One of my great leaders dumped a talk on me recently that he was meant to deliver to the medics lunch time meeting (150 physicians and students). He was called away somewhere more important and emailed me late at night to ask if I’d do it. 

I arrived at work in my best smart dress and heels with more than the usual level of hair and makeup effort. Great Leader met me to hand over the pen drive and I started nervously wringing my hands that they would be disappointed to get me and not him. 

It was a topic I know inside and out and I make decisions based on the evidence I was presenting every day. I smoothed my dress and stood tall, shoulders back and exhaled. I peered in the Professor’s mirror (I know- a professor of surgery with a mirror in his office!) and tutted at my reflection. “I’ll be there nice and early and make sure the computer works” I reassured him, scowling at a dirty mark on my shoes, “I hope they aren’t disappointed not to get you”. 

He took me by both shoulders, looked at me and said “Why are you nervous? Go and put your scrubs on, put your hair up, put your hat on and relax. Turn up 5 minutes before you are due to talk and let them worry about the computer”. 

The talk went well, they asked easy questions that revealed how little they knew about the subject and how much I knew. I felt happy and relaxed and I  looked like myself, by which I mean my surgical self. 

“#Looklikeasurgeon” is great and God knows most of the time I don’t conform to the stereotype and even take great pleasure in not doing so, but sometimes looking exactly like a surgeon is very helpful. 

I don’t look like him. He looks like a surgeon. 

The intimacy of care

The intimacy of care

I was on my knees on the floor, one tiny, slight student nurse was hauling the man over on his side as I stuck a rigid sigmoidoscope 30cm into his KY jelly (cheap NHS version of actually, not the branded KY) lubricated rectum. 

I inserted a Faucher tube (largest one on the shelf, 36F) and stood back. Hurtling towards me down the tube came litres of gas and liquid stool, the noise was quite dramatic and was heard by the rest of his 6 bedded bay. 

The man’s abdomen decompressed and he could breathe again, but there was shit everywhere. It was pooling round his wasted, skinny little buttocks. I cleaned him up with the patient cleaning mousse, wiping his thighs and buttocks and scrotum clean and the nurse and I got a fresh sheet for his bed. 

We tucked him back in, abdomen almost normal again, flatus tube stuck securely to his thigh to keep his colon deflated. It was the fourth time I had seen this man, the fourth time I had decompressed his volvulus, he is paralysed and condemned to blow up time after time. 

As I kneel there, wiping and cleaning his pressure sore covered sacrum, I look at my bare arm splattered with faeces and  I hope that it will never happen to me, that I should never be where he is. That I couldn’t bear what he does with such dignity and composure. 

Afterwards I explain again what the plan is, ask him if he feels better. He thanks me for doing it, tells me he feels much better now. His dignity in the face of what he has to endure is humbling. My eyes fill with tears, partly due to tiredness and partly due to doing something so simple and easy that has made someone instantly better. It cost me nothing, it took no real skill, used just 15 minutes of my time, there was no ego, no risk. Just me, on my knees, covered in shit, making someone feel better. 

Being a good guy

Being a good guy

Most people get a job in a Big hospital because they are appointable and lucky to be finishing when the job came up, not because they are better than everyone else. In fact, I can think of many below average surgeons with above average jobs. 

Picking a consultant colleague is difficult, it’s hard to get rid of someone once you’ve employed them and much like a spouse, they’re at risk of changing once they have that ring on their finger. 

In order to help you appoint only good guys to your team I would suggest doing away with the regular interview questions  and instead using my questionnaire below. 

1. Your theatre nurse who you know well has a contraceptive implant under her arm that she wants removed. She can’t get an appointment at the local family planning clinic for 3 months and her GP who inserted it isn’t trained to remove it. Your list finishes early and she asks you to take it out. It will take you 5 minutes. What do you do? 

2. An anaesthetic nurse with Crohn’s disease says that they are tired and have abdominal pain, they ask if you’ll check their bloods to save them a trip to the GP. Yes or no? 

3. A colleague has a huge, painful abscess that needs draining. They come to you to ask for help, do you send them to their GP and get them referred or admit them for theatre? 

4. Your senior specialist nurse has had a cough for 6 weeks and lost some weight. You tell her she should maybe have a chest X-Ray, and she asks you to arrange one for her. Yes or No? 

5. A porter tells you he has a new onset bad back and oddly enough was catheterised by A&E two nights ago as he became acutely incontinent of urine. He needs an urgent MRI, do you head along to radiology to arrange it or send him back to the emergency department for a proper review? 

There is a right answer to these that isn’t the same thing as doing the right thing. The right thing is the wrong answer. What you’d really do and what you should do are also not the same thing.

Are you a good guy or a wank?

Hunt: not a good guy