Many years ago, I was in theatre in Derby Royal Infirmary with my Registrar.
We were doing a really complicated mandibular fracture on a patient as an emergency and there was a routine operating list happening next door. I remember it vividly.
Phil Hollows was running the routine operating list as a Senior Registrar and he was removing a malignant melanoma from a man’s forehead. I remember because we wanted him to come and help us because we were struggling but he couldn’t so he was relaying instructions verbally through a runner to tell us what he thought we should do even though he hadn’t seen it (that man is good)
What Phil was doing next door was manufacturing a solution to close a huge hole in the middle of a man’s forehead using various rotation flaps and pedicle flaps which ended up giving him a scar which unfortunately looked a little bit like a swastika!
What Phil did that day was utter creative magic to give someone a solution to a huge problem in their life through experience and creativity.
I was inspired by the fact that he could do that almost every time I watched him work.
It seems like nowadays everything needs to be pre-planned in advance to the nth degree and if it doesn’t go to plan we are laden with guilt that we might have done something wrong because what we found when we started the operating was different to what we expected.
That, my friends, is actually the essence of what surgery is about.
Having enough knowledge to start the procedure knowing that the likelihood is you’ll be able to finish it using the experience and your creativity to fashion a solution for a patient that is acceptable.
I encountered it again on a Tuesday morning before Christmas when I was treating a lady I have known for quite a while.
The surgery was lower right, two implants, complicated, close proximity to the inferior dental canal and difficult ridge anatomy. I planned it digitally, had a surgical guide that fitted perfectly but when I opened it up the circumstances changed. It was different to what I expected and I had to fashion a different solution than the one I suspected I would.
I was assisted by Nish that day and he watched on, amazed at how I would get out the perio probe or other types of measuring devices to check and re-check what I was doing like a carpenter. Because I understand the principles of placing implants, the dimensions they need to have and the positions they need to be in and the spaces that need to be around them.
In the end (although a compromised result) I was really pleased with what we’d achieved.
If we continue to teach people that everything is a pre-planned procedure and the plan will never change then we will breed a new generation of surgeons who are unable to act when the s*** hits the fan and difficulty arises.
Maybe it’s not the same in medical surgical training but it definitely feels like it with the young colleagues were seeing.
They need to practice in order to be able to practice.
I said it recently and I’ll say it again…
‘Everybody has a plan until they get punched in the face’ Mike Tyson
Blog Post Number: 1870