We should sing the praises of surgeons more often

Several weeks as a patient in a surgical ward of a Sydney teaching hospital recently gave me an opportunity for ‘participant observation’.

There are a number of features of the patient experience in the hospital setting that usually loom larger than others: the quality of the food for instance, the degree of pain, the extent to which your dignity is preserved, with the competence of the surgeon often coming far down the list of importance.

Below I list the high and lowlights which I hope serve as a reminder as to why medicine remains a fundamental social good.

I’m sorry – would you mind shouting?

I’m hard of hearing, even with aids. Understanding the speech of non-native English speakers is difficult. Interpose a face mask and hearing becomes harder. Add a perspex splash mask and I am forced to surrender.

In bed, with SARS-CoV-2 limiting the number of social contacts, I had time while staring at the ceiling to reflect on how conversation is critical for interaction, problem-solving and human contact.

In fact, to my mind, conversation is the high point of our evolution as H. sapiens.

And that is the reason why people with deafness or inability to speak find alternatives.

Despite the still common view that sign languages are artificial creations, they emerge naturally, evolving their own grammar and syntax. There are some 300 commonly used sign languages worldwide.

Unfortunately, there doesn’t seem one which can be easily acquired to deal with the circumstances faced by a patient in the hospital environment.

Dignity

Surgical tampering with bowels and related organs often leads to incontinence. I marvelled at the goodwill and coping skills of the nursing staff who dealt with this at any hour. We can easily forget how basic our needs become after surgical intervention.

Even when staff were in short supply (another COVID-19 consequence), help came quickly, the bed was miraculously changed, and comfort and dignity restored.

The surgeons

For complex reasons (available on request) my surgery took ten hours – unravelling adhesions being a particular challenge.

So along with the nursing staff,  I also marvel at my surgeons and anaesthetists.

Procedures like mine are unusual, but not uncommon. The skill, technology and patience of these colleagues is frequently assumed without question and too often goes unremarked.

We should sing their praises more often.

And I have to say the pleasure of the human interactions of daily visits from my surgical team was hugely important to my recovery.

Pain

Not too many decades ago, pain relief was viewed as an indicator of moral failure. This attitude bore some relation to women’s suffering in childbirth. I never understood why.

Patient-controlled analgesia, where the press of a button can administer a small bolus of analgesic, is another technology to be celebrated. The dosage is regulated – preventing overdosage.

There are other technologies which clearly need further development.

Ileus for several days meant a nasogastric tube. Please! Someone needs a research grant to invent a more comfortable device. Mine caused pharyngeal discomfort to the point where I needed opiates. It prevented me from coughing easily; only when it was removed did my atelectasis settle.

Contemporary anaesthetics have come a long way since the ether for my tonsillectomy 75 years ago – a trauma that lives on in my memory.

Food

My memory of hospital food was not good, and it was usually served like in the army – breakfast at 4:30am and dinner at 17:30.

Times have changed. Once I was no longer on nil-by-mouth and total parenteral nutrition, I was offered a choice appropriate to my post-operative condition.

The hot food was actually hot – served on the half-heated part of a tray with ice cream or yoghurt or fruit in good shape on the unheated half. This was a fine example of technology, perhaps induction heating, being used to great effect.

I could go on and talk about the pancakes, but I’ll stop. You can become obsessive about hospital food when you have time on your hands.

Fitness

Oh dear. Lying in bed never helped any Olympian win a medal. After two weeks, I could hardly walk. On one occasion, my physiotherapist encouraged me to go for a wander with him. After about 15 metres, I was breathless and faint. My oxygen saturation had dropped to 85%.

Recovery was swift, but the experience shocked me. Even six weeks on, I was incredibly unfit. Not that I was competing in the 400m hurdles beforehand, but it will take many weeks to get back to ‘normal’.

Friends and family

I feel so sorry for patients and their families who cannot be with them because of the pandemic. I find myself wondering whether we have exploited every opportunity to ease these restrictions.

Friends and others who have been close in past years often made contact. I found this a great comfort and the wisdom of many to keep the contact short was appreciated.

Read more: Simple manoeuvre 'curbs pain on coughing' post-surgery

The mind, like the body, is not up to much after major health interventions.

I am delighted to be home – a couple of residual problems to solve and some dodderiness to overcome.

I count myself immensely fortunate to have been the beneficiary of the skill and care of outstanding professionals and the unwavering love of family, especially my wife Kathy.

Published in Medical Observer OPINION 
5th October 2021