Choosing Paediatrics – Reflections from a Surgeon

female doctor examining little child boy in hospital
female doctor examining kid little child boy

Reflections from a Surgeon

Mrs Nicola Comer

From early on I knew I wanted to be a Doctor – my Mum had one of those six-year-olds confidently predicting her future life. Along the way, several people tried to dissuade me; one in particular sticks in my mind. As a 17-year-old applying to medical school, the daughter of a family friend who was working as a junior doctor at the time put quite some effort into trying to put me off. I remain incredibly grateful to her for this – it is crucial to go into medicine with your eyes wide open.

Once at medical school, I loved it. The course was challenging, yes, but also fascinating and absorbing. Then, as a 4th and 5th year, the question started to come – ‘have you thought about what speciality you might want to do’? Among the sometimes bewildering array of possibilities, it was difficult to know how to begin to make that decision.

“I tried to look for role models”

When deciding on a career – any career – people often talk of searching for role models, people you can look at and think ‘that’s who I want to be like’. For me there was a group of doctors with whom I felt comfortable, I understood their way of making decisions and in general, I liked and respected them. I knew I wanted to be a surgeon. Finding a specific role model proved more difficult, it is a sad fact that there are still very few women in senior roles in surgery. Trying to find a woman who I could emulate was very hard. Now, I can think of several – at the time I struggled. I hope this is because the landscape is changing.

Within surgery, there is a huge breadth of specialities – from orthopaedics to ophthalmology, from neurosurgery to plastics. My decision to pursue paediatric surgery came about for several reasons. Firstly, there were more women in this speciality than any other branch of surgery meaning it was easier for me to envision myself there. I also loved working with children, they make me laugh and I love the way they can deflate the biggest ego in just a few words. The final link in the chain though was working with a truly inspirational individual. As a house officer (F1 in today’s parlance) I worked in paediatric surgery. It just so happened that this was in a centre where the department was very small, so I was given much more responsibility than I was used to. The Consultant was one of the most dedicated surgeons I have ever met, and some of his focus, diligence and enthusiasm must have rubbed off on me – I was hooked.

I pursued a fairly straightforward course towards my goal – advancing through the ranks of junior doctors with ever increasing specialisation into paediatric surgery. Several sets of exams and a research degree under my belt, I was ready for a Consultant job.

A Week in the Life of a Consultant Surgeon

So, what does being a Consultant Surgeon involve? That is perhaps less straightforward to answer than you might think. Certainly, there is operating, but this occupies much less of the working week than many imagine. In a ‘standard’ week (although I’m not sure there was ever really such a thing!) I would operate for one and a half days, with one day in out-patient clinics, and an average of one and a half days ‘on-call’ for emergencies. The rest of the time was split between planning meetings, management responsibilities and general administration (writing letters to colleagues in other hospitals or GPs, planning operating lists etc.). Of course as well as the ‘regular’ week, the out-of-hours on-call needs to be covered, meaning an average of one weeknight per week and one weekend in six. As the Consultant, I would invariably receive at least one phone call each on-call and needed to go into the hospital on about half of the nights. Weekends meant going in to see the patients every day, and emergency operations on about half the days. Some weeks were mad busy, others allowed time to breathe. I can say for certain that the old-fashioned image of the Consultant on the golf course while the rest of their team looks after the patients didn’t happen.

Much of my role was about managing a team. The team involved in caring for a surgical patient is huge – ward nurses, physiotherapists, speech and language therapists, specialist nurses, junior doctors, theatre nurses, anaesthetists, staff in out-patient clinics, secretaries, and managers are all involved in the safe and effective care of patients. As a Consultant you are the figurehead for that care – the buck stops with you – so organising, cajoling, encouraging and berating all these people to deliver the best possible care is ultimately, and certainly in the eyes of the patient, your responsibility.

Of course, the biggest responsibility is in caring for the patient and their family. There is the challenge of diagnosis, decision-making and operating, all alongside outstanding communication skills to ensure the needs and expectations of the family are met, and that they are completely on board with the management plan.

“Life comes with complications – it is important to keep up the self-belief”

The greatest reward of the job is in achieving a successful outcome and potentially changing the life of a family and child. But alongside that comes the sometimes overwhelming responsibility, and the challenge of coping when things go wrong. A junior surgeon is often taught that ‘if you are not getting complications then you are not operating enough’; sadly complications are a fact of life and people are not machines that can be fixed with the help of a manual. However, maintaining self-belief, the trust of your team, and most importantly the trust of the patient and family is hard – and crucial – when they happen to you.

Surgery is not a career to be entered lightly. Nor is it one to go into with the aim of earning an ‘easy buck’, surgery is hugely challenging and can be immensely rewarding. With ever increasing scrutiny on outcomes, results and targets it takes skill, resilience and determination to make it work. The grateful tears of a mother when you tell her the operation has gone well, or the lively 5-year old coming back to out-patients after a life-saving procedure can make it all worthwhile.

Mrs Nicola Comer

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