HEART BEAT: The Leaving Certificate results have just been released, bringing their usual share of happiness and grief. For those students who have the points to do medicine, I have the temerity to offer some advice.
Think hard before you commit. It is a vocation and you will not be truly happy unless you really want to be a doctor. If you do, then come and join us and feel welcome in this most satisfying of careers. I know we all complain a lot and things are not always as they should be. Perhaps in your future professional life you can make a difference. You must always so believe.
Thinking of the pathways in medical life returns me to my own. I was in my surgical internship in the Mater and was beginning to feel I had been there all my life. I had become used to low pay and anti-social hours and had become brainwashed to expect nothing else. I had not become used to the ever-changing patterns of illness and disease and to the medical responses. The fascination gripped early and thankfully it never left.
Quite early in our internship our little group began to evince interests in the various branches of the profession. More inclined towards the medical as opposed to the surgical side; slowly, hesitantly, career paths were being chosen. Reality intervened here, and mentors and colleagues sometimes pointed out the pitfalls along the way and maybe ever so gently queried the suitability of the aspirant for the path they had selected. The wise heeded the advice.
The putative surgeons and, I suppose, I would have to include those strange folk whose interest lay in obstetrics and gynaecology, began to spend as much time as possible in the operating theatres and their environs. Assisting at surgery was the thing to do, where you began to learn the craft, and where you found if your heart and hands were up for the job. This, bearing in mind the aphorism of Alexandre Dumas Snr that "a good surgeon operates with his hand, not with his heart". This is undoubtedly true in the individual case, but in the generality the heart must be involved in the commitment to the surgical life.
From student days we had learned to stitch cuts. Now we learned to sew up surgical incisions and set simple fractures, albeit under strict supervision. This ranged from the consultant to the registrar to the operating room nurse, the latter usually being the most severe critic. I must not forget the anaesthetists who frequently hissed at you if you had been left to close a wound on your own. "Hurry up for Christ's sake, do you want to keep us here all day."
We were expected to move quickly and were beginning to learn that, as Russell Howard put it, "speed in operating should be the achievement, not the aim, of every surgeon". We learned to tie surgical knots, and the backs of chairs, handles of drawers and indeed door knobs became festooned with our efforts. We read the basics of surgical handicraft and operating techniques and imperceptibly and invidiously surgery began to possess our souls.
Accordingly, it was with mixed feelings for the rest of us when a colleague said smugly at breakfast one morning: "I did an appendix last night; Joe [ the registrar] took me through it."
The stakes were raised and thereafter the registrars on emergency call were haunted. Acute appendicitis became a very important diagnosis for us tyro surgeons as we waited our chance to do our first real operation. For those of you reading this who have had their appendix removed in a general hospital, you may have been somebody's first operation. There comes a time when every bird flies for the first time, thus it is with surgeons. Yes, you are supervised but you hold the knife. We had the surgical registrars damned to find suitable cases with which to launch our careers and, finally, on a rainy Friday night in November my moment came. The patient was an 18-year-old boy with the classical signs and symptoms of acute appendicitis. Theatre was arranged and I was on my way. I would lie to you if I said that scrubbing up, gowning and painting and draping the patient was the same as always. Things are always different when you are doing them yourself.
My stage was set, grumpy anaesthetist, grumpy nurses, united on a common grump of "Jesus, he's not going to let the intern do it, we'll be here all night." The relaxed registrar was the epitome of calm efficiency. Wherever you are Gerry, thanks. Knife to skin, gentle pressure, little bleeding, separate rather than cut muscle layers, open the peritoneum - the membrane that envelops the abdominal organs. Hook a finger inside and extract the small bowel, check for a rarity called Meckel's diverticulum. Follow the small bowel down to where it joins the colon, and there, Eureka, a large fat inflamed appendix. Totally engrossed yet moving quickly, appendix removed and wound sewn up. Out of there realising that I was a changed man.
If you had your appendix out in the Mater hospital in November 1962 and have a neat one and a half inch scar, you may have been my first surgical case. On the other hand, if you have a scar about 10 inches long that looks as if it was sewn up with baler twine, it must have been one of my colleagues. This is one of the rare instances when men think one and a half inches is preferable to 10 inches any time.
It was then back to earth with a bang to the ordinary humdrum life of an intern. But deep down something had changed.
Maurice Neligan is a cardiac surgeon.