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the thoughts of a surgeon in the notorious province of mpumalanga, south africa. comments on the private and state sector. but mostly my personal journey through surgery.
Showing posts with label prof. Show all posts
recently i attended the association of south african surgeons congress. it's always strange and maybe fun for me to interact with surgeons. they are extremely interesting to me. i feel that i'm a bit of an outsider in the sense that i don't view myself as a typical surgeon, so i can sit back and observe, fooling myself that they are not looking at me in exactly the same way.
but one thing about these congresses is that you get to see and rub shoulders with the heavyweights of the profession. it took me back many years to another congress that i attended when i was still a mere mortal registrar and truly was not yet one of them.
the congress in question was in durban. at that stage i pretty much kept away from all the big names. it seemed the safer thing to do. however, one of my fellow registrars and a good friend of mine was quite friendly with the vascular prof, a greater than life man and a true legend in his own time in south africa. in fact my friend went on to specialize in vascular and is now himself a well known vascular surgeon in one of the big centers. so when my friend invited me to the vascular dinner the one night, i should have just said no. i didn't.
the vascular dinner, as i was to discover, was a fairly exclusive affair. it was sponsored by one of the companies that supplied prosthetic grafts, mainly used for the repair of abdominal aorta aneurysms. all the big names were there, including our massive prof and the vascular prof from wits, who at the time was also head of the department of surgery there as well as the president of the vascular society of south africa. in fact the only two non entities were myself and my friend. bearing in mind the entire vascular fraternity knew my friend would one day be one of them, in all reality, i was the single individual there who deserved and got sideways glances. my usual tactic of keeping my head down wasn't going to work; it stuck out like a blushing throbbing aneurysm and there was little i could do about it.
the function was advertised as a dinner on a boat that was supposed to cruise around the durban harbour, all very fancy. but, as it turned out, the weather was a bit too bad and the owner of the boat, which was a bit more like a large raft, all fitted out with tables and chairs and, of course, a bar, decided it wouldn't be safe to take the entire vascular complement of the country on a cruise where the boat had a good chance of sinking and rendering vascular surgeons in our country even more scarce than they already were. i was fine with this. besides the chance of dying, i felt it might be a bit awkward stuck with such eminent beings far from shore and no place to hide. but the sponsors of the event felt let down. they wanted to show off a bit i think and a boat safely anchored in the harbour just wasn't going to cut it. they felt they needed to make a plan, so a plan they made.
after the snacks and a fair amount of dutch courage had been consumed the plan became apparent. suddenly next to our safely moored raft appeared the biggest baddest speed boat i had ever seen. it looked like the type of thing you see on national geographic deep sea fishing specials. i wondered if we would limit ourselves to just the harbour cruise or would we venture into the big blue.
quite soon all the big names had made their way onto the boat. i, being the most junior person there, waited until last to see if there was enough space. as it turned out, it was a very big boat and there was plenty of space, so, somewhat reluctantly i followed my friend aboard. there were three areas where the vascular passengers could sit. one was the main area downstairs which was full. the next was the front portion of the boat which was fulling up quickly and seemed like not the greatest place to sit, just in case we did venture beyond the protection of the harbour. the third was a fairly quaint upstairs area. it seemed like the only real option. my friend and i climbed the ladder.
the upstairs area was the smallest of the three areas and was not yet totally crammed with vascular academia, but there was a reason for this. you see when the profs had gone aboard, they had all gone upstairs. the mere mortals, not wanting to seem forward, had decided to rather remain below. my friend and i didn't know this because we had waited until the last moment before we came aboard so when we got to the upstairs area, i was quite perturbed to see all the great profs sitting there. it was too late to go back down. for one thing, there was no space downstairs and for another all the eyes of all these great and intimidating men were staring at us as if we had just walked in on an awkward conversation. there was nothing for it but to stay there. i immediately decided i would stand as far away from everyone as possible. if there was a corner there i was determined to find it.
the president of the south african vascular society and great and mighty head of the department of surgery at our neighboring university, and more than likely someone i would be meeting soon in my final exams, looked at me and, gently tapping the seat next to him, spake he.
"come sit here next to me." he said with a wry smile.
" no thank you, prof, i'm fine here." i replied. he seemed persistent. again, almost stroking the seat next to him, he repeated his invitation.
"ag, come on, bongi, come sit here next to me." occasionally in life, you are presented with a situation where you really can say the wrong thing, and at the last minute, better judgement prevails. that day it seems i had no judgement at all. the words just seemed to roll out of my mouth, which I confess, stayed open in absolute shock at what had just escaped.
"no thank you prof, i'm not that type of boy."
the vascular prof from our university at least got a good laugh out of it.
Posted by Bongi at 1:30 pm 8 comments: Links to this post
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Labels: congress, funny story, prof, registrarship, vascular, vascular surgery
Thursday, June 07, 2012
granted, the prof had good hand skills. but i personally had doubts about the depth of his academic knowledge. i wish i could say that as i studied and got up to date towards my finals, i gradually realized that the prof may have been a little behind the times. but there was a more subtle sign that i cottoned on to much sooner.
even as a mere medical officer in the prof's firm, i was always amazed that on academic rounds he tended to swing the conversation towards constipation and how to avoid it with the consumption of enough fiber. far be it from me to criticize a good high fiber diet, but i did wonder how one ended up speaking about the colon, even when we were discussing a patient with breast cancer. but to be fair, it wasn't that the prof was clueless about other things pertaining to surgery, so in the end i just assumed he had a great interest in and a love for all things relating to the colon and how they could be managed with fiber. maybe he wasn't really trying to hide his lack of knowledge about other things but couldn't help always swinging the conversation back to his one true love.
many years later, when i was the senior registrar and it once again fell to me to rotate through the prof's firm just before my finals i at least knew what to expect to be taught on academic ward rounds.
when joining a firm, more often than not there are already a group of students there that know the ropes. sometimes they even view you as the new guy and it can be quite difficult to assert your authority. the first day in the prof's firm i realized i was likely to have problems with the incumbent group of students. on the morning rounds there was a silent resistance to everything i said, a sort of unspoken 'who do you think you are?'. it annoyed me. i was so close to finals i really didn't feel like having to stamp my authority on a bunch of snotty nosed students. i started wondering if there could be another way of approaching the problem. in the end i understood working for the prof changed one somewhat. maybe just the fact that they had been in his firm for a while was why they were being subtly aggressive. maybe to hammer them in the prof's typical style would achieve something in the short term, but it would further affirm their belief of the stereotypical surgeon. another approach was called for. i decided to bide my time and wait for the right opportunity.
the academic round with the prof was as painful as i remembered it always being so many years before. and yet somehow he didn't swing every patient and every condition towards constipation, which was at least a relief. finally we got to the last patient. the student presented and the prof gave instructions about how to further handle him. and that was it. the rounds were over. i was quite excited to move on to the ward work and get on with the rest of the day, which in my case would probably entail putting my tail on a chair and my nose in a book. we all walked to the door, but i could see the prof wasn't walking with his usual determined stride. he wasn't finished with us yet. suddenly he stopped.
"you know, constipation is a very real problem." at last, the old prof was back. by the reaction of the students i could see they had heard it all before. the one rolled his eyes. another's shoulders sagged, almost too obviously. i smiled. i'm sure they were all thinking i'm smiling out of naivety, seeing that, in their minds at least, i didn't know the prof's favourite topic. i was smiling for another reason.
"yes," continued the prof, "it is a problem that i have been struggling with for all of my professional career." too easy, i thought.
"well then prof," i looked at him, trying to mimic an expression of sympathy, "why don't you just try a high fiber diet."
once the students had composed themselves after fits of what i'm sure the prof viewed as inappropriate laughter, i never had another problem with them again. the prof?...well that's another story.
Posted by Bongi at 8:53 pm 1 comment: Links to this post
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Labels: fiber, funny story, medical students, prof, student training, surgical stories
Saturday, November 05, 2011
i am somewhat known for not knowing when to keep my mouth shut. but, fortunately for me i once managed to put a watch in front of my mouth, but only just in time.
i was on rotation just before intermediate exams. this was a difficult time when generally you had to make sure you didn't make enemies in other departments. you always ran the risk that the guys you irritated would be in the exam or write a scathing report to your own prof. then, no matter how well you knew your work, you would not get through. it's just the way things were.
interestingly enough the obstetric and gynaecology department stood apart from all other surgical disciplines. for many years they had not done the rotation and therefore did not write the intermediate exams common to all the rest of us. other than the fact that this meant that they didn't share with us the burden of running the icu department (which they did use, however) it also meant that they could be very narrow minded. they didn't have an overall knowledge of physiology and the management of acutely sick patients. to them a patient was simply a vagina and a uterus of varying size, with or without a bun in the oven. in short, the rest of us thought of them as lazy and stupid.
i was on call in the icu at kalafong (hell). the way things worked there is we all knew all the patients in the finest detail. on a call day that knowledge was absolute. we could recite the finest details of any patient under our care in an instant. so late that afternoon when i walked into icu and saw the prof of obstetrics standing at the bed of one of my patients who we were treating with severe pre-eclampsia and hellp syndrome with his entire entourage i immediately walked towards them to answer any questions they might have.
as i approached i remembered that prof from my pre-grad days. we used to call him red beard which was some sort of a reference to a scary pirate, but more a comment on his interesting choice of facial hair. he always seemed to try to intimidate and to be honest i think we were all scared of him. looking at him now i couldn't understand that anyone could be scared of an obstetric prof. thinking back it seemed to me that his so called intimidation tactics were no more than posturing. he must have been trying to hide something. i walked up the the group of gynaecologists milling around my patient.
"hello prof." i greeted.
"oh, are you in charge here?" he asked looking up at me. i could see his underlings shifting uneasily. maybe he still had the power to intimidate them.
"yes prof, i am." i smiled in what i thought was a friendly, disarming way. i readied myself to help them with any and all questions they might have. after all there was absolutely nothing about the patient that was not at the tip of my fingers.
"good, because we are trying to make head or tail of what is going on here." simultaneously a few things happened. firstly i realized he was not going to lower himself to the point of actually asking me anything in front of his hordes. secondly, right there i decided that i would not be intimidated by what i now saw as the posturings of an old sad man. i stepped, back and folded my arms. secretly i enjoyed watching him struggle and flounder as he went through the patient notes. lastly the perfect sentence popped into my mind. by some miracle i actually kept my mouth shut and did not actually say.
"of course you are prof. after all the only thing more stupid than a gynaecologist is an obstetrician."
Posted by Bongi at 12:10 am 9 comments: Links to this post
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Labels: icu, kalafong, prof, surgery training
Thursday, August 04, 2011
dit moes 'n misverstand gewees het, ek weet nie. watookal dit was het dit 'n slegte smaak in my mond gelos.
toe die nuwe regering oorgeneem het het hulle stelselmatig ontslaegeraak van alles wat hulle geassosieer het met die ou regering. een van die dinge wat moes waai was afrikaans. volgens hulle was dit blykbaar sleg vir een of ander rede. ek het nie saamgestem nie. so toe ons afrikaanse prof druk op ons uitgeoefen het om net engels te gebruik by alle amptelike vergaderings het ek hom min of meet geignoreer. ek onthou 'n saalrondte 'n maand of twee daarna.
ek was die senior kliniese assistent in die prof se firma. volgens sy nuwe beleid het hy net engels op die rondte gepraat. tussen die pasiente, as hy net met my gepraat het het hy wel afrikaans gepraat. dit was natuurlik sy moedertaal. ek het al sy engelse vrae in afrikaans geantwoord en al die pasiente in afrikaans voorgedra. hoe meer hy probeer het om vir my die boodskap oor te dra dat ek engels moes praat hoe meer het ek volgehou om afrikaans te praat. by omtrend die derde pasient kon hy homself nie meer inhou nie.
"bongi, speak english. why do you refuse to speak english on rounds?"
"prof, my english is perfect. i don't have any reason to practise it." het ek in engels geantwoord.
hy was kwaad, maar hy het dit redelik goed weggesteek.
'n maand of wat daarna was ons almal by een van ons m&m bespreekings. die was 'n gesamentlike m&m met die vaskulere departement. die prof van vaskuler het ook sterk gevoel oor die taal beleid, maar sy gevoel was presies die teenoorgestelde van die prof s'n. hy het gevoel ons moet aangaan om afrikaans te praat in die universiteit, want engels was klaar so dominant in die land as 'n mens nie moeite gedoen het om afrikaans as 'n taal wat op 'n tersiere vlak goed kon funksioneer op daardie vlak te hou nie, sou dit vinnig agteruitgaan. ek het met hom saamgestem. baie van die afrikaans spreekende studente het klaar gesukkel om pasiente in afrikaans voor te dra, self as hulle aan 'n afrikaanssprekende dokter voorgedra het. hulle het medisyne in engels geleer en kon nie mediese afrikaans praat nie.
die m&m het voortgegaan. toe dit die beurt van die vaskulere kliniese assistent was om sy pasient voor te dra het hy in engels begin. onmiddelik het die vaskulere prof iets op 'n stukkie papier geskryf en dit vir sy kliniese assistent gegee. die kliniese assistent het dit gelees en onmiddelik in afrikaans oorgeslaan. dit was nie nodig om einstein te wees om te weet wat op daardie stukkie papier gestaan het nie. sy prof het duidelik vir hom opdrag gegee om afrikaans te praat en hy het wel so gemaak. die res van die vaskulere gedeelte van die m&m het min of meer gegaan soos my saalrondtes met die prof. die prof het al sy vrae in engels gevra en die vaskulere kliniese assistent en prof het albei alles in afrikaans geantwoord. dit was vir my nogal komieklik. na die m&m het ek maar aangegaan met my lewe.
omtrend 'n uur later het die vaskulere kliniese assistent vir my gebel.
"bongi, daar is groot kak in die land," het hy gese. "die prof het my vaskulere prof ingeroep en ordentlik in sy broek gekak oor die feit dat mense in sy departement weier om net engels te praat by enige bespreking of saalrondte. hy het drie kliniese assistente uitgesonder. dis ek en jy en dr b (ek het al van hom geskryf). natuurlik het my prof vir ons al drie opgekom en toe ek uitgejaag is was hulle amper op die punt om mekaar te lyf te gaan. hoe dit ookal sy dis blykbaar ons drie wat die prof se woede gaan voel. hy het self gese dat as ons volhou om te weier om engels te praat gaan hy bedank as hoof van die departement."
ek kon dit nie glo nie. in een opsig het ek amper trots gevoel dat ek so 'n invloed gehad het oor die prof dat hy 'n persoonlike beroepsbesluit sou maak gebaseer op my doen en late. maar eintlik was dit nooit my plan om soveel aandag van die grootkoppe te lok nie. daardie tiepe aandag was nooit 'n goeie ding nie.
"hy kan seker bedank as hy wil." het ek vir my mede beskuldigde gese, maar toe onthou ek wie in sy plek sou oorneem. ons prof het sy probleme, maar tog was hy beter as die moontlike alternatief. moontlik was die beste ding om maar engels te begin praat.
die volgende week by die m&m was ek 'n bietjie verbaas om te sien dat my vriend en kollega, dr b sy gevalle in afrikaans voorgedra het. dit was weer die geval van die prof wat sy vrae in engels gestel het en my vriend wat alles in afrikaans geantwoord het. tog as dit die prof geirriteer het, het hy dit goed weggesteek.
onmiddelik na die bespreking het ek met my vriend gaan praat.
"b, is jy mal?" vra ek toe. "na verlede week se storie, hoekom weier jy om engels te praat." hy het effens geglimlag toe hy geantwoord het.
"ek weet nie wat die prof se fokken probleem is nie. voor verlede week het ek nooit afrikaans gepraat by al die amptelike besprekings nie. ek het wel engels gepraat. en tog is ek een van die ouens wat in die kak beland het. wel, nou het ek klaar die straf gekry omdat ek afrikaans gepraat het al het ek dit nie eintlik gedoen nie. omdat die straf klaar uitgedeel is moet ek dit darem die moeite werd maak. daarvoor se ek nou vir jou, ek sal nooit weer engels in hierdie plek praat nie!"
en volgens my kennis het hy nie.
Posted by Bongi at 7:28 pm 14 comments: Links to this post
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Labels: academic discussions, academic rounds, afrikaans, prof, surgical politics, vascular surgery
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I'm a general surgeon working in the notorious South African province of Mpumalanga.
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suture for a living
Just Up The Dose
cutting through the crap
cut on the dotted line
this blog was the runner up in the literary category of the 2009 and 2010 medical weblog awards
the aim of this blog is to give insight into the mind of a particular surgeon, me. although every story is loosely based on fact, patients have been changed suitably to protect their identity. the opinions expressed are mine alone and are not meant to be considered medical advice or the opinion of any institution.