TheSecretSurgeon - Ask me anything - go for it!

[TheSecretSurgeon]

I am a surgeon in the NHS (and other)

I've been a fully qualified surgeon for 10 + years and I currently mostly do bones/tendons/ligaments,
I treat fractures too. You smash yourself up on the tarmac, I put you back together.

I've trained in plastic surgery, vascular, abdomens and brains. The insides of you, I know it.
Medical, school, junior doctor years, all the guts, all the gore.



AND.... posting from an anonymous account, so no holds barred.

GO for it! Ask me anything

[TheSecretSurgeon]

LargeRed said:

can you cure my 'Trigger Finger'

Yes

dontlookdown said:

Is there any operation you perform on others that you would not have done to yourself? And why.

Boring answer no.
All the operations I do, I would happily do on my near relatives (which isn't really allowed, but you get my drift) Or have done on me.
Some of them have only a 50% success rate, and I think I wouldn't take those odds, but that's a judgement thing.

sherman said:

Why wont the dvla give me my licence back?

I have been cleared fit to drive (epilepsy) by my gp but the dvla medical group is waiting on my consultant to fill in a form. What takes so long to do some paperwork?

Consultants (me) are busy.
Consultants (some) are lazy. But paperwork is paid time whatever it is. Yes I have time paid for paperwork.

[TheSecretSurgeon]

GranpaB said:

Why do you were those blue masks in surgery as according to a few people on here they are useless?

T.i.a.

A. I don't want your blood/urine/bile/faeces/fat in my mouth.
B. they do cut down on some (largeish) bacteria going into your wound

Interestingly some surgical disciplines aren't too bothered with some bacteria going in the wound, within limits

[TheSecretSurgeon]

Stick Legs said:

What colour are bones inside a living person, are they white or does that only happen once you have died and all the blood is gone?

Is it possible to have corrective surgery on bone grafts? I had bilateral Tallipies corrected as a child (last op 38 years ago) but my mobility is playing up now and I am being seen by an Orthopedic specialist but it is early days so don;t want to ask too many stupid questions. I just wondered if you can muck about with bone that has already been grafted, or of once it's been messed with can it be tinkered with again?

Thanks.

Bones are a creamy white in colour.

Is it possible to have corrective surgery on bone grafts?
Bone is continually turning over, like water flowing in a river, so pretty quickly 'bone graft' turns into bone. So yes.

Trophy Husband said:

Is there a particular surgery that still stresses you and if so why?

Surgery where my knife or saw blade is near an artery or nerve. Tiger Country we call it.
One slip and potentially amputation or floppy leg forever.

R1gtr said:

Just the man to ask....{stuff edited out}
Is that all normal and just the way it is or should I go back to the docs?
You probably didn't want serious questions but hey ho

I dont know is the answer, and I'm not able to do individual medical questions, sorry

ReverendCounter said:

I've just googled something apparently called the xiphoid process - if this is enlarged and deviated, can it be removed or modified so it functions normally (I mean diaphragm + abs attachment)? I think mine is responsible for GERD/GEJ issues which I've had for a long time. I understand there may be the possibility of oesophageal cancer as a result.

Don't know. You need a Thoracic surgeon for this.

No individual medical questions please.

Keep it general, or questions about the grossest thing I've ever cut off

[TheSecretSurgeon]

Drezza said:

When you first started were you grossed out by blood and guts and if so, over time have you got used to it to the point it no longer bothers you?

I see a grazed knee and go light headed, so couldn't imagine being a surgeon.

For about 30 minutes yes, then no.

Dissection class was year 1 in medical school. So we were are very very hungover and tired.
But cutting up a very dead person quickly becomes normal.

Which is weird in it's own way.

stuthe said:

Was there one op where something complex happened and you just nailed it, smashed it out the park and felt like it was a 1/1000 miracle you pulled it off & felt like a hero(ine)?

Yes, this happens a few times a year.
This is the great thing about surgery, you can rest on your laurels and stick to simples, or find new and challenging things to do, which reap massive reward (but are stressful)
The reason I nail it and smash it out of the park, is however because I overplan for operations and don't reach too far.

Tango13 said:

I had a K nail put in my femur 32 years ago, is there an upper time limit for it to stay in there?

Generally no. They are inert and the body walls it off. I've taken stuff out that was 20+ years in. Bone overgrowth is a pain though, it often needs a lot of chiselling and swearing.

Greshamst said:

Has anyone died on your operating table?

Yes. We operate on some very fragile and ill people.
You have to have a mechanism for dealing with it.
It's terrible. But you have to process/accept/learn and move on

There is a quote from René Leriche, “Every surgeon carries within himself a small cemetery, where from time to time he goes to pray—a place of bitterness and regret, where he must look for an explanation for his failures"

It's this. None are forgotten.

[TheSecretSurgeon]

Sterillium said:

What's the grossest thing you've ever cut off?

Yes !!!!!!

Now we're in business !!!

I cut a man's lower leg off, whilst he was awake on a trolley in A&E with him still awake.
It was hanging on by mere threads and skin.

The plastics guys took the (cut off) limb up stairs and harvested usefull stuff off it for 30 mins. before he was taken up, and they put bits back on him.

The student nurse stood next to me in A&E whilst I snipped went a funny colour and walked off.


And that's not the grossest, but just the one that comes to mind as hard core.

Go on chums, drop the level of questions., I'm posting anonymously !!

[TheSecretSurgeon]

texaxile said:

My Mrs is a T&O Matron, also runs a fracture clinic etc (8B)

Do you share the same feeling of being dispondent and frustrated with the system, needless waste and other issues within the NHS as many other employees appear to?.

Yes,

But if I'd won the £184million, I would still like to be a surgeon and operate

[TheSecretSurgeon]

MXRod said:

Meralgia paresthetica , numb skin upper thigh , caused by a trapped/damaged nerve
I have had this for some time now , my GP has said essentially I have to live with it , I am now getting waves of a hot/cold feeling and tingles .
Is there an invasive proceedure to deal with it. Or do I have to live with it ?

There are lots of other things to try, Ask to be referred on to the hospital

Digger said:

What's the funniest moment you have had whilst operating etc?

I was once assisting (second in command) during an operation and the surgeon said "cripes this woman is so fat it's a wonder we can find her hip, what a fatty. It reminds me of one like this about 3 years ago, I needed a rope tied around me ankles"

At which point the patient, who was awake (spinal injection not GA) said "yes that was me, you made the same joke about the rope last time and I was awake then too "

We all looked for a hole in the ground to swallow us up.

essayer said:

Did the leg get put back on then?

the muscle and skin was harvested to be put onto the stump, which was veyr short. He now as a same length stump but with more padding and a prosthesis fits much better. Clever eh?

paulguitar said:

Have you read Henry Marsh’s books and of so, did you enjoy/relate to them?

Nope. I don't know this man. I don't watch any medical drama or similar as they are laughable inaccurate and I want time off work.
Sci Fi is my thing.

I read War Doctor by David Nott, which made me cry and I now donate to his foundation
I read The Adam Kay book This is Going to Hurt, which I also shed a smal tear to in parts. And then realised I had just as many stories and hadn't written them down, and he was the rich author now.

Although he quit medicine, and I'm not to badly off

[TheSecretSurgeon]

mcelliott said:

Do you dust off the board game Operation at xmas to show your off your skillz?

Yes.

And I am LEGENDARY at it

[TheSecretSurgeon]

nuyorican said:

Ooh I know. Do you sign your work with a soldering iron?

No, it's quite frowned upon

https://gizmodo.com/the-doctor-who-branded-a-patie...
and
https://www.nytimes.com/2000/01/22/nyregion/doctor...
and

[TheSecretSurgeon]

Greshamst said:

What’s the most embarrassing reason that a patient has ended up in front of you for?

The usual.

I have a vibrator up my ***

nuyorican said:

Do you get your pick of the nurses?

Have you ever heard of anything dropped into an open cadaver by mistake? Watch/ring/ash off the end of your ciggie?

Is it an urban myth or does an anaesthetic occasionally fail leaving the patient conscious but paralysed and having to endure the procedure? I'm guessing, hoping that monitoring equipment would pick up on this, and that the anaesthetic is a mix of potions... a 'Belt & Braces' approach, also, what do they use? Apologies if I should save this one for the 'Anaesthetist - Ask Me Anything' thread.

Thanks

Nurses: Yes.
The bad guys used to say "nurses are like a dart board, you can have as many goes as you like, you just get your aim in and eventually hit the bullseye."
In my junior doctor days I had dalliances with:
Student nurse, Nurse, ward sister, Microbiology technician (werido), Physio, Occupational therapist, other doctors (obvs), Dietician (max points for this), Paramedic, and Never a patient because thats beyond weird and wrong.

TwigtheWonderkid said:

If your cat needed an op, or broke it's leg and it needed fixing, and you didn't have pet insurance, would you pay the vet £4K or would you fancy your chances and have a crack at it yourself.

I don't have the correct sized equipment or facilities.

But otherwise, hell yes.

[TheSecretSurgeon]

nuyorican said:

First off: Wow, what a job. Respect!
Have you ever heard of anything dropped into an open cadaver by mistake? Watch/ring/ash off the end of your ciggie?

Is it an urban myth or does an anaesthetic occasionally fail leaving the patient conscious but paralysed and having to endure the procedure? I'm guessing, hoping that monitoring equipment would pick up on this, and that the anaesthetic is a mix of potions... a 'Belt & Braces' approach, also, what do they use? Apologies if I should save this one for the 'Anaesthetist - Ask Me Anything' thread.

Thanks

Cadaver is a dead person, you mean patient.
We count everything in and out very carefully about 3 times, and nothing has ever been left behind in one of my operations.
But it does happen and is one of the Never Events. The government collects data about them.

Patient awake during procedure:
Very very very rare and less likely than dying in a car crash on your way home from the hospital, is my understanding.

ian in lancs said:

Who carves the turkey in your house?

Me, but I cut flesh for a living.

Also see previous answer about legendary skillz.

Sorry these answers are out of sync.

[TheSecretSurgeon]

CharlesdeGaulle said:

Do you wear crocs in surgery? If yes, do you have any shred of self-respect?

Good thread by the way, and goodonyer for the brilliant things you folk do. I saw some amazing things in the army, people I knew would die being saved by brilliant medical staff. Respect.

Serious answer: Come over my end and tell me the same when I'm putting your broken bones back into the skin and fixing you up. They are shoes worn in the theatre and nobody in this room cares a single thing about style. The room is 100.00% function.
Amicable answer: They are non-slip, non-sparking (flammable gases), very comfy to wear for a 4 hour operation, and I can put them through the clog washer when they are caked in other humans' blood.

I don't wear socks in my crocs, which is really going to mess with your noggin, so I often have drippy blood on my toes.
but blood is sterile and not that bad.

[TheSecretSurgeon]

PugwasHDJ80 said:

Is ash cash still a thing?

When was the last time you saw NFN written in notes?

Ash Cash = Cremation Form 4 = £82

NFN, never seen.
We don't write these things because they are very disrespectful and discriminatory.

What we say about patients however.....

[TheSecretSurgeon]

snoopy25 said:

has a patient dropped a massive fart on the operating table when you have been mid-surgery?

Yes, quite often, last week was the last time.
If you have a spinal injection, instead of tube-in-throat General, then some relaxation occurs and people can float an airbiscuit when we transfer them from trolley to theatre table.

xx99xx said:

Any truth in the rumours that some doctors go out on heavy lash, then afterwards go back to the hospital to find an empty room and hook themselves up to a drip so they are good to go and hangover free for their morning shift?

Is there a hierarchy amongst surgeons? You know like is a brain surgeon top dog and the ones who remove vibrators lower down the pecking order?

Have you ever been out somewhere and the shout went out 'is there a Dr in the house?'.

Do you get fed up of non medical friends/family asking you to diagnose their problems?

Out on Lash: No, never seen this or heard of it. Too much hassle and a disciplinary offence probably.
I have fallen asleep at some bad moments on shift after big nights out,
I'm just working out if I have the balls to tell you about the bad ones.

Doctor in the house: Yes, lots of times, twice on an aircraft, once where I attended to an old lady who was having a stroke above Germany. I helped her and the purser said to me, what next? I said well we need a some proper help.
5 mins later I stood up, having been kneeling in the aisle, and realised we were descending very very fast. Like the gangway was so steep you couldn't stand up. We went from cruise altitude to runway at Geneva in about 5 minutes and the pilot later told me that the manoeuvre would cost Easyjet about £50,000 in fees. The patient did fine.

I witnessed a car crash at about 7am on a rural road, hopped out and attended to a casualty with a GCS of 5 (=bad) for 20 mins until the ambulance arrived. 20 mins with ditch water up to my knees.
He lived.

Friends asking about problems: No this is a deeply flattering request when they ask me.
I've operated on 2 of them

[TheSecretSurgeon]

valiant said:

Ever cut the wrong bit off by mistake?

Another "Never Event" and none in my career

and I'm trying rather hard to have none in my career by the end.

Human's make mistakes, but we, like aviation have multiple levels of checking and redundancy.
Errors happen with complacency, boredom, rushing, seniority dominated teams, and no checklists.

[TheSecretSurgeon]

xx99xx said:

Is there a hierarchy amongst surgeons? You know like is a brain surgeon top dog and the ones who remove vibrators lower down the pecking order?

A little yes.

Plastics think they're the best, but Paeds Cardiac probably is.
In fact Paeds surgeons of any variety probably win.
The great surgeons don't really need some sort of hierarchy, they are just good.
Obviously orthopaedics (my speciality) is the coolest. Because it is, and we have ALL THE POWER TOOLS

Brain surgeons aren't top of the pile by any means, in fact sometimes quite the opposite, it doesn't have a great inside opinion.
The trouble is, a proportion of all surgeons are megalomaniacs, and so they all think they're best.
What's interesting is: "Are aholes drawn to surgery, or does being a surgeon make some people into an ahole? "
Power is certainly a bad thing for some people

[TheSecretSurgeon]

Cyder said:

Have you ever had an ‘watch this… oh fk’ moment while operating?

No.
Some "watch this" because my ego is so fragile.

Some plain "oh fk" moments without the preceding "watch this". It's what you do next that counts.

[TheSecretSurgeon]

Sheets Tabuer said:

Firstly why did they only give me paracetamol when I had an operation on my foot? it hurt like a bh and all I got was two stty pills.

Are there operations that you think are a waste of time or unnecessary but they are carried out on the NHS anyway?

Operations: In my specialty there were a few, but the research got better and better and now NICE pretty much tries to ban them as a waste of money. But the trouble is NICE are a little to ban-happy.

Private practice is much worse.

And that's why the NHS is a wonderful thing.
Surgery or no surgery I still get paid them same.
Private practice: No operation, no big invoice.

[TheSecretSurgeon]

valiant said:

Do you ever find yourself watching Casualty or Holby City and shouting things at the telly?

Don't watch for this very reason

Meeten-5dulx said:

Ever been asked by a criminal gang if you will do an ‘off book’ operation?

Sadly not. I've had a few people try to bribe me to try and get to the top of the waiting list. Not with cash, and quite surreptitious.

Meeten-5dulx said:

Ever been asked by a criminal gang if you will do an ‘off book’ operation?

coletrickle01 said:

Thanks for posting - great reading.

Do you think you're paid fairly?

Honestly, No.
For this much hard work and exams and skill I should be paid about 3 times more. Total honesty because you don't know who I am.
I did exams from age 19 to age 34.
The average salary for my job in the USA is $850,000

But as I tell every single junior doctor who comes to learn or experience surgery, Don't do it for the money.

Some Gump said:

What's the most random 3 objects you've had to remove from an arse?

Also, what classic excuses went with them?

I haven't removed anything myself, but seen them come in through A&E.
From what I can see it's always : 1. Vibrator 2. Vibrator 3. Long smooth shaped object

Lotus Notes said:

Have you ever found some unusual natural 'architecture' in one of your patients? E.g. Something inverted etc

Yes, but not weirdly so. Anatomy is quite exciting and interesting, even though I failed all of it at medical school.