The Patient (11 page)

‘Anything interesting?' she said, saying the only thing she could think of, to get him talking.

‘Crap. Jake is at it again,' he muttered at the screen. ‘Has Dad gone?'

‘Yeah, he's gone to see your mother,' she said softly.

‘Why can't he just let her go?' As he said that, he buried his head in his hands. Jonathan was scared. Even though the doctor couldn't be certain yet of the full scope of his cancer, he knew that his life was surely unravelling. His thoughts were dominated by the idea that something unnatural was growing inside of him. Ever since the surgeon had spoken the words to him that afternoon – ‘a tumour, a cancer' – he had felt a sense of foreboding that emanated from his mid-section. He could almost feel the cells reproducing, taking root, travelling inside of him. He thought about the
upcoming tests to see if it had spread. Even the word itself – spread – was frightening. Spread like a germ, like an evil spirit.
A blackness spreading through my body,
he thought. He shuddered.

Tracy walked over and hugged him to her. ‘We will be fine. We'll make it together,' she whispered.

Derek and I were trying to get a pencil out of a woman's bladder. She had presented to her general practitioner several times with bladder infections and each time had been given antibiotics. Each time, the infections recurred. Finally, she was referred to Derek, who was sensible enough to order an ultrasound of her bladder. There, to his surprise, was a pencil.

‘How did this get into your bladder?' he asked.

‘Well, my husband and I were making love, and he used a pencil to try to stimulate me more. We were both drunk at the time. I had no idea that it had been lost up there.' She was less than embarrassed telling him the story.

What a macabre situation: a pencil stuck up the urethra into the bladder. The patient obviously had what we lovingly call in medicine the ‘Fith Syndrome', ‘Fith' being an acronym for ‘fucked in the head'.

Now here we were trying to get the thing out of her bladder. It had been over an hour, and each time we grasped it with our instruments it would slip away. The decision had to be made whether to open her bladder surgically and remove it that way. One last attempt and we would have to open her.

My interview for a consultant's position at the Victoria Hospital was that evening. If I was successful, I would get an academic position as a lecturer or, if I was lucky, senior lecturer at the university. It would be my name at the top of the patients' charts. They would be my patients, undergoing my treatments and the operations I advised. This was the pinnacle of surgical training, the graduation.

As Derek worked away at the pencil, in my mind I rehearsed answers to the interview questions that I thought were likely to come up. I knew who would be on the selection panel: the professor of Surgery and the head of Surgery, plus Jacob, one or two of the other urologists in our department, an external representative from the College of Surgeons and the mandatory administrator from human resources to ensure that equity was upheld.

These days, such decisions are often made prior to the interview, and there is no spontaneity because the questions have to be written down and vetted by the equity officer in advance.

Back in the early 1990s, when I was being interviewed, there was none of that formality. An interview could decide your future, and there were no holds barred. Any question was allowed, from ‘Are you married?' to ‘When are you planning to have children?', which a female colleague of mine was asked in her interview.

We still had to get this damned pencil out of this woman's bladder and then repair another penis laceration before I could get to the interview.

‘You'll have to open her up,' Derek said. ‘I'm giving up. There is no way to get it out endoscopically. Will you be OK on your own? I have to get back to the rooms. I have to see that young guy you saw in Emergency – you know, the one with bladder cancer. It turned out to be a T1. He'll probably need his bladder out eventually.' With that, he was gone. I thought for a minute
about Jonathan Brewster. He was young for bladder cancer. Pity. But I hoped he would come to the Victoria to have his treatment so that I could end up taking out his bladder. A cystectomy would be good practice for me.

I put away the endoscopic instruments and put the patient in the standard position on her back. We prepped her and scrubbed. I called another registrar down from the ward while the anaesthetist was changing the patient's anaesthetic to ensure it was suitable for an abdominal incision. I rushed everything and everybody so that I could get started as quickly as possible.

‘Scalpel,' I uttered.
Focus on this case now. Forget about the future.

‘Can you just wait a moment? I still haven't got her ready.' It was the anaesthetist, struggling with the patient's airway. Finally, he secured a tube down her throat to oxygenate her while we operated.

It was a quick operation. A horizontal lower-abdominal incision and retraction, to pull the edges of the abdominal muscle apart. Stay outside the peritoneum and the bladder should be on view. Diathermy across the bladder, and there it is, open. Put a finger in, and out comes the pencil. Close up.

Done properly and without any bleeding, the operation took about ten minutes. It reassured me that I had all the required skill of a consultant. Only the interview stood between me and glory.

‘Are you going to use clips or a subcuticular stitch?' asked the scrub nurse, wondering how I was going to close the abdominal skin.

The scar would look nicer if I used a stitch under the patient's skin, but I was in a rush and so clips – surgical staples – would do. I should have enjoyed this case, but I was too nervous about the interview.

Now I only had to repair the penile laceration I had seen in Emergency earlier and get it to the recovery room, before going off to try to get a job for the rest of my life. The patient was a 22-year-old gigolo whose 60-year-old benefactress had caught him in bed with a younger woman. The older woman had bided her time, then one night got a knife while he was asleep and attempted to cut off his penis. She had been unsuccessful but had made some deep gashes, which needed to be sutured.

I had asked him how he'd got his injury, and at first he'd kept insisting that his penis had got caught in the shower door. So I'd pulled out the ‘big doctor' routine: ‘Mate, your life depends on you telling me exactly what happened. I'm a doctor, and I need to know the truth so that I can repair this injury properly.'

It was then that the truth had come out.

By the time I had sewn up the gigolo in theatres, changed into my suit and got up to the administration suite where my interview was to be held, I had a dry mouth, sweaty palms and the inevitable nervous cramps. I found a toilet and relieved myself, only to find that by the time I had finished and washed up the panel were ready and waiting for me.

I rushed into the boardroom and sat down at the vacant end of the oak table. My interview was to be held in a room designed to fill visitors with awe. The walls were covered with portraits of the hospital's medical superintendents dating back to the 1800s, and it felt to me as if there were a hundred observing the interview. In fact, there were 12, which was plenty in itself. They were introduced to me, but many of their names and ranks were just a blur. The weight of history oppressed my chest, and I could hardly swallow. The chair of the panel was the professor of Surgery. ‘This
is an interview for senior lecturer and consultant in Urology …' He gave the usual introduction describing the position and the expectations.

The panel members then took turns asking me questions.

‘We have read your impressive CV. Could you summarise it in a couple of minutes and then tell us how you would contribute to the Victoria Hospital?'

Easy question to start with, as I'd fully been expecting it. I rattled off my pre-prepared list of the various contributions I could make, including teaching and research. I talked about my PhD in progress and the research projects I was working on.

‘What would you do if you felt that one of your colleagues was impaired?' It was Jacob.

It was a good question, because it tested a candidate's wisdom. There was a legal position, a moral position and then a pragmatic one. If I gave the impression that I would apply the letter of the law to all such situations, the panel might be wary about my loyalty to my colleagues and the department. On the other hand, if I seemed like the kind of person who would fail to act, they might question my integrity as a professional. In my answer, I tried to cleverly strike a balance between morals and expediency.

‘What do you understand by the term “equal-opportunity employment”?' It was the human-resources-department representative. I had to say the right things to make sure she felt that I would adhere to their policies. I omitted from my answer the fact that there was no such concept as ‘equal-opportunity employment' in practice at the hospital and that on my first day as a registrar I had been questioned about my origin, background, birthplace, religion, schooling and parents.

I also failed to mention the comment a surgeon made when
he found out that I had obtained my medical degree from a newer university, as opposed to a traditional medical school. He took great delight in telling me that in his view the medical school I had attended should be scrapped and that it produces little more than social workers.

I also neglected to tell the human-resources rep about the hundreds of times I had been made to feel inferior through comments about my name, my religion or my culture. I smiled and told her what she needed to hear: all was fine and I loved the department's policy.

The next question caught me by surprise, and I had no answer prepared for it. It was asked by the professor of Surgery.

‘What would you regard as your greatest weakness?'

This is the hardest of all interview questions to answer. No matter what I said, it could be construed as a reason not to employ me. For example, ‘I find that I work too hard and devote too much time to the hospital at the expense of my family' could be followed by the counter question, ‘So, Dr Khadra, you're finding it difficult to balance home and work. Do you think this could result in a problem further down the track?' Then I could look like I was on the brink of divorce.

I have subsequently asked this question in almost every interview I have conducted, and it amazes me what profound weaknesses people will report in the heat of the interview. One candidate admitted to me that he found his consumption of alcohol a weakness. Another that he felt he needed to work harder. A third that his memory was lapsing. All disastrous answers in an interview for a medical position.

My mind did not fail me during this interview, and I gave the best answer I could, the only appropriate answer. ‘My greatest weakness is interviews. I find it hard to show my best during
interviews.' If I was going well in the interview, then the panel would feel that I was even better than I had shown myself to be. If things were not going well for me, then the panel might put my poor performance down to interview nerves.

The professor smiled, recognising that I had not taken the bait. I smiled back, knowing the same.

‘Well, thank you, Dr Khadra. We will be in contact with you shortly,' he said, and with that I was dismissed.

By the time I arrived home, there was a message to ring Jacob.

‘Welcome aboard. The panel decided to appoint you. You'll be starting in January.'

Immense elation and relief spread throughout my mind and body. I jumped for joy at the news. I think I uttered the words ‘thank you' over a hundred times. Sheer triumph overwhelmed me.

‘There is a slight issue, though.' Jacob was trying to tell me some bad news, and I was not listening. ‘There will be no office or secretary. You'll have to supply that yourself.'

Suddenly, silence. My triumph turned to confusion and then to wariness and disappointment. As a visiting medical officer (VMO), one had no research and teaching role or salary but a high income due to unfettered rights to private practice, including consulting rooms, an office and a secretary supplied and funded by the hospital. As an academic, I would get a meagre salary but have restricted rights to private practice.

I was keen to throw myself into a career in academia, but not without any financial support. Give me the low salary of an academic and I would do the research and teach the registrars and attend the conferences – but I needed a place to see patients and someone to assist with making bookings and sending out
correspondence. Without those, I might as well have applied to be a VMO and at least enjoyed the high income that came with that position.

I was bitterly disappointed because I would have to put my energies into creating a private practice that could fund the overheads of a set of rooms. There would be little time left for academic pursuits, research and teaching. Urology had a shortage of academics because the temptations of private practice kept so many of my colleagues fully occupied. They had little or no time to progress knowledge, contribute to the training program for new urologists and develop themselves and the profession.