How to Do a Liver Transplant (6 page)

I can't believe they are going to let me operate on people

S
tarting to operate on patients marked the beginning of a surgical way of life. Dr Smith instilled in me a work ethic of seeing my patients seven days a week and I still adhere to that to this day. He quite rightly pointed out that if I was going to have all the fun of operating on people, then I had to be totally responsible for their wellbeing 24 hours a day, no matter how tired I was. There was no way he was going to look after my patients
while I was off lounging around with my friends telling them how good I thought I was. I took a lot of ribbing for doing all this extra work and missing out on the more social aspects of intern life. But I had a plan. I wanted to be a surgeon and somehow needed to fit in having a few babies along the way. It was essential that I put the rush on surgical training before my eggs withered and died. Women having children during surgical training were rare when I went through. There was no part-time training and no one I heard of had ever applied for maternity leave whilst a surgical trainee. It wasn't really needed because there simply weren't many women general surgeons – at least I had certainly never met one. The only female role model I was aware of was a wonderful kidney doctor called Carmel Hawley. Although she was not a surgeon, Dr Hawley had a busy and prestigious career along with a lot of children. She managed to do it all really well. I wanted to be like her and I saw all this hard work as a junior as a necessary means to attempt to hurry through surgical training to achieve my goal of surgery and motherhood. Dr Hawley showed me that there was a way.

So, following the first two years as a junior doctor, my next step was to become a surgical registrar. In order to do this, I had to compete for admission to surgical training with the Royal Australasian College of Surgeons. Once accepted I had four years to learn everything there was to know about surgery. Those years in Nambour had left me
in good shape to climb up this next rung in the ladder and I began my push. Thanks to Dr Smith, I was head and shoulders above doctors two or three years older than me in terms of surgical experience. To apply for surgical training, I needed to pass a series of examinations called the Surgical Primary. These consisted of three days of written and practical examinations with hundreds of multiple choice questions. These exams were touted to be really difficult, testing all aspects of anatomy, physiology and pathology. They also cost a thousand non-refundable dollars per attempt and for me this was a real incentive to only do it once. This money was due to be paid several months prior to the exam, well before I had done enough work to think I had any shot at passing. I wrote out my cheque and stood in front of the mailbox for several minutes before I allowed my hand to release the envelope into the slot. Posting that cheque made me put my arse in gear and study enough to pass. I went straight home and did little else for the next six months other than eat, sleep, work and study.

I gave up everything except for a ration of an hour of TV a night. At the time, Andrew and I were huge fans of
The X-Files
. I discovered that the actress Gillian Anderson, who played Dana Scully, would be coming to Australia to promote the
X-Files
movie, and that she would be doing an autograph signing at a local shopping centre. To my horror, it became apparent that she would be there on the day of the written Surgical Primary examination. I was such a
fan that I actually considered deferring the exa m for another six months so I could go and see her. My hopes were buoyed, however, when I found out that she would not be arriving until half an hour after the exam was over. This was my window of opportunity. I flew through that exam, checked my work once and made my exit early so I could drive like a bat out of hell across town to see Dana Scully. As it turned out, all I got was a glimpse of her red hair over the heads of 4000 other frenzied, sweating fans, but that was all I needed to be satisfied.

I had to wait three weeks to see if my celebrity addiction would cost me six months of study and a thousand dollars. Finally the day arrived; we had been instructed to call the exam hotline in the afternoon for our results. Of course I couldn't concentrate all day and by two o'clock I couldn't wait a moment longer. I locked myself in an office to make the call. The next few minutes would determine if I could move forward with my life. If I passed, it would show everyone that I was serious about being a surgeon, and if I failed, I would have to go back to the drawing board and do the gruelling study all over again. I dialled the number, said my name and held my breath while the secretary on the other end of the phone rifled through her pieces of paper.

Finally the words ‘Slater – pass,' came down the line.

‘Are you sure?' I asked, feeling warm tears of relief well up. I did it: I saw Gillian Anderson and I passed the Surgical Primary.

Now I had the exam, only a few things stood in the way of my dream of starting surgical training. There was an interview before a panel of wise surgical men, and the positive recommendations from my bosses. I was only a junior doctor from a small provincial hospital, so no one aside from Dr Smith had really ever heard of me. To improve my chances of being selected, I travelled to Brisbane to introduce myself to the power players of general surgery to at least show them my face and tell them that I was really keen on being a surgeon. My first interview was with the Chairman of the Queensland Board in General Surgery, an important person to get to know, and funnily enough it is a position that, almost 20 years later, I now occupy. It is quite strange to think that people might be as intimidated by me as I was of him that day.

‘I'd like to be a surgeon!' I blurted out eagerly, before he even had a chance to sit down. He stared at me for what seemed like a long time, obviously thinking I was quite an idiot.

‘Let me see your résumé,' he said finally, extending his hand to receive it. I tasted a little bit of vomit in the back of my throat. I didn't bring a résumé. In my extreme naivety, I had failed to realise that he might need to see anything more than my smiling face.

‘I haven't done anything to put in a résumé,' I stammered, instantly wishing I could take the words back. The corner of his mouth lifted in a bemused smile and
he continued to give me a look that is still burned in my brain. To this day I cannot talk to him without reliving that moment. He didn't have much more to say after that and I left the room thinking my career in surgery was probably over.

That same day I also had an appointment to see Professor Russell Strong, one of
the
pioneers of liver transplantation in the world, i.e. not intimidating at all. I arrived ten minutes early for the interview and was greeted by his faithful secretary of many years. She did not look up from her computer as she told me to take a seat. She informed me that Professor Strong was in surgery and he would be along at some point. The first hour passed and I sat in silence.

Out of nowhere, her eyes never moving from her computer screen, the secretary eventually said, ‘A lot of girls come in here and say they want to be surgeons. Some of them start, but most of them don't make it, you know.'

I squirmed in my chair and didn't know what to say. She was crushing my dreams. I waited another hour. I had to pee.

The secretary looked at me this time and said, ‘Look, I don't think he is coming, do you?'

She clearly wanted me out of there. I was reluctant to leave because what if he appeared a moment later and I wasn't there? Was this a test? Was he waiting to see what I'd do in a tricky situation? After two and a half hours, I
began to think she was right. I decided to go. My one vindication was that, years later when I returned to work at that hospital as a surgeon, Professor Strong's secretary also became mine and we laugh together when I remind her, in a good-natured way, that some girls
do
become surgeons.

Having failed to gain even the most meagre advantage by getting to know the surgeons who might grant me a future, I turned my attention to preparing for the surgical interviews. That year I was competing with 35 other doctors for only eight positions. In only my second year out of medical school, I was the most junior of the applicants and the only woman applying. Despite my youth, all my after-hours work in the operating theatre meant my experience gave me a definite leg-up on the rest. That night of the interviews, Dr Smith must have also spoken up for me and told them to take a chance on the unknown girl from Nam.

Shortly after, I received my acceptance letter to commence training in general surgery and I was elated.

The life of a surgical registrar

M
y first year as a fully fledged surgical registrar got off to a terrific start when I was assigned to work in a hospital situated in a picturesque beachside setting. Working at a coastal hospital was a coveted posting and six months there meant living the high life in a beachfront apartment and hanging out every night with the other junior doctors in the local restaurant precinct. The hospital was two minutes from the shore and there was a spectacular view of the sparkling Pacific Ocean from every floor. The transient tourist population made every day feel like a working vacation.

My move to this new location also proved to be the beginning of a very testing time for my marriage. The rigours of surgical training would mean changing locations every six months as I toured the hospitals of Queensland. From our wedding day to the time I finished training, Andrew and I could count 12 different homes. This is what breaks many budding surgeons – living away from their family for long periods of time. Andrew and I had to live separately off and on for the entire four years I was a registrar and it was tough. He had a job working for the National Bank in Nambour – just like my father in his youth – and my move hundreds of kilometres away from him meant he had to live with my parents, eating meat and three veg with them every night while I was enjoying the nightlife with my fellow registrars. He kept smiling through it all, though, maybe because of all the whisky my mother gave him. Andrew began to sacrifice a lot for the sake of my career and it became clear to us that our marriage would not survive if we both wanted to build big careers. Andrew decided to make most of the compromises and stepped back from the bank and instead pursued his lifelong dream of becoming a commercial pilot. This job at least let him move around with me and we had great weekend trips when Andrew would fly me away in tiny rented Gazelle aeroplanes. We made it work.

I threw myself into my new role – I was now a surgical registrar, ready to heal the sick. I was scheduled to be ‘on call' my very first night on the job. This meant that I worked a normal day and, when the sun went down, my phone began to ring. On the line would be the emergency department, calling about patients with surgical problems.

One of my calls was about a patient who had been vomiting profusely and had not moved their bowels for a number of days. I listened to their story very professionally and carefully examined their abdomen. I noted that it was as tight as a drum and that they looked quite unwell. I evaluated the x-rays and decided that the correct diagnosis was a blockage of the large bowel. The only thing left to do to confirm my stunning diagnosis was to examine inside the patient's rectum by putting my finger up there. I pulled on a rubber glove and plunged in. I felt like I finally had used my clinical acumen when my finger confirmed what I had brilliantly suspected; there was indeed a large cancer just inside the anus. My chest puffed out with pride as I congratulated myself on being really great. I was feeling good, I was feeling special, and when a doctor feels like this, it is never actually good for anyone. Buoyed by the knowledge that I was indeed a magnificent doctor, I then decided I needed to biopsy this cancer. Now, considering I was already pretty sure about the diagnosis, a biopsy was not absolutely essential but I felt that this additional step was sure to impress my
boss (who I was actually yet to meet). ‘He will think I am the best registrar ever when I prove this is a cancer with a biopsy,' I thought. I triumphantly took the tiny biopsy and sent it away to the lab for analysis. By that time it was after midnight, so I decided I would inform my new boss about my diagnosis in the morning. This was my last job for the night, so I went home and drifted into a contented slumber.

I was awoken an hour later by a blaring pager. It was the resident ward doctor.

‘I just wanted to let you know that the patient you were just seeing is bleeding profusely from their anus,' she said. ‘Their blood pressure is low and I am going to start giving them a blood transfusion.'

I flew back to the hospital to find my patient lying in a pool of blood. My tiny biopsy, that I had done safely many times before on other people, had inadvertently bitten through a blood vessel that wouldn't stop bleeding. This bleeding complication can happen with any procedure, but why
tonight
I asked myself mournfully. With my tail firmly between my legs, I had to call my new boss in the middle of the night and let him know that on her first day as a registrar, a doctor he had never met had biopsied a patient he had no idea was in the hospital, and ask if he could come in and help her do an emergency operation. A few expletives were uttered and in he came. It was four o'clock in the morning and I was berated every minute of
that three-hour operation to remove the patient's cancer. The surgery was always going to be required at some point but it would have been preferable for it to at least be left until daylight hours. I was constantly reminded that this took the prize for the most spectacular start to a job that any registrar had ever had. I learned a golden rule of surgery that first day: never do anything that is not absolutely essential in the middle of the night, just in case there are complications. Also, never, ever feel too good about yourself because surgery has a real propensity to bring you back to earth quickly.