and in a cheerful voice said "Yeah, I thought that he had had a bleed into his thigh."

Once this man's leg had been saved, I thought to myself that on this day, my surgical career easily have come to an end. I could not help but to think what would have happened if I was wrong about the diagnosis.  Thankfully things have changed a lot since then.

Addendum 8 February

To respond to questions as to what happened afterwards?  Back then, morbidity and mortality review meetings essentially did not exist.  To this day, I am not even sure that the consultant surgeon in charge even knew of this complication.  The registrar went onto to become a consultant surgeon and I have had no contact with him since.

A week of so later after the event, I bumped into the consultant surgeon who had yelled at me over the phone. I took the diplomatic approach and apologised for calling him. He responded in a kind forgiving voice and and said to me "Well we all learn from our mistakes".  As for the vascular surgeon, we became friends and I am forever grateful for his assistance.  He was an example of how there are brilliant role models for human beings as surgeons out there and one who led by example. 


  1. I really, really, REALLY hate the bullshit in medicine. You did the write thing - what you felt was best for the patient.

  2. Thanks Anon. I was fortunate that it was at a time not too long after I passed the surgical primary exams on first attempt and I perhaps had better knowledge and perhaps a little more confidence in myself compared to before I sat the exam. I was additionally fortunate to have the vascular surgeon as a mentor that I could approach. It is often hard to be confident about your clinical judgement as a junior doctor and I will admit that back then, I did lose sleep ruminating over what could have been the consequences if I had turned out to be wrong.