Heart Beat/Maurice Neligan:Writing last week about surgical training and trainers retuned my thoughts to times past. I know this is a family newspaper but I cannot but include this salutary story from my registrar years.
My consultant at the time, Mr X, appeared one morning in theatre in extremely good humour. He told us that he had been at a largely medical dinner party on the previous evening and had met a GP who told him about a patient with a most unusual problem. Apparently the patient, a youngish man, was in the habit of walking around with his finger inserted in his rear end.
This somewhat disconcerted his family who sent him to the luckless GP. The history given was that a bee had somehow gained admission to these parts and the buzzing, particularly at night, the patient avowed, was driving him out of his mind. The doctor avoided the temptation of observing that such would be a short journey.
Instead, after an unrewarding physical examination, he reasoned with the patient and stressed the implausibility of such an event. It was all to no avail and sedation and purgatives were no help. Nothing could shift the bee, the fixation or indeed the finger.
Treading carefully with a now disgruntled patient, who felt that he was not being taken seriously, he managed to arrange a psychiatric consultation. No joy there. The patient disclaimed any history of bee stings or even that he had been sexually molested by a bee in his childhood. It was at this stage that my boss became involved. Some might have doubted the wisdom of this, as surgeons traditionally are held to be more doers than thinkers. This of course is pejorative nonsense as my man was about to prove. He positively beamed as he told us his postulated solution.
In short, a very light quick anaesthetic for the patient, who on coming around, would be simply told that the bee had been removed. "What do you think of that?" he asked
Not much we all felt, but fear of lese-majeste rendered us cravenly quiet.
The day dawned and the procedure was undertaken, the anaesthetist also expressing grave doubts about its efficacy. Mr X then played his trump card. From a pocket he produced a glass jar containing a large indignant bumble bee culled from his garden earlier that morning.
Despite ourselves we were impressed, but not half as much as the patient apparently; "God bless you Mr X. I knew all along that I was right. They were trying to make out that I was mad."
"Not at all," said Mr X smoothly, "but luckily for you I had a similar case before and knew exactly what to do."
The patient was discharged, elated and cured. As Mr X was never one to hide his light under a bush, the story spread like wildfire. The gist of the expected response was to be the acknowledgement of what a wily cunning clever old bird he was.
The Ancient Mariner had nothing on him and we heard the story repeatedly over the next few weeks, (the Highest Authority maintains that I have a tendency to repeat my stories, but this of course is quite untrue).
The saga came to an abrupt end at the next out-patient clinic. The patient was noted to be wriggling around uncomfortably and indeed on being brought to the cubicle for examination it was found that he had reinserted his finger. Mr X was incandescent. "Don't tell me there's another ******* bee up there," he roared. "Oh no" Mr X, came the reply, "but you did such a great job curing me, that I'm making sure one can't get up there again."
Since then, we never heard the story again.
Each day seemed to bring something new then. You learned something or you did something for the first time and gradually you became competent.
I am thinking about the deep fear that you might have if you felt that you had unwittingly harmed a patient. The "registrar's test - cut it and see what happens" was meant as a joke. We didn't find it very funny.
Years of anatomy stood us in good stead. Anatomical variations were not uncommon when nerves, veins or arteries were not where they were meant to be, or where they divided and branched unexpectedly. Experience made you less bothered by this but there were times when the wisest course was to down tools and send for help. It was always there.
Re-operations were always a cause for concern. Crudely put, everything was often stuck from the previous operation, ie there were multiple adhesions. The tissue planes and normal anatomical landmarks were often obscured and festine lente was the rule.
Dense fibrous scar tissue had to be dissected away, millimetre by millimetre and yet in a manner that kept the operation moving forward in a seemingly unhurried fashion.
A truism early taught was that for best results you had to have good exposure of the area being operated upon and that you must have control of any major blood vessels therein.
Sounds easy doesn't it? Well it wasn't always, and this is where previous surgery and obese patients caused problems. It was not that you were likely to sever something inappropriate but a nick in an artery or vein could cause serious bleeding and obscure the field of operation.
It was one thing to anticipate trouble, it was another to deal with it when it came from a clear blue sky. This happened too.
Maurice Neliganis a cardiac surgeon.