Consultant Colorectal Surgeon, York Teaching Hospital
& Senior Clinical Tutor, Hull York Medical School
I love Surgery… No steer back a bit. Actually, I am still in love with Surgery.
It is almost a decade of being a consultant colorectal surgeon and yet time and again I marvel at what Surgery is. Despite the long hours (reducing all the time), the tedious moments of waiting in theatres, the multiplying paper work, the constant juggling of priorities and demands on time; I find myself loving the operating, the problem solving, the results and outcomes, the grateful patients, the teams, the people around you – ALL of it. All – a wonderful jumble of experiences that make Surgery what it is – exciting, fulfilling, satisfying and exhilarating – how could you not love it!
Of course sometimes it becomes stressful, the wonder ceases to enthrall, but every so often it stops you in your tracks – like a summer sunset in the vast plains of India. You pass by a whole season of sunsets not looking at them and then you suddenly stop and the breath-taking magic of it all holds you … and you feel better for it. Then you move on…
When I was asked if I would write a blog for students at Manchester, I was delighted. Manchester is where I trained in Surgery. It is a great place and I had a good time there. I learnt from many people there and many of the lessons I learnt, I still carry with me today. I think of the figures from 1997 – Rick Salem, the first surgeon I worked with at Bolton – his attention to detail, the little things, the planning, the checking, the rechecking! I still check the diathermy plate is in firm contact with the patient – every patient. I learnt that from him; amongst other things. I learnt from Graham Ostick to do every discharge letter yourself no matter how busy you are. I learnt from Graeme Ferguson to always be on the wards or there about, know all the blood results better than the registrar. From Hamish Michie I learnt how to present an argument, from John Hobbiss how to see things from the patients’ perspective – to give them time even when you do not have it. They were my first teachers in Manchester. All this from one hospital – Royal Bolton Hospital.
Every hospital I went to I learnt things I think of today and I worked in many hospitals in the Manchester Deanery – Bolton, Bury, Wythenshawe, Stockport, Trafford, Burnley, Salford, MRI, Wigan. All of them trigger special memories. Like when on a Sunday morning ward round with Sarah O’Dwyer, to my chagrin I discovered I had put a size 18 drain on one side and a size 12 on the other and she spotted it and I had not realised it util then…I check every drain size meticulously now! And along the way, I learnt to operate, learnt to recognise when not to operate, learnt to think of endoscopic and radiological ways of intervening and sometimes letting nature determine the course.
Think of this; we read about such things a lot. But just for a moment stop and think – a cancer starts, it grows; the patient is ill. You open their belly; find the part of the bowel the cancer is in. You remove that part of the bowel, then join back the bowel and close. Job done. It seems ordinary every day stuff. But look at this. The symptoms were minimal; all that was found is anaemia. A long tube was passed into the whole colon. This tube is one and a half metres long – yet from one end you control the tip at the other end 1 ½ metres away. Your accuracy of control is in mm. You can take photos, you can change the light and instead of white light you can pass a narrow band of light and the colours of what you see change. You can then see the glands opening on the mucosa. You can see patterns in it. And a diagnosis is made. And this is just a routine colonoscopy. We have not even touched advanced endoscopic therapeutics yet.
Or think about that surgery. You make small holes – key holes; about 1 cm long or even half a cm long. Through one of them you pass a camera. This is a high definition camera. The images are on a high definition screen. The picture quality is just fantastic. You can see tiny changes in contour. The colour is vivid. You can see thread vessels in the peritoneum. You don’t allow these to bleed. How? You use a current rod, much like a cautery iron in medieval times. But things are now much improved. The current heats a probe in a controlled way. Then this probe touches the vessel. It coagulates the vessel. There is no bleeding. The patient is safe. The current does not electrocute him, because it is carried away. Remember the diathermy plate Rick Salem used to worry about!
And you know what? There are so many alternatives to diathermy. You can use bipolar diathermy – one where the current only passes form one jaw of the instrument to another and safely out of the patient. The risk is even more reduced. What if you want no risk of electrical currents? You can use ultra sound waves. Now there’s a marvel. The sound waves are moving at about 55,000 cycles / second. And all this vibrating is causing heat energy to develop. How much heat? A considerable amount. And it vaporises the tissue in a very controlled fashion. And there are even other energy applications. In endoscopy, I use an inert gas called Argon. The tissue is bathed in Argon through a fine bore tube and then an electrical current is carried via this inert gas. The depth of burn is even less, making it possible to use it in a colon whose wall is only 1.5 mm thick without burning it through! Thus we reduce the chances of a perforation. I could go on and on…
Everything you do in surgery I find fascinating. Yes, there is a lot to learn but with time it becomes second nature to you… Like breathing out and breathing in…(1)
And for those of you who worry about the time demands on your life – there is no doubt Surgery is demanding. But there will be time for other things. I have designed and run two websites and neither of which are about Surgery. I have started blogging on aspects of history that fascinate me (2), I have made a DVD for patients about to have bowel cancer surgery (3). I had time to write the script, film the scenes, edit them with a specialist film buff and now for more than five years this is given to every patient with bowel cancer having an operation in our hospital. I follow my wife and kids when they go to music or orienteering festivals. Only a month ago we went to the international orienteering festival “The JK” where I have to confess I was an onlooker (4). I have even started learning to play the flute (though I am making agonisingly slow progress in it). There will be time for yourself – you will, however, have to learn that life is a constant reappraisal of priorities but Surgery will teach you that anyway.
And then occasionally, ever so suddenly like a summer scene, the overwhelming beauty of it all transforms you. And the rewards are immeasurable – job satisfaction, the chance to lead a team, the frequent possibility of making decisions after weighing up options, solving problems, the privilege of looking after patients and curing them mostly. Why would you not fall in love with it….
As I said at the beginning… I love surgery.
1. Prof Higgins describing Eliza Doolittle in My Fair lady. If you want to listen to that here is the link.
2. Vivaart – Visual art in motion
3. Bowel cancer surgery DVD and booklet
4. Jan Kjellström International Festival of Orienteering 2014