Last Minute Decisions and Iffy Results

Last Minute Decisions and Iffy Results

So this morning I made an error. I call it an error, say of judgment, rather than a mistake, because split semantics aside, it came off a gamble I took which didn’t pay off as it should have because of unexpected circumstances beyond my anticipation.  There was this case we had posted for surgery a week (10days?) ago and back then we had reviewed the case and had decided to go for a full thickness (epithelium+ connective tissue+ periosteum) flap. But today when the patient turned up for surgery and was prepped, anaesthetized and ready to be operated on, I took a long, long look at the operating site and my surgical judgment (my intuition?) telling me that with a split thickness flap (a half-way flap) will give better results and also help in preserving the donor site from where I was going to harvest the graft and then stitch it to the new (deficient site), I made the split-second decision to go for the tougher to do split thickness flap instead of the agreed on protocol and proceeded to raise a beautiful split flap. And then came the anti-climax. 

The theatre staff handed me 3-0 sutures which is what they had ready for a full flap while I prefer to use a 5-0 suture (thinner one) to stitch a thinner split flap. Although the theatre IS  supposed to have all sizes of sutures at all times (for all surgeries) somehow they did not have what I wanted right then and I had to make do with the had – a 3-0 size only which dint really fit the thin flap I had taken. So I wasn’t really satisfied with the end result of my surgery and will eagerly wait for next week when the sutures come off to see the result – fingers crossed. 

The thing is I am still in a dilemma about whether I should have stuck to my original surgical plan frozen a week ago or should I have made the call to change the design at the moment of surgery. Do good intentions excuse an error of judgment? What if the gamble had paid off, as it would have if the nurses had properly stocked the operating theatre? There are so many “IF’s” but no clear cut answers. The only thing of certainty is I took a risk and it didn’t come off as it should have – maybe a 70% success rate only- which may be good enough for the patient but still is kinda hurting to my ego. So was I justified in giving precedence to my surgical skill over the team decisions by invoking my privilege as the operating surgeon? The jury’s out till the sutures come of…and till then feel free to pop in with your views on what I should or should not have done.

No Shame In Saying I Don’t Know, Is There?

No Shame In Saying I Don’t Know, Is There?

So they called me today all of a sudden in the middle of my canteen break (for those of my readers from countries which were never under the shadow of the British Empire – a canteen break is a midmorning visit to the in-house cafeteria – say around 11am- for a coffee/tea) with an emergency call and unlooked for appearance of a postgraduate student standing beside my cafeteria table, staring morosely down at my tea before saying “they want you back at the department sir, something not right with the laser”.

So I leave my half drunk tea on the canteen table with a look of longing and hurry back to the surgery room screaming “What? What? What? What happened?” to find the two guilty persons who tried to use the laser unit in my absence (temporary/tea break) adopting an unconcerned “we are not responsible” look. Seems they had tried to do a case (a surgery) all by themselves and the laser had malfunctioned and they tried to lay the blame solely on me saying that “you were the last person to use it” to which I replied irritably “yeah and I left it in good working condition just a few minutes ago”. For I knew they were trying to pin the blame of the malfunctioning unit on me and try to appropriate my next month’s salary towards repairs for the at-fault laser unit- on the principle that the last person gets blamed and foots the bill. 

So I went up to the unit and checked it and found it was working fine. Surprised I asked them to demo to me what they were doing with the laser. So they sat there the two of them and applied the laser to the anesthetized patient and waited for it to start cutting and then after a few minutes they turned towards me and said “See, its not cutting”. Whereupon I asked one of them to vacate the seat and sat down took the laser in my hand put it near the surgical site, operated the foot switch, cut the tissue and showed them “see, it works now, by magic”. The poor fools had not realized that the laser operated with a foot switch which they had comfortably left all alone between the two of them and neither of them operating it and they had thought that you just need to point a laser at something for it to start working. And of course they had thought they could do it in my absence in the mistaken belief that what he does we can do too- without learning at least the basic functions of the machine. 

Which shows once again that people would pretend anything except to accept their ignorance of something. I hope they all realize soon that it’s never too late or too much to ask for help and its definitely no shame to say those three magic words “I don’t know”.

Lasers Vs Conventional Surgeries

Lasers Vs Conventional Surgeries

For those who ask me why lasers, well I got a one word answer for you (well, actually two words) – no sutures. Remember those sharp curved long needle things with threads attached to them which doctors poke into your body umpteen times and use weird contortionist positions to tie them into knots (knot after knot after knot?) well those stitches or sutures are “gone with the wind” baby when it comes to laser surgeries. Now coming to the other side of the argument that lasers are expensive to use and why surgeons are pushing lasers more than scalpel surgeries all the time and is it because it’s convenient for them and not for the patient. Well, I agree that surgeons more and more prefer to use lasers nowadays for even the simplest and shortest of surgeries. But it’s not only because of its convenience given that a laser surgery is done in a clean and bloodless field for laser automatically coagulates (clots) the blood vessels- thereby preventing bleeding and thereby allowing the surgeon to see what actually he is doing with sharp instruments and voila you get great results, which is what you want right?. And because the surgeon can work calmly with no blood and clear vision of the operating site – even in extremely bleeding sites like, for example, the tongue which is notorious for its rich blood supply and for bleeding excessively even for minor injuries and hence tongue injuries are a real bitch to treat (sample case below of a tongue tie patient -with a pronounced lisp- being treated by me with a laser during a tongue release surgery). And of course the USP of lasers – no stitches. Now tell me isn’t a laser worth the price?

The Tongue-tied patient

Me using the Laser to cut

Pulling back the tongue with a temporary stay suture to expose the undersurface

The End. Finis. Bye-bubyee

And so, we learn something new every day.

Laser Surgery Conference, 2014.

I am writing this at the end of a long and tiring day, a Sunday when I could have been at home resting after the rigors of last week although I must say that the mental exhaustion is far more than the physical tiredness. But I guess you can’t avoid it when you spend all day on screen- talking to a live audience watching you perform on giant screens placed all around a stadium sized auditorium with everyone hanging on every word of yours from morning to evening- so what in effect I am suffering from is performance fatigue as familiar to every showman.

Now before you imagine any naught things about me, let me assure you that the live show I am talking about here relates to work- doing surgeries live on the big screen for the audience to watch and learn- an audience I might add who has spent quite an hefty amount for the privilege of watching me teach them how to do laser surgery. And it would all have been well and proper if I had been previously prepared and mentally ready to give the performance of my lifetime- but i was not- which is the story i am going to share now. 

Last week all of a sudden I got a call from one of the local organizers of a prestigious state level laser surgery conference who sounded desperate on the phone. He asked me if I could do him a little favor and when I asked him what the favor involved he told me that they had arranged a grand laser surgery conference for the coming Sunday and had lined up eminent speakers and famous surgeons to do demonstration surgeries to teach the conference attendees and now when everything was ready and all the invitations were printed and sent out weeks ago, they were suddenly one person short for the surgery team as one of the ladies on the panel had pulled out citing some unavoidable circumstances. They had six surgeries lined up for the day - six difficult procedures to showcase how lasers can be used- and now they had just five surgeons and he wanted me to pitch in at the last minute as a personal favor.

Now regular readers of this blog would remember me bitchin’ often about how unless you are well connected (second generation or so) or prepared to spend all your time ass-kissing you cannot expect to be invited to these conferences which run purely on patronage and quid pro quo. So even though I would be a nameless, faceless entity at this surgical workshop for someone else had already had her name plastered all over the invitations as the surgeon who would do the demo- I agreed to step in at the last minute in the hope that at least now they would recognize my talent and at least next year they would invite me as one of the recognized speakers and not as a temporary stop-gap. But what really happened there was quite the reverse.

So this morning when I reached the venue for the conference I was quite surprised to see the magnificent arrangements made by the local organizers- the host university. The auditorium was quite large by normal standards of scientific conferences and the operation theater set-up was first class. The first thing I did was go down to the wards and check in with the local people on the types of cases- the patients and their diseases- they had made available for the demonstration surgeries. The post grad students in charge of preparing the cases told me that one of the patients had suddenly taken a turn for the worse so the anesthetist had refused to give fitness for surgery and hence they were down to five patients. Which sobering news suddenly made me realize that I was now superfluous- my entire journey had been made in waste.

Well, left at a loose end I just went back to the auditorium and settled down to watch the conference with a free mind- after all my whole day had just become free. So when the welcoming ceremony and the felicitations on stage started I was surprised to note that all six of the original invitees were on the dais - surprise, surprise -including the unavoidable circumstance lady. Now I felt like a double idiot. Why did they call me at all? And for what purpose had I made the long journey on an early Sunday morning? Was it just to watch people who are second best to me muff up their surgeries? While I who was a kick ass surgeon sat among the watching audience. but the story was not done yet and there were still twists to come.

After all the dignitaries on stage had made their speeches, accepted their mementos and certificates from a grateful conference host team there was a lull in the proceedings. It was right about then that one of the organizers- the one who had called me originally- sidle up to me and tell me that they still needed me to do the surgery I had promised to do as one of the other surgeons had a sudden family emergency and had to leave early- right after getting her memento. And he asked me which surgery I would like to do? Nonchalantly I told him that anything would be fine with me- I was equally competent at all surgeries. And that’s when he told me to go down to the theater and start off the conference as the first surgeon – which he put it to me as a marquee post and a great honor. So happily I traipsed down, changed, put on gloves, mask, head-cap and the heavy duty black goggles we put on for laser surgery to avoid damage to our eyes (the retina is very sensitive to laser beams and so all laser surgeries require black goggles) from the powerful laser rays and looking like a space suited astronaut I was ready to start the surgery.

They hooked me up with a mike, they positioned three powerful video cams for the live feed to the auditorium and when the cameraman said we were live, I introduced myself (my only chance to have at least someone know who was the real surgeon) to the audience explained the procedure and started  doing the surgery. Immediately there was feedback from the auditorium that I was going too fast for them to see properly and they requested me to make my cuts slower which i reluctantly accepted for I am usually a very fast worker. As I was working and explaining I kept getting questions from the audience in the auditorium who were questioning my every decision during the surgery and I had to keep convincing them as to why my decision was best.

There was the usual assortment of cranks among the audience who kept asking questions just for the limelight. One of the questions was why plastic surgery was at all necessary- it is of no actual benefit to human health. For answer I asked the old gentleman what kind of smart phone he had- whether an i-Phone or a Galaxy something or the other and then hectored him with the knowledge that as long as any basic phone can make and receive calls why go for smart phones? Why pay extra? Because the smart phones add value beyond making calls. Similarly plastic surgery adds value to basic health and makes a healthy life happy. And I then reminded him of Steve Jobs dictum on the first “i-Phone” as an “aspirational device" which everyone would value and taking the analogy forward told him that plastic surgery too is an aspirational specialty as everyone wants to look good and was there anyone, anyone at all in the audience who had not looked at the mirror before coming out of the house that morning? By then I had completed the surgery and I told the PG student assisting me (a nice looking girl) to call up the organizers and inform them to send down the next surgeon for the subsequent surgeries.

So after washing up I was getting ready to go back up to the auditorium when the organizers as a group came up to me and started fidgeting. I could see that something was up but did not guess how far they had screwed up things. After a little hemming and hawing the chairman of the scientific committee said that the others had all left. As I stared flabbergasted at them they said that the other surgeons on the panel had one family emergency after another, had relatives visiting, had children crying and all sorts of excuses to give and they had all left the place leaving me to hold the can. I felt like asking them how stupid they could be to let all those “experts” escape like that and how all these emergencies had suddenly developed only after the welcome function and certificate (memento/shawl) distribution. To me it looked clearly like a case of cold feet. They had come expecting something else but having taken a look at the large and hostile audience they had quaked and run away on flimsy excuses and the organizers had allowed them to leave without holding them to account.

Anyway the organizers were now requesting me to complete the rest of the surgeries- all five at a stretch single-handedly. For a minute I thought of screaming at them, throwing a temper tantrum and just walking away like everyone else had done. After all who could stop me?  I had taken no payment from them and made no firm commitment beyond one case. But when I looked around everyone especially the poor students from the host institution were watching me expectantly and I could see they were thirsting to learn something from me today.

And there were also the patients to think of, the poor patients who had all been told they would get to have their surgery today and had been waiting for days for the surgery. After that, I just didn’t have the heart to walk away and leave them to stew on their own juices. So I agreed like the sacrificial goat to do the rest of the surgeries on my own and went on to do the first three before lunch and hurried away to eat a couple of spoonfuls of curd rice (I had to avoid sleepiness) before getting back to the theater to finish the remaining two surgeries. Late in the evening, after wrapping things up I accepted the organizers empty thanks and then started back home.

As I came back home this evening, all the way back I was thinking of what had gone on today. I had spent an entire Sunday working like a donkey doing case after case for free. I had spent my own money on petrol to travel to and fro from the university venue situated outside the city limits. For the price of two spoonfuls of curd rice I had done five surgeries and had answered question after question (while doing the surgery too) leaving my throat dry. And all the while no one knew that it was I who was doing the work. My name was nowhere on the invitations- the ladies who had run away had got all the name fame and certificates for doing a splendid job. All I had was back pain, a stiff neck, a raw throat and mental fatigue. So what did I actually achieve?

Well for one, I got my lesson. I gained firsthand knowledge about how things actually work in the real world. How people can get others to do their work for them in the background while they bask in the limelight getting all the recognition. I also realized that I am not as clever as I thought I was- it was a wake-up call for me to be more streetwise and not fall a prey to such tactics again.  I learned that I still had a lot to learn about life - even if I knew a little about surgery - that there are umpteen numbers of excuses to get out of firm commitments. I learnt that giving our word is no longer sacrosanct and people don’t always keep their word.  I learned that organizers of conferences who go after famous names are at their mercy and have to beware of being tripped up by those very same big names. And I learned that when push comes to shove I don’t have the heart to abandon a challenge but am ready to bear the cross of others failings too.

So at last I came away filled with equal parts contentment and equal parts chagrin. The chagrin because once again I was the nameless faceless entity working hard behind the scenes for others success. The contentment because- all said and done- minus the affront to my ego and my envy at the well connected few- I got something out of this experience that I had never imagined I could get- I got to strut my stuff on the big screen, live, all day long, with my own dialogues and no one to say cut or action or to edit me. Even the biggest stars get just 3 hours on the big screen and here I was a rookie- with thrice that screen time. And so I have finally made my big screen debut and all the pain and fatigue finally sounds worthwhile. And in the end the take home message- damn I love the big screen. Plus- I have arrived- a new star is born. Take that, you guys.