Consultant

A precise perfectionist

Peter, an intrepid young surgeon, had recently arrived in Africa. His English Gentleman origins could, no doubt, be found in some comparatively genteel hospital in the UK. Peter was the brilliant - the youngest ever Consultant to have been appointed Head of a Firm at the Grot. In keeping with his superior intellect, Peter could appear, at times, a little curt: while in the company of his Junior Doctors and Final-Year Students from the Illustrious Medical School, Peter would endeavour to conceal his friendly nature behind a gruff facade; he was able, with some effort, to sustain this illusion for up to two or three minutes at a time.

Peter’s full-figured physique and military bearing supported a large rounded head, for the most part smooth and a little shiny, though partly ringed with a band of rigorously disciplined dark hair. Peter’s clean-shaven faced delightfully enhanced his tendency to flush dramatically: the merest ‘Peter’ exclaimed within earshot would result in his head radiating a remarkable red, almost the colour of claret, with a warmth enjoyed by all in proximity.

Peter prided himself on being able to do everything perfectly. One morning, during a Consultant Ward Round, always a solemn event, Peter and his trail of acolytes: Nurses, IMSs, Interns, and Surgical Registrars, came to a halt at the bed of a patient who was completely obscured beneath a light blue cellular blanket. The blanket was rising and falling a little and emitting gentle snoring sounds as the occupant of the bed slept on, serenely oblivious of the small crowd of people now gathered around him.

Peter looked briefly down at the concealed form, and then reached over and delicately folded down the top of the blanket, revealing the head and shoulders of a skinny, weathered-looking man. Short brown crinkly hair covered the man’s scalp, while tattoos and wound scars adorned his olive skin. The patient was shirtless, but his knobbly thorax was swathed in bandages from which, on one side, protruded a drainage tube, which snaked its way over the side of the bed, down into a glass bottle resting on the floor below. The bottle was half full of collected blood.

“One of last night’s stab chests,” remarked the Registrar laconically from the foot of the bed, as he flipped through the notes on a clipboard which dangled there.

“So it would appear,” concurred Peter slowly, with a minimal nod of his head, which began reddening immediately.

For a moment longer Peter gazed down at the partly exposed gentleman, still snoring softly in innocent oblivion. Then Peter leaned over and tapped the sleeping man smartly on one shoulder. The man’s eyelids shot open, revealing small startled black eyes. His palpebral fissures widened further as he stared up at the large round red head hovering just above, and further still when he took in the small crowd of faces surrounding his bed. The patient glared briefly up at Peter, following which he pulled the displaced coverlet protectively up to his neck as he wriggled himself a little upwards into a more defensible sitting positon.

“Good morning,” Peter greeted him brightly. “And how are we doing this morning?”

The man’s dark eyes grew even wider as he stared back at Peter some more, but he said nothing.

“I think,” said the Registrar, “you will find that this gentleman speaks Afrikaans, of a sort.”

“Ah, yes,” said Peter, rubbing his hands together, “of course.”

Peter turned back to his quarry, holding aloft one index finger.

“Goy-yuh morah,” said Peter concentrating carefully, his enunciation an impressive display of how nearly complete was his recent, rapid mastery of the Afrikaans language.

The patient continued to stare at Peter, his brows furrowing and his eyes narrowing a little.

“Hoo gann dit met joe?” Peter added, his tone faltering almost imperceptibly.

“Hoe sê?¹” blurted the man, his head tilted a little to the side, in an enquiring manner.

Peter’s head reddened rapidly. He turned abruptly to the Registrar and in clipped tones requested a translation.

“He said ‘What did you say?’ more or less,” said the Registrar.

Peter retracted his head, frowning erythematously.

“Please ask the patient how he is currently feeling,” Peter requested.

In response the registrar strode to the head of the bed on the opposite side. Grasping and shaking gently one shoulder of the perplexed patient, the registrar enquired, “Hoe gaan dit man?²”

“Nee-wat, dis goed, dankie,³” the man in the bed replied, a relieved looking grin brightening his expression, his smile exposing missing front teeth.

The patient turned his gaze upon Peter’s still much reddened features, following which he lay back and pulled the blanket back up over his head, covering himself entirely.

“He says he’s good,” said the Registrar.

“What was the difference,” demanded Peter, “between what you said, and what I said?”

“Well nothing, really,” said the Registrar with a little shrug.

“Then why could the man not understand me, whereas he had no problem understanding what you said?”

The Registrar hesitated before replying:

“Well sir, I think it may have been in the inflection.”

Peter frowned briefly at this before moving on to the next bed, his glowing red head a visible beacon to us all.

My colleague Phillipa was another Final-Year Illustrious Medical Student allocated to Peter’s firm. Phillipa was softly spoken and possessed a contemplative expression, partly obscured by her large round spectacles. Phillipa favoured the then fashionable garb of the student political activist: colourful ankle-length woven skirts, leather sandals, and closely-cropped hair.

One day the Registrar asked Phillipa and me to assist in the Operating Room. Peter and the Registrar were due to perform a Popliteal and Tibial Artery Bypass Graft, a daunting and delicate procedure. The prolonged surgery would involve dissecting out obstructed arteries in the patient’s leg and replacing them with veins harvested from the other leg.

Phillipa and I were tasked with holding thin silicone loops which had been threaded around slender exposed arteries. These tiny elastic tubes retained each artery in a particular position as required by the surgeon. The thin catheters also occluded the artery, thereby preventing blood squirting from any severed branches. The two of us had to stand frozen in posture for hours on end, holding the ends of the catheters just so, while Peter performed the painstaking micro-surgery…

“Doctor?”

A Nurse had entered and interrupted the quiet flow in the Operating Room. Peter was head down, deep in concentration, his eyes obscured by black cylindrical magnifying loupes attached to the lenses of his spectacles, throwing his round face into an alien relief. Peter did not respond.

“Doctor,” the nurse repeated, a little louder.

“Yes, what?” Peter grunted, not looking up.

“There is a group of students outside. They say you’re late for their tutorial. They want to know how much longer you’re going to be.”

“Fuck,” replied Peter under his breath.

“I beg your pardon,” said the nurse. “I didn’t catch that.”

“Tell them to go away,” said Peter.

“When should they return?”

“Never,” said Peter, his face reddening rapidly, contrasting vividly with the baby blue of his paper bonnet and surgical mask.

“Oh, right,” said the nurse. “Sorry.”

“Fuck,” repeated Peter, again under his breath, his mind seemingly settling back on the task in hand.

Peter cut delicately through a small branch of an artery.

“They just want to know when you’re going to be able to teach them,” said Phillipa.

Peter glared at her, the visible portions of his head now so red we could feel their radiating heat. Phillipa’s words died away uncomfortably amid the ensuing silence.

The deathly quiet seemed to trigger a moment of anxiety for Phillipa, for her hand twitched - the hand holding one of the silicone loops, a loop which just happened to be holding firm the artery whose branch Peter had just severed. The loop slackened its grip on the artery, loosing a needle like jet of pressurised blood from the its cut branch. As the jet of blood sailed obliquely across her line of vision, Phillipa pulled on the catheter, cutting off the spume, but not before it had planted a single drop of blood in the middle of Peter’s forehead. Phillipa cast a look of horror at the red droplet, her eyes widening rapidly, the effect enhanced by her specs.

“What are you staring at?” hissed Peter, as Phillipa’s gaze remained focused on Peter’s now extremely red head. Phillipa appeared mesmerised by the small scarlet blob, adhering seemingly miraculously, to the crimson background of Peter’s sweaty forehead.

“Um…” said Phillipa, raising slowly the index finger of her free hand and pointing toward the offending droplet.

At that moment a nurse appeared fleetingly in our vision. She darting across from the side of the room where she had been counting swabs which had been removed from the surgical field,and crossing them off one by one on a writing board. The nimble nurse applied a piece of paper towel, deftly removing the blood from Peter’s forehead.

“Just a bit of perspiration Doctor, not surprising, hot afternoon and all that,” the nurse explained lightly.

With a grunt Peter lowered his head and returned once agaon to his field of operations. Phillipa gave the nurse a grateful glance.

Several hours later Phillipa and I were released, as Peter and the Registrar began to close up the soft tissues and skin over their newly implanted arterial grafts. It was a relief to step outside the theatre, and be able to move and rub our stiffly aching limbs.

“That was close,” said Phillipa quietly. “Thank goodness for that nurse.”

“Yes,” I agreed, “she was superb.”

That same saintly figure had returned often during the procedure and wiped our own foreheads, surreptitiously pressing barley sugar sweets behind our paper masks into our mouths. I think there must be a special heaven for such people.

While on our surgical rotation the time came for the entire hospital to move. A vast rectangular glass, steel, and concrete monolith had been constructed in front of the old hospital. The original airy Victorian building, with its high ceilings, and iron bedsteads lining the walls of long rectangular wards, had been supplanted by this new modern structure, designed for efficiency.

As in the old building, offices were allocated to the medical staff serving on each ward: the Interns had been given a small shared office, with a sign on the door which read ‘INTERNS’. The Registrars now had an office each, each office door adorned with the word ‘REGISTRAR’. The Nurses had a rectangular area in the centre of the new ward, bounded on all sides by waist-high counters, affording them a three-hundred-and-sixty-degree view over the entire ward. A sign attached here proclaimed proudly: ‘NURSES STATION’.

Peter, being the Consultant, had his own office too, of course, though, for reasons unknown, his door had no sign. Several of my fellow IMSs, Phillipa, Petra, and Helena, stood aghast at the sight of Peter’s naked door. After several minutes muttering to each other about the unfairness of this neglect, the three of them set about correcting the deficiency, making use of a length of printer paper and a box of coloured marker pens. The result of their labours was a colourful paper banner, about five metres in length.

Their ‘sign’ was far too large to fit on Peter’s door. Making use of pink sticking plasters appropriated from the ward, Phillipa, being the most nimble, stood on a stool and taped the sign to the wall above, stretching it out evenly on either side of the doorway. Then they stood back, fingers on chins, considering their handiwork.

“It’s a bit confusing,” said Helena. “It’s so long, that it almost reaches the neighbouring doors.”

“True,” said Petra, “but Peter’s door is right in the centre of the sign.”

“I think we should add a few arrows, just in case,” Phillipa said, her tone earnest.

“Arrows,” the other two chorused, “an excellent plan.”

They retrieved more paper from the printer and constructed several sizeable red arrows of variable length. These were placed beneath the sign, along much of its lower edge, each angled arrow pointing to the top of Peter’s office door.

“That will do nicely” said Phillipa, standing back and gazing upwards to appraise the result.

A little later Peter arrived in the ward, leading a delegation of besuited gentlemen: Professors and Surgical Consultants all. As we were to learn a little later, these eminent individuals hailed from many parts of the world, . They were all renowned surgeons, visiting our hospital to attend an International Surgical Conference concerning the latest advances in vascular surgery. Peter had apparently brought them to his office for an Important Meeting. As the group approached, Peter nodded curtly at us, blushing mildly.

On arrival at his office door, Peter seemed at first not to notice anything amiss. However, as he stood before the portal, his gaze was drawn upwards, and a shadow of consternation passed over his face. He blinked and shook his head, and then looked up again, reddening further, following which his mouth hung open, briefly.

Above the door frame, resplendent for its full five-metre length, ran the colourful banner: “DOCTOR PETER, CONSULTANT SURGEON”, each large letter proudly displayed in a different bright primary colour, with an exuberant background of butterflies, birds, flowers, trees, and clouds, and a bright, yellow, smiley-faced sun. As Peter stared upwards, it appeared as though the red arrows had been aimed with purpose, their points converging directly over Peter’s bright red head.

Peter turned around and glared at the group of girls gazing at him expectantly.

“Who placed that sign there?” Peter demanded, his voice a stoccato whisper, forced out between tightly clenched teeth.

“I did,” replied Phillipa, a trifle hesitant, her hesitation tinged through with a tangible pride. “Do you like it?” she added, beaming an angelic smile at Peter.

“Remove it,” Peter commanded curtly through pursed lips, as he pushed open the door, before stepping aside to allow his bemused looking colleagues to enter.

During the two months in which we served as Peter’s minions, we benefitted from several academically exacting tutorials presented by Peter, who had become our erudite mentor. Peter seemed always able to dredge up some obscure bit of his encyclopaedic knowledge with which to interrogate us. As our time in surgery drew to a close, we were all seated before Peter for a farewell tutorial.

“Well now, Phillipa,” said Peter, smiling, and flushing mildly. “Where will you be spending your Internship next year?”

“I have a post at CMH⁴,” Phillipa replied.

“Of course you do,” said Peter.

Phillipa glared at him. Peter’s grin broadened, as his head reddened further.

“So tell me, Phillipa,” Peter continued, an ocular twinkle gleaming through his spectacles “how do you treat snake bites?”

“Um,” stammered Phillipa, her eyes widening behind her spectacles at this side-ball question. A rare moment of befuddlement clouded Phillipa’s usually calm gaze. “Uh, that is,um,” her voice petered out. “That is, actually, I don’t know,” Phillipa finally admitted.

“What?” cried Peter. “You’ve been a medical student at the Illustrious Medical School for over five years, and you haven’t yet learned how to treat snake bites?”

Phillipa stared at Peter, suffused in silence, her own face reddening now, redolent of horrified anguish and inner turmoil.

“What’s going to happen next year?” demanded Peter, with obvious relish, “when you find yourself in that rural bush environment of the far Eastern Cape. Just imagine, you’re all alone in the Emergency Unit, and they bring in a little farm urchin with a snake bite on his foot? Are you going to look at the little tyke and say, ‘Um, I’m so sorry, but you see, I’m from the Illustrious Medical School, where they don’t teach doctors how to treat snake bites, so I don’t know what to do.’?

“Or what about when you’re visiting your Aunt Mabel,” Peter continued, getting into his stride now. “You’ve just finished Sunday lunch and you’re settling down for some of Aunt Mabel’s delicious home-made chocolate cake. Aunt Mabel turns to you and says, ‘So, my dear, you’re a doctor now, tell me, how do you treat snake bites?’”

Phillipa didn’t reply, as her own face reddened further.

“Are you going to say, ‘I don’t know’?” Peter harangued. “And then Aunt Mabel is going to be astounded,” he continued. “‘What kind of medical school is this?’ she’s going to exclaim. ‘Where they don’t even teach doctors how to treat snake bites.’ That’s going to do a world of good for the reputation of the Illustrious Medical School, isn’t it now?”

“But we have never been taught how to treat snake bites,” Phillipa pleaded.

“Well may I suggest, Phillipa Dear,” said Peter, “that you find a good textbook and read it up, before starting work next year, or, for that matter, before visiting your Aunt Mabel again.”