Sometimes I ask myself what factors allow students to make firm decisions about their future. Perhaps it's the exposure and our experience through the rotations. Maybe it's our academic thirst to understand the underlying principles of diseases affecting certain organs. Could it be for the detrimental effects of specific disease(s) on the population? Or it may even be our passion to help people in the areas we are most comfortable with. Of course, let's not forget about those who want to study diseases that have or are affecting them or their loved ones.
Thinking about it reminds me of the times I started to seriously consider the rough climates and violent seas of the surgical pathway. When did it start? Where did it start? Most importantly, what was the context in which it started?
It definitely started in the operating theatre, which is no surprise I'm sure. I was in my first year and we had just started studying the musculoskeletal system. Our hospital didn't have many rheumatologists at the time, thus the clinical teachings were conducted by the orthopaedic boys and girls (yes, there were girls).
Dr. QD was the orthopaedic surgeon who made us feel he had all the time in the world for our questions. He asked us all to take turns bringing shorts or singlets so the group could examine one student at a time, rather than asking surgical patients to volunteer for strenuous tests on joints. The week we examined the foot and ankle was my turn to be the patient. I sat down in front of the group of 10 students while he explained the importance of watching someone get undressed to understand their global function, restrictions and disabilities. I proceeded to take my shoes and socks off as everyone watched quietly. At that point, we were all just trying to understand what normal was and I definitely was not a good example of that. I hadn't told anyone I had a problem.
The interesting part of examining your colleagues is one can always pick up underlying abnormalities that have gone undetected for many years. The majority of these are "innocent" heart murmurs. But I had something else going on. So I knew full well Dr. QD was studying me as he was studying all of us every week to ensure the findings were in fact normal. I looked up at the group after I rolled my trousers up to my knees and asked "what do you think Dr. D?"
"You've got a lot going on there." My colleagues were confused as they didn't notice much wrong through their untrained, inexperienced eyes. It was also the fact I had mechanisms in place to make the abnormalities as subtle as possible, just like anyone else with health problems.
After my colleagues took turns examining me and asking questions, Dr. QD and I spoke briefly about my "orthopaedic problem". That's when we built some rapport. It's also when he agreed to let me into his operating theatre every Monday morning.
It was my second Monday morning in theatres and I was thrilled to watch the amazing things they do... from the anaesthetics bay. I remember walking in and feeling the stress of the staff: nurses running around getting equipment ready, the anaesthetist sedating the patient and Dr. QD quietly looking at an MRI of the knee. He was alone and studying the images carefully. "Good morning!" - he turned around and the look on his face was almost "thank God you're here."
The registrar's wife was in the middle of giving birth and Dr. QD told him to be by her side. He had no assistant until the other team's registrar was free to assist him... after their morning list, which wasn't helpful. "Could you give me a hand?" he asked me. "Of course," I said but I didn't know how to scrub or what to do. "Follow me, let's get started before the patient is ready."
He patiently taught me his technique and I carefully imitated his motions. We scrubbed together and my anxiety settled with his patience. He showed me the way to wear gloves after putting gowning up. After several failed attempts of putting on gloves with the gown's sleeves, we both realised time was running out. He asked the nurse to open a new pair, which he took and stretched for me. "Here, just slide your hands through" he said. It's the only time in my life a consultant ever held gloves out for me. Not that I'm special, it's just unheard of.
Luckily about half way through a total knee replacement, a junior registrar showed up and took over my position as first assistant. We completed the procedure altogether and it was a team effort. At the end of it, Dr. QD thanked me and I left to attend the late morning's tutorials. It was then I was sure I wanted to do orthopaedic surgery.
Was I? Ever since the end of our musculoskeletal studies, I lost interest in it while my curiosity for general surgery grew. Something changed... but what was it? Eventually, I forgot about orthopaedics until recently.
Paediatrics has been a tough rotation not only because it's difficult but because the dedicated children's hospital I've been allocated is infected with political bullshit. People are anti-social, arrogant and occasionally just rude. After following them around for several hours, they throw you a bone with a short piece of knowledge that you read the day before.
It's my fault - I expected to get a lot more out of it. My first week was orthopaedics and given I had spent my elective mostly in theatre, I thought it would be a good idea to have an understanding of what outpatient medicine was like in the fracture clinic.
The orthopaedic team were welcoming, friendly and we clicked quickly. Next thing I knew, I was assisting in theatre when needed and when they didn't, I was seeing patients in the clinic. At first, it was with the fellow. A few patients later I was seeing patients on my own. I would take the history, present it to the consultant or fellow, show them the follow-up imaging and offer my management plan. They would obviously over-write it with a more precise management plan while giving me constructive feedback. It was an amazing learning experience.
There was an icing on the cake as well. It was Thursday and the rostered consultant showed up to the clinic: it was Dr. QD! We were both very surprised to see each other again. We shook hands and caught up briefly. "Good to see you again mate." I explained I was here for a week during my paediatric term. "Well, we have a busy clinic this morning! So, let's get to it!"
So off I was seeing patients on my own and by the end of a six hour clinic, I had seen 40 patients. The experience was amazing. I decided to stay back and see some patients in emergency with the orthopaedic registrar. Dr. QD was the on call consultant that evening and I had a brief chat to him on the phone.
"You should really consider orthopaedics mate. It's a good career choice and you've made it clear you can tolerate the workload. Thanks for your help today." I was very happy he gave me his opinion and it very much lifted my spirits. There's nothing better to be useful to both patients and doctors as a medical student.
After almost four years of being a medical student and pondering about the influential factors facilitating our career-decisions, I realise now the most important factor is our personal experiences with the teams we are allocated. It's the passion of the team, their dynamics and we hope one day, we return to the very same team and do more than we ever thought we could. At least that's what I want, but teams in hospital change every six months if not more frequently. We all move cities, hospitals and get rostered on different times.
I'll never forget the people who didn't brush you aside as a medical student. They took me in, realised my potential and convinced me that it's possible to do what I'm expected to do in a few short years. Unfortunately it's uncommon; doctors don't teach very much because they are over-worked and pre-occupied with more pressing issues.
Overall, the people that validate you with recognition and the allocation of responsibility are those who we wish to see again and work with in the future. They are the essence of my inspiration.
Who knows? I am actually re-considering orthopaedics as a career choice and the only substance behind that are the brief, direct words of Dr. QD, orthopaedic surgeon.
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| The Symbol of Orthopaedic Surgery |
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