Last Minute Wisdom ????

Last Minute Wisdom ??? Or Blues ????

Disclaimer: This post is a work of fiction and any resemblance to any person or incident in real life is strictly imaginary and no way involving any professional trust issues.

This morning I was left completely free of any work, quite unexpectedly if i may add. And no it was not of my own volition for I would much rather have been busy doing some surgery but my only patient for the day canceled her surgery and walked away without looking back. And that is the story I am going to share with you now. There i was all bright and early in the morning, with a strong filter coffee inside me and entering the operation theater for my morning surgery when I heard a mild commotion near the operation table at the far end of the room - near the anesthetic apparatus. I walked over to see what the heck was going on and that too right on my surgical time and was surprised, well shocked would be a better word - to see my patient still on her feet when by rights she should have been flat on the table conked out by the anesthesia and ready to be cut open.

As i neared the group surrounding the girl(the patient) and arguing with her- the girl shook off the nurse who had a restraining hold on her arm and saying "I don’t want the operation" she walked out of the theater leaving us all flabbergasted with her insouciance. There was nothing we could have done to stop her- she had every right to decide on the surgery- right up to the last minute and she had obviously exercised her right to walk out at the very last minute possible. My mind working overtime on the why, I hurried back after her to catch her before she left and ask her if she could at least tell me her reason for canceling at the last minute.

And as I came out through the swing doors of the theater I could see my patient arguing vehemently with her mother who was waiting outside the operation theatre and just as I neared them her mother turned towards me and said "doc, give her anesthesia and just do it, don’t listen to her, she is just afraid". I shook my head sadly at her and said "now listen Mrs. So-and-so, she is a major and she has every right to decide what’s good for her. I never treat people who are unwilling for treatment" and as soon as I said that the girl pulled her mother along by the arm and they left without a backward glance- ruining my day effectively.

A few minutes later as the entire surgical staff got back together in the empty operation theatre to discuss what had just happened there was an immediate attempt to lay the blame on me as the admitting surgeon for not getting the patients wholehearted willingness before the surgery. I immediately defended myself by taking out the case notes to show that the patient had met me thrice over the past ten days and had done all the necessary investigations promptly which showed she was willing to undergo the surgery till she had come in and I wanted to know from the operating staff nurses and the anesthetist what made her change her mind just before anesthesia.

As a matter of fact no one really could say why for sure but we all could make a guess- some patients, in fact most patients rarely realize the seriousness of what they have signed up for until the moment they are lying on that operation table staring into the overhead light and waiting for the anesthetist to start injecting. Its then that they have a profound realization that this is IT- I am undergoing a surgery involving my body parts and a lot of blood. If it’s a case of where the patient has been suffering from pain or disease for a long time then they actually welcome the surgery as the last step towards a permanent cure for their disease. But most cosmetic surgeries are not for pain relief- but just for vanity's sake. Hence second thoughts when they are on the verge of changing something they might not have liked but had been born with and accepted till now.

And later on as I sat in the canteen sipping an insipid cup of tea I went over the various visits of that girl (before today) for consultation and I could have kicked myself as I realized that the patterns fit. Right on the first visit she had said “my mother feels that I have so-and-so problem” when she described why she had come. And then later on during the second visit when I had complimented her on her punctuality she said the credit should go to her mom who had dragged her there on time. In hindsight I see now what I should have realized before - that the patient was not interested much but it was the mother who had pushed the girl to get it done to improve her chances in the marriage market and so the patient had gone along with her mother’s wishes up to a certain point and then had suddenly rebelled -causing a shock to the poor unfortunate doctors.

The trouble with doing cosmetic surgeries is most patients don’t realize themselves why they want the surgery. They are usually confused and act on the advice or more probably the taunts of their near and dear- usually a mother or a boyfriend or a husband. Many's the time when a young and good looking girl walks in to our cosmetic clinic and says straight off "My husband feels my nose is too large and wants me to reduce it". Whenever I hear this dialogue I am immediately tempted to advice her to go back to her husband and ask him how come he didn’t notice the large nose before the wedding and which body part of hers had captivated his attention so much that he was willing to marry her just to get his hands on it disregarding the obviously large nose staring right in front of his face. But of course I can’t tell the women patients that kind of truth can I? Or else I would be accused of breaking up families, god forbid. In fact, most nose surgeries are unnecessary in my opinion for every individual has a different shape and all of them have their own beauty- we don’t need to make it all the same boring type.

And this is the reason why for any cosmetic surgery we docs spend a long time counseling the patients against the  surgeries or at least make them wait and come back again and again until they are absolutely sure they want to undergo the treatment and not do it on a sudden whim. Especially when it is for young girls who  are about to enter into the marriage market and want to get things corrected beforehand- we always do counseling to make them understand that their self esteem is not affected by body issues and they are doing it for the right reasons. And as I personally keep saying every chance I get- for below 45 years of age- just diet and exercise will achieve all the results that surgery can give. It’s only in the late 40's and early 50's you need face lifts and wrinkle removal surgeries. A balanced diet and adequate exercise does wonders for your face and keeps you young forever.

And this is the respectable part of the profession I am talking about while in fact there is another less disreputable part of the profession we don’t usually talk about which involves unnecessary surgeries (from the surgeons point of view) but where the patients are willing as hell to get them done- things like breast enhancements, buttocks lifts and vaginal tightening and hymen reconstructions etc. Doctors are supposed to be non-judgmental when it comes to patients but that can’t stop us from thinking inside our own minds can it? Like itching to ask a patient "ok you get your breasts made big for one boyfriend who likes 'em big and then he dumps you and your next one fancies bigger butts and you sign up for it too..How far will you go? How many alterations will you make to all your body parts till you finally catch "that dream boy" for whom you have been holding out? Why don’t you marry an ordinary guy who will accept you as you are and not demand you get any of your body parts enhanced according to his fantasies?" That’s simple logic isn’t it? Instead of getting so many surgeries done just to impress the unworthy?

Call me old fashioned but some of the very worst/worthless surgeries in my opinion are the sexual satisfaction surgeries like vaginal tightening and new hymens for old surgeries.  The gossip in the change rooms of surgeons is about the several society ladies and businesswomen in their 40's who have had their vagina's tightened and hymens reconstructed post divorces – something which is becoming commonplace and routine over the past few years. But the worrying trend is of younger and younger ladies (even in their 20's) getting it done multiple times after every break-up just to act like a virgin for their new boyfriends and that sounds sickening to me. And in one extreme case I heard of recently -getting a new hymen every year (for the past three continuous years) after taking a nostalgic annual vacation in Goa with the ex boyfriend - who of course pays for it.  Even if it comes cheap at 30,000 bucks a pop for your cherry how many times will you get it popped? Is it that important to act a virgin/sexual innocent even if you are not and won’t it be much simpler to just find someone who accepts you as you are- even if he learns you have been around the block a few times? Hmmm, somehow I just can’t understand the logic behind some of these decisions people make. I don’t care much about the inner beauty/outer beauty concepts but the one thing I do believe is to learn to accept people the way they are.

Anyhow I guess that is enough ranting for one day and this post is getting too long and boring for you. Conclusion- lesson learned and never more a surgery scheduled unless the patient agrees multiple times in front of multiple witnesses...ok?

For a “Purr-fect” Nude Look…..

For a “Purr-fect” Nude Look…..

"If you were me, would you go with the nude look?" she asked and I replied "oh honey, I go nude every single day".  Now if your overactive imagination is picturing me going about in a, well, in a state of undress, perish the thought. Cease, desist, and don’t think like that for a minute- for the nude we were talking about here refers to the face- a nude look sans any make-up for the face. Now if you are wondering what I have to do with makeup and such things, let me start the story from the beginning.

As part of a team of surgeons who do extreme make-over’s, I happened to treat an interesting patient recently. This particular patient was a 22 year old female and what’s more important, unmarried and looking to get married pretty soon. In quest of which marriage she had tried to look prettier by becoming thinner, even though she wasn’t very heavy looking to start with. But as they say, is there anything like being too thin or too wealthy?

This patient’s chosen method of rapid weight loss involved starvation, as she was hell bent on achieving a zero-size figure in time for her wedding. Unfortunately for her, she failed to realize that being thin does not necessarily translate into beautiful. There are lots of thin, ugly women walking around if you look, which is incredibly sexist and might bring me brickbats from the feminist brigades, but, hey it’s the truth, so sue me.

Anyway to get back to our patient this girl by binge dieting and extreme starvation became as thin as a stick and then having achieved her life's goal assumed that she had become beautiful. Imagine then the shock to her system when she realized that despite the weight loss she was basically what she always was, albeit a thinner version with a constantly hungry look in her eyes. And then when she realized her folly she did what she should have done in the beginning -approached the professionals.

Let me digress here a bit and offer some general advice- losing weight and becoming thin if done the proper way with exercise retains the muscle tone but losing weight with starvation makes you lose all fat beneath the skin- which pads out and fills up the skin and consequently the skins sags and hangs - giving you an aged appearance - unless you get a skin tuck done by a cosmetic surgeon (if you don’t believe me - check out any liposuction patient after all the fat's been sucked out- they look like the pug dog from the Hutch mobile advertisement- with loose rolls of skin hanging down). So, take my advice- walk, run or dance- but don’t starve.

And also, there is a general rule in plastic surgery that says "Soft tissue follows Hard Tissue" which translated from medical jargon means that the flesh follows the shape of the bone. So anything you do to the muscle and skin will not last long if it’s not in conformity with the bone beneath. If your jaw bones are long and protruding, however much you reshape your lip muscles, you will never have a pout till the bone beneath is also re-shaped and then the flesh above the bone will automatically adapt to the bone below and achieve the perfect shape we want.

So, after doing the very best we could to give her face an all-natural look- a few nips and tucks here and there, some bone grafts and some collagen/fibrin to bring the shape back to her face- we let her go home to heal. And she returned to us after the usual six weeks of healing to check up on her final results. As part of the hospital protocol- especially for extreme makeovers- and to guard against future litigation by disgruntled patients who are unable to bridge the gap between fantasy and the reality of their looks- the hospital has mandatory post- operative photographs for documentation (and as evidence for the legal team).

In any hospital which does cosmetic surgeries, there are specialists appointed for the purpose of getting patient photographs- photographers and make-up specialists. One of the tricks the photographer employs is to undershoot the pre-operative photos to highlight the post surgical effect- which is unnecessary in my opinion. And vice versa they go all out - overboard sometimes- in getting the post surgical photos- with heavy make-up and lighting effects- which is where the creative difference arose as I mentioned in my first para above.

As an end user and as someone from the team responsible for the actual result- I like to be involved in these photo shoots despite murmurings that I am a know-it-all poking my nose everywhere. I discount the murmurs as I feel that it’s only my insatiable curiosity to learn something new which drives me to hang about the patient photo shoots. Anyway, I always feel that the stark look which the photographers shoot for the pre- surgical pictures are way better than the heavily made up faces they shoot for the post-surgical photos. And hence I decided to get hands-on this time.

As I had been the one from the team who had coordinated the entire makeover for this particular patient and she trusted my judgment, I had to put my foot down for the look I wanted for this patient- a nude look. Now a nude look for those who don’t know much about make-up (which is me -before wikipedia) is a minimal make-up look- as far as possible approaching the natural face. Which is the very point of doing a cosmetic surgery- to make someone look beautiful even in the morning when they wake up sleepy faced.

The make-up team had an ingrained habit of applying make-up liberally but I convinced the patient that a nude look would show her the real results achieved and I sat down with the make-up team and was constantly giving them advice to restrict the amount they usually dab- something which almost drove them nuts, I think.

And the conversation during the photo-shoot went something like this:

Please put just a hint of concealer around the shadow areas of the nose and eyes. Now use that foundation sparingly and blend it in please. Yes, use that marble tone- that would suit this skin tone better. No, no blush please, please don’t, not over the cheek bones- we have accentuated it naturally with bone grafts- we don’t want to highlight it further. Ok, just a little hint of powder. Do you really want to make it soo glossy? Or do you think we can pat it down for a matte finish? What does the photographer feels- shall we ask him? Oh, ok, you would adjust the effect with the lights then?

Now for my signature look- add on the lipstick....MAC raspberry? No I prefer the Estee Lauder one- Coralline Red- here, this is the shade I was telling you about- apply it to her lips and see how the peachy shade makes the lips more inviting and perfectly complements the nude look of the face rather than the bright red raspberry you advice. Yeah, it’s not my province, I know, but hey, who better to admire a lipsticks effects than a man? We look at it from the consumer point of view, so trust me go with the coralline red- it will make your lips all peachy and delectable. What, you want me to apply it and show you the effect? Oh, just kidding me, were you? 

OK time to pose- be natural, don’t use all those patented poses like the photographer showed you pictures of-  be free to give us your own poses- we can always delete later on if we don’t like it. So mr.photographer, are we ready with the soft focus lights? And after you finish shooting the regular ones, I want a few grayscales for my own patient records- no I prefer grayscale without any hint of touch up- for my surgical notes. OK. Thank you all. Nice shoot. And I expect to see you again- next month- for your final check up. Bye.

And you walk away with the sense of a job well done having captured the prefect image you wanted, but then you are in for a surprise -for whatever effects you tried to achieve on the floor of the studio- the photographer who does the final post-processing uses his photoshop software to give  the pictures a uniform bland look like all those models with plastic faces you see on magazines- any sign of individuality in your shot composing is all lost by the time the picture is printed out and you grin and bear it and just add it the patient records and close the file.

Disclaimer : I am not recommending the nude look for everyone- every look should be decided by the individual’s skin tone and more importantly- by the occasion. I am also not recommending you go for a matt finish over a glossy finish or you apply highlights over the cheeks. I am also not recommending you try out coralline red lipstick. I am especially not endorsing any of the products named above. To each their own.

P.S. I would have loved to show you the pictures of the patient we shot as examples for what I am talking about -but medical ethics and doctor patient confidentiality forbids me from using them on social media. Only the hospital has the right to use those photos as part of their promotional campaigns and advertisements.