About 30 years
ago, coronary artery bypass graft surgery (CABG) was the mainstay of treating
narrowed coronary arteries that supplied blood to the muscle of the heart. Such surgery was predominantly, if not all,
performed in the public hospital system where there were long waiting
lists. Demand outstripped supply of such
service and cardiologists were at the mercy of cardiothoracic surgeons who
could determine which of their patients they would accept for treatment and the
priority afforded to them. The CABG was
a genuinely life saving type of surgery and the high success of this surgery by
highly trained surgeons provided them with unparalleled status in the hospital
pecking order. The cardiac surgeons
received the adulation of the press and public for the life saving work that
they were performing and sure enough, they came to truly believe that they were
the heroes of the medical profession.
The behavior of
cardiac surgeons was one of self-entitlement and demand for unquestioned
respect and admiration. Whilst capable
of great empathy and care for their patients, they treated members of their
surgical team and own profession with disdain and at times unbelievable cruelty.
As providers of essential services that were in short supply and high demand,
hospital administrators would bow to unreasonable demands. They were
effectively untouchables.
Whilst there are
too many stories to mention, here a couple that I recall as vividly as if it
happened yesterday.
When I was a junior
doctor, I had softly remarked that my nose was itchy under the theatre mask.
This was overheard by “sir” who then came up to me and squeezed my nose and
twisted and said “this will fix it” and went off laughing. The pain was excruciating and I quietly
slipped away outside the operating room pretending that it did not hurt at all.
My nose was bleeding. Once cleaned up, I
returned to the operating room and pretended that nothing had happened. I did not dare challenge him for this assault
and I also knew that nobody in the room would dare to support me for all of us
were afraid of him.
My six months as
a surgical registrar to “sir” was a tough gig psychologically, The work itself
and at times long hours was never an issue but the constant barrage of abuse
was taxing. I was so ashamed of
admitting that it was getting to me that I recall not even discussing it with
my girlfriend of the time (who was also a junior doctor) or any friends as I felt
that I could not afford to demonstrate to anybody any sign of weakness or
potential inadequacy to make it through the rigors of surgical training. “Sir”
loved an audience and we would usually have up to twenty people in the
operating theatre to observe such as medical students and physiotherapy
students. He just adored the
physiotherapy students, particularly the attractive female ones who appeared to
get special attention and this was returned with blushing adulation. Not uncommonly, I would start closing up the
wound and he would go out to make a phone call. He would then return and yell
to the entire room “Henry, you’re meant to be getting better, not worse” and
would then storm out of the theatre. The
operating room would then be so quiet that you could hear a pin drop above the
noise of the anaesthetic monitoring devices. I could go on and on, but I made
it through. I survived.
In later years I
had transferred training programs and went from being a general surgical
registrar to a urology registrar. At a
different hospital, I entered a service lift and the only other occupant was a
cardiac surgeon, a different “sir”. He
did not acknowledge me in any way but what did I care. The next floor, a wardsman entered the lift
and tripped over the lip of the elevator floor and bumped into “sir”. Yes, he committed the greatest possible crime
and touched “sir”. Over the next couple
of floors, “sir” proceeded to abuse him “how dare you blah blah blah …..” and
refusing to listen to his repeated attempts to apologise. The wardman was petrified that the surgeon
would lodge a complaint and that it would lead to his dismissal. I was so shocked that I stared in silence and
whilst he had little ability to impact on my future career, I was still too frozen
in fear to say anything. Immediately
after the event, I felt enormous guilt for having said nothing. For me it will
always be one of those moments that you remember where something could have and
should have been said.
These stories are
pretty tame compared to others I have heard. The fortunes have changed
significantly for cardiac surgeons.
Coronary stents are now used where surgery was once necessary.
Cardiologists control the flow of work to cardiac surgeons and can make or
break the success of their practices. I
have personally seen where a cardiac surgeon at a hospital I worked at was
completely starved of work to the extent that he had to take a salaried
position interstate. There was never an
issue with his clinical judgment and technical skills but with a totally
obnoxious personality from the cardiac surgeon old school, his private practice
disappeared in favour of other surgeons who were prepared to be more
personable. Cardiac surgeons can no
longer be seen to be self entitled poisonous individuals. Everybody knows that cardiologists are the
masters of cardiac surgeons and what huge fall it has been from the top of the
ivory tower.
Having said all
that is above, I have great respect for my cardiac surgery colleagues. Their professionalism
and care for my own family members who have needed their skills will always be
appreciated. I really believe I have
seen the worst and now best that these surgeons can offer.
At least in this
surgical specialty of cardiac surgery, technology and medical advances have had
a positive affect on surgeon behavior.