Tuesday, May 26, 2015

I am a Bully (Yes, you read that correctly)

Not long after I gained my RACS Fellowship and became a fully-fledged consultant surgeon, I found myself operating at 3am on a bleeding patient. This young girl’s life was literally slipping through my fingers. I had tried everything: pressure on the bleeding veins, applying clamps and pushing with swabs on sticks, suturing the holes that were getting progressively bigger and bigger, pledgeted sutures, packing the abdomen, clamping the aorta to stem the venous haemorrhage.

Everything I did seemed to make things worse, and I felt this rising tide of frustration beginning to well up inside me. Even worse everything seemed to be happening in slow motion. The retractors I needed weren’t available. The scrub nurse couldn’t find the instruments I asked for. The needle holders didn’t grip. The scissors didn’t cut. The lights weren’t right. The psMonitor was going flat.

I had never experienced this as a trainee. There was always a senior surgeon to turn to, who had the responsibility. Up until then I had not truly faced the prospect that a patient would imminently die because I wasn't up the the task - and then my assistant stuck the back of my hand with a needle.

“What the F!@)(k did you just do?” I exclaimed. The moment after I had said it I had realised what had happened. I had just abused my hard working registrar, who was just as tired as I was, even more nervous than I was, and completely undeserving of my foul-mouthed critique of his left-handedness. The look on his eyes told it all. His face went pale, and he looked like he was about to pass out. But it was too late. I had become a bully.

Anyone who has read my blog before will know how much I love to boast about myself (completely justified, of course). I am, after all, the perfect model of the considerate, caring surgeon. I spend an inordinately long time with my patients in clinic, and they all love me even though they have to wait two hours beyond their appointment slot.  I put up with the incompetence of the constantly rotating stream of junior nurses all the time because I love to teach, and it takes an extraordinary level of medical student ignorance to irk me.

But it has taken a long time for me to become this tolerant. I have had to hone this skill over many years, gradually learning how to refrain from my natural instinct to yell, throw sharp objects, scrunch my face and stamp my feet. This has turned me into the wonderful teacher, leader and all-round nice-guy that I am today (except for Othman who thinks I am a "nasty consultant").

Occasionally, however, something makes me snap. I liken it to a generalised epileptiform seizure. If I am tired, stressed, ill, overworked, underpaid, and forced to work in an underfunded, under-resourced healthcare system, or god forbid going through a divorce, then my likelihood of losing my cool increases. I can keep it in check, but given the right stimuli my inner bully emerges and a torrent of abuse will inflict itself upon whomever is the nearest appropriate target. Sometimes the odd phenytoin-laced movie voucher from hospital administration for unpaid overtime will stabilise my condition but otherwise I am like a coiled viper ready to strike at the next inappropriately metaphorical simile.

Last night, however, I watched the Four Corners episode on Bullying in Surgery and realised that I am not alone. Indeed, there are many latent bullies out there just like me. We are a horde of ugly monsters hiding in a world of reasonableness, tranquility and sincerity, like those damn vampires in Twilight. We do not belong here. We cannot change or adapt to this modern world. We must either destroy humanity and reclaim our place at the Iron Throne of Westeros or fade away gently into the night due to our irrelevance.

Indeed, I expressed this to Mrs Sheepish and she suggested that perhaps I should retire and then we could go all Greece-like and default on the massive debt I used to finance my medical education, specialist training and private practice. It took me a while to realise that she was joking and then she very sensibly pointed out that everybody has the capacity to be a bully in the wrong circumstances and that does not mean that I am a “bad person” who is beyond redemption.

Therefore tomorrow I will ring my ex-registrar who is now a respected and successful neurosurgeon working at an ivory tower and I will apologise for almost destroying his career. And I'll have a quiet laugh at him because he still holds the forceps funny.

PS For those of you with no sense of humour then you have my pity.

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