What is an Otolaryngologist? What does an ENT surgeon do? Part 4: Paediatric ENT

Posted on 03/06/2012 by

I still remember vividly the day I sliced open the trachea of a neonate who weighed less than my Apple Mac computer. Such tiny creatures with no necks. Such soft and delicate beings. Such a narrow airway. All my instruments were small. The retractors I used in the neck were actually eyelid retractors. And the tracheostomy tube I inserted was a little bigger than the diameter of my pen.

One of the reasons ENT captures my heart is because we operate on all ages. One day I could be in the mouth taking out a tongue cancer on a 70 year old who weighs 100 kg. Another day I could be doing a tonsillectomy on a 2 year old with no space in the mouth for my fingers. In fact, a typical ENT practice would involve seeing lots of kids. That keeps me happy. And truly humbled. I have a 3 year old son. I can only imagine the anxiety I would have if I had to surrender my son to a total stranger to cut into him. As an ENT surgeon I hold dearly the privilege and trust I am given to operate on another person’s child.

What keeps the pediatric ENT surgeon busy? Tonsils, adenoids, ear infections and foreign bodies that children put in their ears, noses and throat.

Tonsillectomy is the most common operation any ENT surgeon does. It is also the operation that keeps the ENT surgeon humble. We do it both in children and adults, for obstructive sleep apnoea, recurrent tonsillitis, or for cancer. I love and I fear the tonsillectomy. There is no such thing as an easy tonsil, and no 2 tonsils are ever the same, even in the same person. A senior ENT surgeon I highly respect asked me at the beginning of my training: What are the 3 most dangerous ENT operations? Answer: tonsillectomy, FESS and rigid oesohagoscopy (I’ll tell you why some other time).

Some of my most difficult tonsilectomiess were done on adults with recurrent infections because they bled, and bled and bled. Even more difficult than those are the tonsilectomies I do on children under 3 with congenital syndromes. Down syndrome, Pierre Robin, cleft palate, neuromuscular disorders or any craniofacial disorders make tonsillectomy and adenoidectomy fraught with so much more danger. These tiny creatures are placed on an oversized operating bed. I insert a metallic gag to hold their tongue down. Parents would say no if I showed them the gag and medieval support I put around their child’s mouth. I suspend their mouth open with their necks extended. Every step of positioning them is hard enough because they are so tiny, flimsy, floppy, cute and so, so breakable. And with my headlight and instruments I get into these tiny mouths and I peel away the tonsils from the muscles that hug the tonsils. The closest analogy I could think of is this: try rolling a sunnyside egg and place it down the bottom of a drinking glass. Now use chopsticks and toothpicks to dissect off the yellow from the white, while someone pours a little shiraz into the glass once in a while. To make matters more challenging, just behind the flat layer of muscle that hugs the tonsil lie several major structures: the nerves that move your tongue and provide sensation to it, the internal jugular veins, and the internal carotid arteries that feed the brain. Kaboom, if you hit them.

If it is fraught with so much danger, why do we still do them? It is because the benefits that outweigh the risks. Parents tell me excitedly 6 weeks after their child’s adenotonsillectomy that I’ve given them a new child. Tonsillectomy gives a child with obstructive sleep apnoea the precious gift of well-oxygenated sleep. For the first time in their lives, they sleep through the night. That gives them a much needed rest, and gives their brains the opportunity to develop. There’s more and more evidence to show that a child cured of sleep apnoea do better in memory development, language, behaviour, attention span, etc. Next to grommet insertions, adenotonsillectomy is our bang for buck surgery. An intervention with so much biopsychosocial benefits.

The paediatric ENT surgeon also deals with many other conditions mostly of congenital nature. We do laryngeal surgeries for kids with floppy larynx (laryngomalacia). I remembered doing this supraglottoplasty with laser on a gorgeous kid who looked so much like my own son. We repair laryngeal clefts, tracheo-oesophageal fistulas, recurrent laryngeal nerve palsies, complete tracheal rings, branchial arch anomalies, ear diseases, mastoiditis, sinus diseases, head and neck tumours, and many others. Laryngotracheoplasty is one of the most exquisite procedures we do. It is amazing. Sometimes, sadly, we also do some horrible surgeries such as maxillectomy or mandibulectomy for paediatric tumours. There are so many others things I could talk about. Everything is just a little harder with kids. Even putting grommets in a 6 month old baby with Down syndrome takes all the strength and wisdom one could muster. It feels so good when it’s perfectly placed though.

And we work closely with paediatricians, paediatric audiologists and paediatric speech pathologists. We have a lot of fun looking after these kids. Can you imagine the multidisciplinary care involved in managing a child with permanent tracheostomy? It takes more than just knowledge and skills to work with kids. It takes a bit of childlikeness and sillyness. Building a rapport with kids and their parents require a little magic. It is said, truly, that you do not choose to work with kids. The kids choose you.

I loved it so much I thought I was going to grow up to become a paediatric ENT surgeon. Well, perhaps, maybe. We’ll see. The beauty of ENT is that no matter what I end up doing, I will still see lots of kids in my practice. That’s a beautiful privilege given to the ENT surgeon.

But my love affair with ENT doesn’t stop here. We’ve done ears, noses, throats and kids. What else is there in ENT? Well, a lot more, believe it or not. Wait and see.

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What is an Otolaryngologist? What does an ENT surgeon do? Part 3: Laryngology

Posted on 02/06/2012 by

The finesse of the ear surgeon and the precision of the nose surgeon is matched by the throat surgeon’s light-handedness. Tremor can be hidden in most other surgeries, but not in laryngology. This one needs a real steady hand. A good laryngologist has a set of steady hands, a calm demeanor, an approach matching that of a psychologist, and an artistic, cultured manner. Why? Because they deal with voice, and professional voice users, including performers, singers, teachers and politicians. Prominent VIPs with expensive voices see the laryngologists, hence the need to be impeccably presentable.

Laryngology is about voice, and it is probably the fastest growing subspecialty within ENT. This is because of the progress of technology and the accumulation of evidence and experience in treating voice disorders. We’ve talked about hearing, smell and taste. Now think about voice. Voice is who you are. You may loose hearing, smell and taste, but still be an active person. Once you lose your voice, you are crippled in communication. Vocal frequencies, intonations and projections add colour to who you are. Voice expresses your character and emotions as much as the face. If you had a different voice, would you still be you?

We ENT’s are privileged to be dancing on this immaculately delicate organ called the vocal cords. I attended a conference once by a laryngologist who is the chief surgeon to some famous broadway productions in New York. He would sit and listen during rehearsals and be able to pick out which one of these professional singing and dancing troupe members not using their voice carefully. He is charged with a mission to get a vocal cord better as soon as possible. Those professional singing vocal cords are insured and are worth millions. Imagine if an ENT says strict voice rest to a lead Broadway Musical performer. How much does that decision cost the production company?

In the past 2 months I had danced about 7 times over vocal cords. Each time it was for a different procedure. One I was really anxious about was when I did vocal cord surgery on a fellow hospital colleague and dear friend who is a professional voice user. This gorgeous young girl spends her day educating, liasing, organising and communicating with so many people around the hospital. Everyone knows her voice. She was a little hoarse, and it was due to a small cyst on her vocal cord. This small cyst has changed the mucosal waves and vibrations of the cords, changing the airflow physiology of her voice production. Operating on her meant everyone in the hospital will hear and know of my results. A few milimetres too shy would result in a potential recurrence of her cyst and keeping her still hoarse. A few milimetres too aggressive could potentially cause her permanent voice damage.

She laid on the operating bed. I wrapped her head with a towel like she has just washed her blonde hair. I stood on the head of the bed. Using a few medieval contraptions I inserted a device that would keep her mouth and throat open in a straight line to her voice box. This device suspended her throat as I mounted it on a chest support over her body. Placed wrongly, I could twist her neck, break a few teeth, bruise her gums, tear her tongue, or damage her larynx. I had to get the perfect position so I could bring a multi-thousand-dollar operating microscope over her throat and work through a small opening onto her larynx.

Once her larynx is well suspended and her vocal cords are in full view I inserted various microscopic instruments through the scope. I used a combination of microscopic knives, forceps, scissors, needles and laser equipment. They are about an arm’s length and the tip is only visible through the microscope. This is why you absolutely need steady hands. The tip of your knife is held about 25cm away through a tiny hole under a microscope over thin vocal cords. Every little movement and tremor is like an earthquake on the microscope view. Removing the cyst and putting the vocal cord back together again so my dear friend could return to work was nothing less than stressful. I was mindful that I was using laser and microscopic instruments on her instrument of living, her voice.

In phonomicrosurgery (vocal cord procedures) I needed to be like a trapeze artist dancing on a tightrope. I did not drink any coffee or tea and made sure I was not in any way rushed or flustered. I had to be in a zen moment.

That’s why I love it! Just like when I tiptoe over the facial nerve and taste nerve in the ear under a microscope, or hanging off the skulbase a little off the eyeballs in the nose, vocal cord surgery gives me that adrenaline rush mixed with zen-like peace. Micromilimetres spell success or disasters. A man I highly respect once said “Faith is walking amongst miracles always at the edge of disaster”. I think ENT is like that too. We can approach the larynx from inside, and outside, whether the patient is asleep or awake. There is one particular procedure we do where we make a cut on the neck next to the Adam’s apple and we fiddle with the voice until we get it just right, all while the patient is awake and we have a knife in their throat. We can put a camera through the nose into the throat, and while we hover over the larynx, we can stab the larynx from the outside with a needle containing steroids to bulk up the cords. In fact, some performers do that regularly before their seasons. Cords on steroids as a performance enhancing drug.

Laryngologists fix vocal cords in all shapes and forms. Those with growths on it, both benign and malignant, those that are fixed, crippled or paralysed in any way, those that are just not working, and those that are the main source of extravagant income in professional users.

But we ENTs do not do it alone. We do it with the help of our friends the Speech and Language Pathologists or Therapists. ENTs work closely with allied health: audiologists, vestibular physiotherapists, and ‘speechies’. We love them, and in particular, the ‘speechies’. Why? (And here’s another reason why ENT is such a blessed specialty.) Because the speechies by far are the best looking of the allied health lot. Seriously. I don’t know why, but it is universal knowledge that speechies tend to attract really good looking people. Most of the speechies I know are pleasant to the eyes. One of the recent Miss America winner was (or going to be) a speechie. And I too have had the blessed privilege of examining a patient with a speechie who is a professional fashion model. You can imagine how hard it was for me to concentrate on her examining the physiology of swallowing on a patient while my mind was on the picture of that revealing dress or swimwear she wore in one of the magazines.

Speechies look good. And speechies make ENTs look good. They train the vocal cords, rehabilitate voice and speech, assess and re-train swallowing, helps children to speak and articulate, looks after tracheostomy and PEG-tube dependent patients, etc. Their clientele include paediatric, trauma, stroke, neurological patients, and many others. They are really good in what they do. And they look good. Have I said that already?

I do take my hat off to the Speechies, Audiologists, Physiotherapists, Dieticians, Psychologists, and many other allied health teams we ENTs work with.

Have you had enough of ENT fun? I’m only halfway through. There’s more to talk about. We’ve now done Ear, Noses, Throats, and next stop: Paediatric ENT! Where fun is really what the patient needs.

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What is an Otolaryngologist? What does an ENT surgeon do? Part 2: Rhinology

Posted on 27/05/2012 by

Otology involves mastery of sound physics, acoustic coupling, tympano-ossicular impedance and a lot of ‘vestibulology’ that is dizzying and still all fuzzy wuzzy to me. Rhinology requires understanding of the science of nasal aerodynamics, olfaction and immunology. The skills required to be a great sinonasal surgeon is different to that of the ear surgeon. Both demand extreme precision and impeccable tissue handling, for a similar reason, there is no room for error in the nose.

The otologist works in the hardest bone in the body. The rhinologist works next to the thinnest bone in the body. There is a flake of bone called ‘lamina papyraecea’ (paper thin) in the nose separating the nose and the orbit. It’s called that for a reason. What could go wrong in a nose operation? Well, you could go blind, have permanent double vision, or have a leaking brain fluid.

What does the rhinologist do? They are not people of study rhinoceros. They help you breathe better. Block your nose for 30 seconds and see how much that annoys you. Your mouth is dry and your spech affected. With their expensive endoscopes and fine instruments, the rhinologist can roam around your nose like it was Disneyland. They’ll sweep away every mucous and shave away every polyp from every corner of your nose.

One of the most basic and common operation we ENTs do is called a septoplasty and turbinoplasties. This is because one of the most common problem that presents to us is nasal blockage. The operation involves making a small incision on the inside of your nose to straighten a bent, broken or crushed nasal septum. It’s pretty much like rebuilding a straight wall between two rooms through one tiny window using an ice cream stick. It is probably the most underrated and understated procedure in all of ENT. I have done many appendicectomies as a surgical registrar before ENT, but I found septoplasty to be much harder to master. And with turbinoplasties, we trim the bony cushions that protrude into your nose using a pair of scissors, knife, electrocautery or powered shavers. Just a few centimetres away from your eyeballs.

But what is at the heart of rhinology is a group of intranasal and paranasal sinus procedures called FESS (Functional Endoscopic Sinus Surgery). Some suggest it should be correctly spelled f€$$. This collective procedure range from opening a simple cheek sinus to going all the way up and back to clear the base of skull. It’s a lovely procedure. I stand to the right of the patient’s head. Camera in my left hand, and intruments in my right hand, all through the nostrils. Everything I do in the nose is magnified on the theatre television screen. Booger looks like Mount Everest and bleeding looks like Niagara Falls. With my angled cameras and instruments including shavers rotating at 5000 per minute, I work my way through your nostrils into your cheek, sliding under and between your eyeballs and making my way within millimetres beneath your brain. There are pockets of sinus air cells hiding blood vessels hanging off the roof of your nose and going into your eye socket. Trying to redecorate a room through the keyhole on the door using chopsticks is probably easier. Sometimes the scenery is beautiful, sometimes I am swimming nose deep in mucous, snort, pus and booger.

Operating within milimetres of the brain and eyeballs means that we can potentially access those organs through the nose. We can go through the nose to unblock a tear duct, biopsy an eye tumour, or decompress an eye infection. Sometimes people forget that we can access the eyes quite easily through the nose. I have met, sadly, a beautiful young girl who has lost her vision in one eye because of an eye infection, and she was referred to us much too late. We got to the eye infection when the vision nerve has already been too far damaged. The next time you get a really bad eye infection, you might need a nose surgeon to help you.

The nose is also now becoming the standard pathway to removing certain brain tumours. For example the pituitary gland is easily accessible through the nose via an endoscopic trans-sphenoidal pituitary excision. When we are in the sphenoid, we really are at the centre of the universe. We’ve got internal carotid arteries, optic nerves, cavernous sinuses, and lots of cranial nerves hanging on either side within milimetres of our reach. Thou shalt not sneeze while in the sphenoid. Some major anterior fossa intracranial tumours are now accessed through the nose. Recently I was involved with assisting in the removal of a large meningioma. What we did was rearrange the furniture in the nose, drill out the roof of the nose, which is the floor of the brain. Drop the tumour into the nose, remove the tumour piece by piece through the nostrils. Lift the brain back up. Create a new floor for the brain with cartilage, fascia and muscle. And leave a balloon in the nose to scaffold the roof up for a while. Awesome. This is nose digging par excellence. No cuts. Removing brain tumour through the nose saves the patient a big cut on the forehead and the removal of a large piece of skull. In a few weeks time, we will be repairing the skullbase of a patient who has been spontaneously leaking brain fluid into the nose and getting meningitis.

You can imagine how exciting ENT is, when we start fiddling with brains and eyeballs. The nose is a beautiful organ inside and out. On one day I can be dancing on the facial nerve in the ear, flipping ear ossicles, putting a cochlear implant in, and the next day I can be pulling out brain tumours through the nose, tickling a pituitary gland, or fixing a skull base brain fluid leak.

Awesome ENT. You’ve tasted ears and noses, next stop: throat. Laryngology.

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What is an Otolaryngologist? What does an ENT surgeon do? Part 1: Otology

Posted on 20/05/2012 by

It is no secret that I have found gold in ENT. It is by far the best medical specialty in all of Medicine and Surgery. A few people who do not know us well enough are curious at what we do. It’s like a black box specialty, filled with magic and wonder. Public opinion suggests that other than ear wax, grommets, tonsils and adenoids, we drink lots of tea. Well that may be true in some places, but here in Australia, we get to have a lot of fun.

An Otolaryngologist, Otorhinolaryngologist or ENT Surgeon is a Specialist Surgeon who investigates and treats conditions of the Ear, Nose, Throat, and Head and Neck.

I’m going to take you on a journey to explore ENT fun across our ENT family of subspecialties. Disclaimer: You might really, really fall in love with ENT.

Part 1: Otology

We’re all ears when it comes to hearing and balance.

Yes, wax, gets in the way. It is suprising how a simple problem like wax can affect the quality of life of many. With some simple equipments, we can make a huge difference particularly in the elderly.

Ear infections can lead to a whole host of problems. One of our biggest bang-for-buck surgeries is insertion of middle ear ventilation tubes (aka ‘grommets’ in Australia). Grommets in children with recurrent middle ear infections result in better hearing, better language development, better learning and behaviour, reduced morbidity of ear infections. Amazing. A tiny tube perfectly placed on the paper thin tiny ear drum under microscope could make a huge difference. I love putting them in.

The main course of the Otologists’ world are the bigger ear operations: canalplasty, meatoplasty, myringoplasty, tympanoplasty, cortical mastoidectomy, modified radical mastoidectomy, ossicular chain reconstruction, facial nerve decompression, stapedectomy, acoustic neuroma excision (translabirynthine, retrosigmoid, middle fossa approaches), and lateral skull base or middle fossa surgeries for semicircular canal dehisences.

I love the precision and finesse involved in ear surgery. When I enter the ear through the mastoid, I must work through fine layers of skin and tissues behind the ear, harvest a piece of muscle fascia behind the temple for later use in ear drum reconstruction, then use a cutting or diamond drill at 5000 rotations per minute to drill through the thickest bone in the body (apparently it takes 1500kg of force to break the mastoid bone). Within this thick bone lies a brain venous lake full of blood called the sigmoid sinus and the fine spaghetti thin facial nerve which controls half of your face. I use my drill to work gingerly around the sigmoid sinus and the facial nerve. I travel deeper with my drill between the two and under the layer of dura covering the middle fossa brain matter. When I’m deep enough, I will then have to work around some of the most amazingly designed and engineered acoustic coupling system, the three tiny hearing bones malleus, incus and stapes, each the size of a grain of rice. To make it more challenging, the hearing and balance centre, the facial nerve, and the taste nerve to your tongue are all milimetres away. In the ear, milimetres make a huge difference. This is also why I cannot have too much coffee before surgery and most otologists do not drink coffee. A minor finger tremor when you’re holding a high speed drill near the brain, vessels, nerves and ossicles could spell disaster for the patient. There is not much room, literally, for error in the ear. It’s almost like defusing a bomb under the microscope with a jackhammer. I sometimes forget to breathe when I’m in someone’s ear. Thrilling.

Hearing and balance are quality of life issues. Try blocking one ear with blue tack for a day and see how much that affects you. You can’t localise sound, you can’t hear properly in noisy environments, you might even feel dizzy. Remember the last time you were feeling dizzy or drunk or sea sick? Can you imagine being like that 24/7 all the time every day with some vestibular problems? Though it’s not life and death, living with hearing loss and balance problems renders one ineffective and unable to enjoy the pleasures of life. Inability to hear the sound of music, my wife’s or son’s voice would make me a very depressed man. I marvelled even at studying the basic science of sounds. The process of sound travel from your computer speakers to your brain and what it does to your brain is enough to make me smile.

ENTs get referred lots of dizzy patients. Hall-Pike, Epley’s, Sermont, Brandt-Daroff exercises and manouvres are part of our armamentarium. Also various medications orally and injectables through the ear drum are some of the things we can use to help with hearing loss and balance disorders. I can recall examining a dizzy patient and later on finding that he has a brain tumour. We do get the interesting and uncommon presentations once in a while. Hearing loss and balance problems can also be an initial presentation in many other systemic conditions such as autoimmune, connective tissue, or neurological disorders, and we love a bit of detective work.

Perhaps the icing on the mostly edible cake and the jewel in the almighty beautiful crown in otology is the innovation of the bionic ear, or cochlear implant. I have been privileged to train and operate in the very theatres where the cochlear implant was  born. The standards of excellence, research and development in this ENT unit is truly world class. I’ve worked with the world standard bearers, and I’m humbled. At this stage in my training I’ve already been involved in the surgeries of about 30 cochlear implants.  The marriage between surgical innovation and biotechnology is exemplified in the bionic ear. Who would have thought that you could make the deaf hear? We’ve gone from multiple designs of non implantable hearing aids, to a magical implantable hearing device. Is it for everyone? Of course not. Like any treatments, medical or surgical, they have to be tailored to the right patient for the right indications.

When it comes to cochlear implant, I have had the privilege of standing on the surgeon’s side. But I also have had the honour of standing on the patient side. My precious little sister was born with profound sensorineural hearing loss. Due to many reasons, she had the bionic ear implanted late as a prelingual deaf teenager. I remembered when I was in her hospital room and seeing the ENT Professor and his team doing rounds. Her results were different, but wonderful nonetheless.

Who would have thought that many years later I would be granted the privilege of assisting in these surgeries as a trainee surgeon?

ENT is simply amazing. And we’re only in ears.

Next: Rhinology.

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Doctors, Money and Pride

Posted on 28/04/2012 by

Have a good read of this Medscape Report.

Its about Doctors and their paychecks. As usual, and same as last year’s results, the top-earning doctors are Radiologists, Orthopaedic Surgeons, Cardiologists, Anaesthetists and Urologists. That’s American data from almost 25,000 doctors, and the Australian data will probably be quite similar. The poorest paid? Paediatrics, Family Medicine (GP) and Internal Medicine (Physicians). It appears that the less time you spend with the patient, the more you earn.

Other findings in the study to me were even more interesting.

These high earning specialties did not “Feel Rich”. Those who felt rich were the Pathologists, Oncologists, Gastroenterologists, and Dermatologists. And who felt least rich? Plastic surgeons.

Who had the highest job satisfaction? Certainly not those with the big money. Dermatology, Psychiatry, Emergency Medicine, Infectious Diseases and Pathology had the happiest doctors. It’s official. Money does not equal satisfaction at all. It’s almost like, the less you touch a patient, the more satisfied you are. And who were the least satisfied? Plastic surgeons.

But the one thing that I found most concerning was the fact that the study revealed a strong and increasing undercurrent of frustration in the medical field. One of the doctors remarked “I love being a physician, but I hate what is happening to medicine. Too many people are coming between me and the care I provide to my patients.”

Read slide 15. The authors noted:  “The 2012 survey showed far more dissatisfaction among doctors across all specialties. In 2012, just over one half of all physicians (54%) would choose medicine again as a career, far less than in the prior year (69%).”

Why? Why are doctors becoming more dissatisfied? The pay, I hope, is not the reason, because we are well paid. Even if you are the lowest paid doctors, you are still better paid than many others professions. The work is stressful, yes, but isn’t that what makes it fun and challenging? The hours are long and tedious. True, but there are also many other professions where long hours are not even well remunerated. Working long hard hours is the curse of the modern age in general, not a curse of medicine.

Is it perhaps because the humanitarian aspect of our work is being eroded daily by a system that pushes productivity rather than compassion? I know that I spend more time with paperwork and computers than with my patients. I get frustrated when clerical duties overtake my clinical duties, when nurses prioritise papers and protocols over patients. The job of doctoring is now weighed down by so many forms and procedures. Productivity levels, performance indicators, financial targets are now the measures of a doctor’s competence.

What is the solution? No simple ones, obviously. Medicine is becoming so much more complex with time. Many years ago we started employing business-minded people to help us run the business of medicine, so doctors can get back to real doctoring. Now this has come back to bite us. The same people we asked to do business are now making us do business. The language of business is applied into Medicine, with bad results. Patients are not happy, and doctors are frustrated.

How can I change that? How can I turn the tide of doctors’ dissatisfaction? Can I lead a new generation of satisfied doctors into an optimistic future of medicine and surgery?

I can’t change the system, but I can change myself. I will begin by taking pride in my work as an ENT Surgeon in Training. I have seen how a surgeon in love with his work is truly an inspirational being. When my patients, nurses and colleagues see me loving my work, and being fully satisfied, I hope they will catch my disease.

What else can I do to turn the tide of dissatisfied doctors?

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The Elephant in Your Room

Posted on 07/04/2012 by

It’s radical. It’s unbelievable & preposterous. It’s incredible and ridiculous, almost incredulous. When you peel off the layers and layers of ritualism, rules, regulations and religion, what will you find? Forget about the commercialism, the Catholicism, the Christianity, the Churchianity. What is this, really, all about?

I’m talking about Easter.

I needed to find proof. I found it in a medical journal. Well, not a medical journal that is currently in print, but a journal written by a medical professional a long time ago, well preserved in its historical accuracy.  As a doctor, I trusted a fellow doctor’s writing because we are both bound by the same oath of professional integrity. A Greek Doctor by the name of Luka gathered his evidence base and wrote about a Jewish Man’s life, death, and life again. And I could not believe, initially, the stuff he wrote.

Don’t throw out the baby with the bath water. But do throw out anything that is man-made. What is Easter without the holidays, festivities, chocolates, eggs, bunnies, ritualistic acts, heartless singing, and church services?

A God humiliated and abused? A God who died? A Man who woke from death? I thought religion was about doing all sorts of good things to attain a higher state of being, of holiness, of being up there. This God says “I’m coming down.” I thought religion was about doing things. This God says, “It’s done. It is finished.” I thought God was meant to be distant and untouchable. This God was punched, kicked, spat on, stripped naked and stabbed in the abdomen.

Who comes up with these kinds of stuff?

Easter is like a King who disguised himself to become a commoner so he can pay for the rent and medicines they couldn’t afford and help them live better lives. Easter is like a judge who knows you cannot pay for the crimes you have committed, so he took your place and went to jail on your behalf so you can be free. Easter is like a surgeon, knowing you cannot afford a heart transplant, paying for your operation and transplanting into you the heart of his own son who died.

Who comes up with these kinds of stuff? Easter is out of this world. There’s nothing else like it, really. That is why it is the elephant in your room. It is so incredible that it has to be considered seriously. Could it actually be true?

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On the getting of wisdom

Posted on 04/04/2012 by

Every medical and surgical specialty is exploding with knowledge. There are so many wonderful things going on in the amazing world of ENT. The future for our patients is bright, that is, if we can translate and materialise what we have learned into our day to day practice as surgeons.

The best of the best in Otorhinolaryngology Head and Neck Surgery came to Adelaide for a 3-day conference. In fact, the axis of the earth moved a little. There were so many ENT surgeons in one place it became the centre of the universe. As a trainee, I saw some great surgical leaders and innovators pushing the boundaries to provide better care for our patients.

Beside gaining much surgical skills and knowledge, it was also a time for me to mingle and rub shoulders with the surgical elders and heroes of my ENT community.

Here are 3 things I learned at the Conference:

1. The patient is the focus, not the disease.

As a trainee surgeon I need to always remember that everything I do should be focused on the patient. Every new research, new developments, new procedures, and new equipments are designed with the patient in mind. This focus and single-mindedness is what separates the great surgeons from the good. I can see that the great leaders of my specialty always place the patients’ interest as an ultimate priority.

2. Surgical advancement is based on hard work and sacrifice.

These great surgeons toil and struggle. They work harder and longer than their peers. They push hard. They persist. They think outside the box. They do certain things that are not normally done, often making many big sacrifices along the way. So how much am I willing to sacrifice?  What am I willing to sacrifice on the altar of surgical advancement? My family? My health? My faith?

3. Surgical humility is the key to surgical satisfaction and longevity.

This surgical trail is a long, tough and lonely road. It takes on the average, 15 years to become a surgeon, 6 days a week doing 14-16 hour shifts and research pursuits in addition. Its tough and rough. The surgeons I look up to are those with what I call surgical humility.  They are content doing what they do. They find joy in the simple things they do. They are honest when reflecting on their outcomes. They are happy to accept responsibilities for their complications, and they are content with not having to be the top dog in town. These are the happy surgeons.

Would these 3 be also applicable to what you do?

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