I had the pleasure of speaking with Dr Mary Langcake, Director of Trauma Services at St George Hospital, and my ex-boss! She has had an incredible career and life with many accomplishments and interesting stories. We spoke about mental health, surgical training pathway, interesting patient cases, and more. I hope you guys enjoyed this as much as I did.
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I had the pleasure of speaking with Dr Mary Langcake, Director of Trauma Services at St George Hospital, and my ex-boss! She has had an incredible career and life with many accomplishments and interesting stories. We spoke about mental health, surgical training pathway, interesting patient cases, and more. I hope you guys enjoyed this as much as I did.
Shout the next Coffee: buymeacoffee.com/DrSyl.AU
Become a Member: youtube.com/channel/UCiOBkubL46VQT9mPqrnJlrQ/join
Become a Patron: patreon.com/DrSyl
hey guys dr sill here junior doctor from sydney australia and today i have the pleasure of interviewing dr mary lancake
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director of trauma for st george hospital um the trauma services at st george hospital cover you know a lot of
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new south wales which is a very big place in australia if you're not aware today we're going to talk a bit about
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her life and training as a surgical specialist but before we begin our discussion i just
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wanted to say a little bit about why we're having this discussion and as we were saying before i feel like a lot of
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the insights that junior doctors even outsiders and especially people like medical students a lot of the insights
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we get come from serendipitous chats that we have on the ward in the hospital and i feel like that's kind of been
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limited during the covert times and so uh i thought we would bring it to youtube so uh we're talking with dr mary
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landcake by the way she's not only the director of trauma at st george hospital she's also been deployed in afghanistan
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with the royal australian air force she is also the ex-chair of the royal australasian college of surgeons and uh
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and as i said my ex-boss so um thank you so much for taking the time to talk to us mary thanks for asking this all my
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pleasure now i really want to talk about your life your career um the challenges you've gone through but before we kind
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of dive into that i want to know if there was ever a kind of a patient or a case that you were
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involved with that made you have that aha moment that man i love trauma surgery moment
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i think as you go through the career in terms of thinking about patients that have had an effect uh where you have
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that you feel like that light bulb moment there are going to be many that affect you in different ways
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i think with respect to trauma it's a patient that i dealt with
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while i was actually deployed i had done some trauma at westmead hospital but while i was deployed i
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looked after an afghani policeman who was shot and he was a very sick man and we were
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working in a limited environment but we did what we could for him and he
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was a you know a proud pashtun male uh being looked after by a female
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surgeon and female icu nurses and female medic which i think he found hard
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but i watched how my staff engaged him and cared for him
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and and it made me proud to be part of that and also obviously managing his
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his injuries and i'd been involved with some you know quite difficult trauma
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cases on deployment and cases at westmead so that when i came back and got offered the opportunity to really i
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suppose pivot from a career pathway that was going to be pretty much purely up gi surgery and had
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the opportunity to to take on trauma i realized that it resonated with me
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and that trauma is not something people necessarily embrace it isn't if you like uh
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in some cases i i hesitate to use the word a sexy specialty but my view is that trauma can interrupt someone's life
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in a heartbeat and change it and that they are as deserving of good care as
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anybody else i feel like there's two points that i found really insightful there the first is the it sounds like
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what actually made you love trauma wasn't just kind of you saving the day as much as it
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was the team and that's something that's really common and a big misconception because of all the drama shows with
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house and whatever making it seem like they're single doctors that change people's lives it's actually it's all about teamwork oh and i think that's for
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me that's the beauty of trauma is that it really is a team i like to say that the trauma service
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starts with the folk that start to care for the person at the scene of the the accident the incident
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that could be the public that could be the pre-hospital personnel right through to people who
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care for them in the emergency department doctors nurses our orderlies are an important part of
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that as well you can't underestimate how important it is to have those folk fetching carrying transporting patients
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and doing it in a compassionate way it's the radiographers the radiologists the staff up in theater it is a team sport
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and to me that's that's the appeal i've always thought we should have like a world cleaners day you know the the kind
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of uh the workforce that's not always appreciated but think about how many covert cases have been like prevented so
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it would be really interesting to hear a bit more about your career and your kind of pathway
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thinking about what put me on the path to to medicine and subsequently surgery um
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from the earliest age that i can recall i wanted to be a doctor really so yes so
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when other girls of my age were talking about various careers or doing nursing i had a
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clear understanding that i wanted to be a doctor i would perform surgery on my dolls at a very very
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young age um always had a fascination successfully uh they never breathed it
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yes indeed but i was very good at dressing oh that's good um
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so i knew going into school that that was a pathway i wanted to take um when i was in um
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grade six the world's first heart transplant was performed by uh christian barnard and while
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some of my colleagues were reading things like um you know anne or green gables i was reading the heart explorers
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and learning about heart transplantation so it's hard for me to say
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why there's nobody in my family who was in health or medicine but it was a clear pathway then as
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occasionally your family support this interest and and i think
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i was quite lucky in that um i had a mother who was passionately um
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interested in my sister and i pursuing what we wanted to pursue and my dad equally
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at a time when there was still occasional thoughts that once you met a nice chap and married that's the role
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that a woman took my mum was prevented from pursuing a career so she
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i won't say drove but supported us as dad did to to have careers um and i
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have a youngest and even younger sister now and and all three of us have um you know double degrees and and had that
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encouragement to to undertake that um so right throughout school
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i found school not easy but i was able to achieve the grades i needed
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but as often happens life throws a spanner in the works and in my
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final year my matriculation year as it was then i developed quite a bad depression and i'm not sure if that was the
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pressure i put on myself or otherwise and didn't set the exams and didn't achieve the
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grades i wanted and i hadn't thought of a plan b so for me that was devastating even
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though i had grades sufficient to get me into a science degree
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for me that didn't gel so with some encouragement i decided to go back and sit my trick again now that was a
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challenge i had been you know one of the top of the school and those sorts of things and
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going back came accompanied with some muttered comments but i was doing much better
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and then got glandular fever and missed all the exams at the end of the year which was again a devastating blow but i
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took up um the position doing science at flinders uni
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but i was there because is this in the uk or in australia south australia south australia
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we emigrated so i am british um we emigrated in 1965 i had my seventh birthday on the
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ship and uh yeah so i grew up in in south
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australia and i started first year science but i
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think because i was there because i hadn't thought of anything else to do i was treading water and and not doing
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as well as i had liked so i ended up taking some time away from uni
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so did you take a gap year was it um between what we would have like year 12 and university that's when you
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had time off no so i did first year uni oh okay and then that's when the you came back because of the market and it
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was as i said probably phoning it in i think is a fair way of putting it and not
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achieving grades that would normally have satisfied me i started second year and the same thing
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was happening by that time i had met my my ex
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and i said if i keep going like this i'm going to end up with a really mediocre degree and
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i think it's time and were you feeling burnt out like was it were you working as hard as you possibly could and still not feeling like you're getting what you
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wanted i think there were a combination of things so i had a part-time job to help fund my way through uni i was doing
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about 25 hours casual work at a fast food restaurant as well as a full-time science degree
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and i think my brain was still recovering from what was at that time an undiagnosed depression because as a
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teenager while i think it's a little different now without adolescent mental health um
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i think people just thought i was moody so it's one of the most like under
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appreciated symptoms i think people just find people either grumpy or irritable and it's
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actually not that it's you've got this organic process that's uh making you
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i think that was a fair comment because study became hard um concentration
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everything was an effort and and i put that down to not being good enough
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so the decision to actually take a step away and consider other things was a
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good one and i worked full time actually as an
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assistant manager for the fast food company that i'd been working with that taught me a number of things it
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taught me about responsibility to people other than myself also helped me learn how to manage staff
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how to be partly responsible for running a business and and i enjoyed it but it was actually
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my husband at the time who said you need to go back to uni and i said why do you say that and he
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said because it would be a waste if you didn't and when i went back
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i was back with a clear vision that whether i made it into medical school or not i could
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bring something to a science career and i could find something within a science career that would fulfill me and satisfy
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me i went in with much better motivation which was noted by my lecturers my
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grades were better as a consequence and i was accepted to to do an honours
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year and then became pregnant with my son so i i took a year and then went back when he was about
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five months old which was a challenge as you can imagine
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and completed honours and then worked for two years as a graduate
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research assistant at the royal adelaide hospital and around about that time
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flinders university medical school had started to look at bringing in lateral entry people in other words
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streaming towards the first graduate program in australia they brought people in previous degrees and so i talked to
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peter about it and said i think i'll apply for this he said so you should and i um interviewed with my
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previous honors supervisor which was interesting um and one of the good things
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well it was interesting because one of the questions asked by one of the other interviewers was going into orders it would have been expected you'd get a
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first class on as given your grade you've got a very good second class what do you think was the factor and part of me wanted to go ask him
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but what i said was to be able to do a first class on is you
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have to have a 100 dedication you need to be able to throw everything into it and i started honors with a
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five-month-old baby which meant there were times i perhaps couldn't put the effort in that might have been required
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i said and with those constraints i'm delighted with the grade i was able to
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get so i was accepted into second year i was given recognition of prior learning for
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first year and started at flinders uni in second year med
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and it was challenging i'd not studied at that level for quite some time but it felt
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like being a round peg in a round hole it felt right and having a little one
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also had its challenges were there any other mothers at medical school with you one
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and she had an older daughter the challenge for her is her older daughter had some disabilities
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i was the only one with a little one but what i found was the younger students many of whom were eight or nine
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years younger if i'd had to take a day off because andrew was unwell would be the first to come to me the following
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day with a set of notes or support and you know one of the best friendships
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that i have from that time and she remains my best friend was one of those students who would just come and say i
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noticed you weren't here so medical school had its challenges but
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i did well and then went into internship and was accepted into basic training
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took some time off again with a bad depression after my father died
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and then
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finished my basic training got my primary exam on my second attempt and uh
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went into what was then known as advanced surgical training and started down the pathway of general
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surgery with uh with the view of upper gastrointestinal no at the time my plan was still to do uh cardiac surgery
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because my ever since was that ever since you said my interest when you read that as a child
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uh and i thought that that would be where i would go um and i had uh done a
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term of cardiac surgery as a resident um but i was loving general surgery and
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i was at modbury hospital once sitting down with a colleague of mine who was an ent trainee
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and she said you're still intending to try apply for cardiac surgery i said oh yeah it's what i've always wanted to do
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and she looked at me and she said is that because you think it's the pinnacle and i said say what now and she
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said you think if you only climb k2 you're not good enough unless you've climbed
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everest and i looked at her and said get out of my head really
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and then thought about it and realized how happy i was doing general surgery the diversity of various things um i'd
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had good mentors and i really enjoyed it and i i think she was right that it was a question of
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setting a goal that you had to pick the hardest thing to do and back then it seemed like that was
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cardiac surgery i now know that's not the case anything you go into has its challenges but she read it and
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thinking about that i realized i loved general surgery um and that's why i
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remained in general surgery um and then moved to sydney after i'd completed my exam
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started an upper gi fellowship at westmead hospital oh right and
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they then asked me to stay on i thought they meant to another fellow year but they actually offered me a consultancy
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and i'd been doing transplant and upper gi at that time and i was really sorry to sound silly so
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what kind of transplants is that involved so westmead at that time was the only um
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what we used to call spk simultaneous uh pancreas and kidney transplant center
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so i would be on call 24 hours a day to go and do organ retrievals and then do the
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recipients afterwards as well as doing the upper gi on call
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i think were your shifts just never ending did you have a stint of what's the longest you've spent at a hospital i
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wonder a long time no numbers i remember a birthday yeah
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where um your birthday yes the day before we were contacted by
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darwin hospital to say that there was a very sad case of a woman who had a
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non-survivable brain injury not declarably brain dead her family were
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american and said that she would really really want to be an organ donor and
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that meant we were going to do what's known as donation after cardiac death or non-beating heart donation and they'd
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asked a couple of other hospitals who weren't able to coordinate it so they spoke to us and i had a full list on that particular
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day and then a full list with another consultant the following day so a full list
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like you have patients already blocked it's
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going to probably go past 5 p.m because it always takes longer than you expect and then you get this call and then we
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get this call and then i had a full list on the tuesday so um the
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we as the transplant team left for darwin uh about five o'clock
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and we got up there um set up to to do the the donation after
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cardiac death um had to wait to go into theater because there was a guy had been bitten by a crocodile that star went
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through that's darwin that's darwin for you probably a tourist indeed uh and then as we
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when we finished it was about 2 a.m the darwin people have very kindly bought me a birthday cake and we were sitting
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waiting while our transplant coordinator had gone to to make some calls and came back and
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said do you want the good news or the bad news and we said how about we get the
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bad news first because we've been joking knowing our luck we'll get one of the kidneys and have to keep working
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he said we've got one of the kidneys okay fine what's the good news
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it's for one of our staff members and they've been a staff member at westmead who had been very very sick and been on
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the waiting list for a long time and he had matched so we flew back then via cairns um
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and if i may tell a little anecdote of course cairns had lost all of its computer power so all the bookings and
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everything had gone offline so just get the geography so you're in darwin and then you've gone to top of queensland on
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your way to sydney to sydney because there were no direct flights at that time sure so we arrived in cairns to
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discover that everything was down and uh all the bookings had to be redone manually so i asked the airport manager
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if there was somebody that would leave somebody safe we could leave the donated organs and he said you can leave them in
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my office but don't forget them i said no we probably won't and we were then allowed to go into
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the qantas club in darwin airport sorry cairns airport to freshen up a little
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bit and eventually all the flights got rebooked again and we were walking towards the boarding gate um and bear in
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mind we've got two eskies with red crosses on the side and uh an american chap stopped us he
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had his wife and two small children with him and he said are those donated organs and
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we sort of said yes they are and he looked at his children and he said kids listen this is important
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somebody died they've donated their organs so that somebody else can live and that's very
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important then he thanked us and we were quite blown away at just how beautifully he put that and i have to
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say that as we carried the eskies on board the only comment we got from an australian was
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you don't have to bring your own forex down to sydney we sell it there
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so yes we then had police cars to take us back to westmead
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where upon we contributed to doing the actual recipient operation so
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they were a long few days but very rewarding wow how i mean were you getting any sleep or
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you're getting little naps oh i think those couple days no not a little does on the plane from cairns
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to sydney but then the adrenaline was pumped because we were met by the police to get us to westmead and uh in pecan
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traffic from the airport to westmead in just under 30 minutes wow that's a that's a big difference there
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yeah that pumped the adrenaline so that's probably good pre-op just get a little bit of absolutely better than a coughing so that was when you were
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working as a transplant surgeon and then you found your way into trauma surgery via the experience in
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afghanistan well actually so in terms of how i got into trauma surgery
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while i was at westmead i became good friends with the director of trauma there dr valerie malker and she was
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short staffed so i offered to help out and so for a period of time i was if you like the sort of acting deputy director
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at westmead and westmead as a major trauma center i was dealing with trauma both as the fellow and then also as a
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consultant when i was on call so working within the department gave me some insight into
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how you know how a trauma service runs the challenges except for working in an interdisciplinary team
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throughout my career i'd had an interest in the military my mother and father grew up during
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world war ii in in the uk so i grew up hearing stories about it dad was in the air
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force he left the air force before we came along and i'd always had an interest in
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possibly joining the military as a way to contribute to give back the public
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hospital system trained me gave me a career that would always sustain me and i felt that this would be a way of
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contributing and the right time came in 2006
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to think about going down that pathway i'd been thinking army because i had a
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colleague in adelaide who'd been sort of pressing that idea upon me but then i
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met a senior air force doctor and senior officer
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and thought that the air force might hold some appeal so i signed up
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in 2007 and went and did my reserve officer training course which was four
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days of learning how to put the uniform on properly and to march without falling down and is that harder than it seems uh yes
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it is it is particularly when the person in front of you starts to square gate and you find yourself doing the same
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thing and for those of you who don't know what square gating is normally when we walk and the opposite arm goes
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forward to the leg that's going back when you square gate the same arm of the same leg come
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forward and go back and it's they're like is it kind of like a traffic jam that if
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someone at the front messes up it just ripples back down the range the person in front of you square gates you find
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yourself doing the same and getting yourself out of it involves a little hop and a jump to switch legs
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so um i'd been back from that just on two weeks when i had a phone
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call from health services wing uh with the raft to say that they were planning
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a deployment and would i be interested and of course i said oh where are we going well we can't tell you that i see
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when are we going well we we can't tell you that well you better sign me up then
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i wish i saw that conversation i'm in yeah that put me in um and obviously
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eventually uh discovered that it was going to be to afghanistan uh i would
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actually be deploying with some folk that i knew through through the college and through doing mst
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and we did a training exercise in the netherlands because we were based with the dutch in taron cot
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and then um after some training um at ralph williamtown we were on our way in
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july of 2008 so i'd barely been in the air force um a
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year when that opportunity came up and obviously
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under war-like conditions you're going to see trauma that you you don't see in civilian practice it puts pressure on
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it's it's an austere environment i'd barely had my uniform on two or
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three times before leaving so there were those challenges coming from having a background of
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mental health i knew that that would be a challenge and thought that um that i had enough
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uh supports if you like to to get through that but it was we yeah we dealt with some fairly major trauma um i
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learned to um i guess be a little bit like macgyver to to deal with some of things we saw
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there were some considerable challenges um you know from a mental health perspective
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but when i look back on the experience now i also realize
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what i gained and you know i am able to look back on it in a more positive fashion
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i did come back with ptsd which i didn't recognize at the time because when i came back
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again that very negative self-talk of well you obviously weren't good enough and probably shouldn't have been there
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and those sorts of things i lost a seven-year-old on my table while i was operating and he he'd been
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shot and he he arrested and i wasn't able to get him back and it's a very deeply
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personal thing that still affects me even though everyone i've spoken to since said they'd have handled it in the same way
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we didn't have the ability to sit down and you know speak to a colleague as much because of
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operational security so you internalized a lot of it and and then you come back feeling
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inadequate and those sorts of things um and it took me a while to get through
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that but in the interim um i was offered uh a position at saint george just
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filling in as a trauma surgeon can i just ask with coming out of a ptsd kind
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of episode of your life or and sometimes it sits with you the rest of your life really and depressive depression can be
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an episodic thing like is it just time and space that gets you personally
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through it or if someone else like other medical professionals are kind of going through similar things like is there
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anything that like worked for you did you macgyver your way out of it kind of thing you know like i think it's a good
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way of putting it i think and the first few times i probably did macgyver my way out of it um
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distracting yourself yes well my way of distracting myself is to work harder and harder and pick up extra work and extra
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ships because um my way of dealing was it was to try and and run and keep in front of it
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and the way for me to do that was to work very hard that doesn't work because eventually i
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think your psyche says to your body right i've not been able to stop her so slam her into a wall for a period of
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time for me right um and then you do you you find you cannot keep working whether that's due to the fatigue which is a big
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factor for me not sleeping um that sense of self-doubt and and becoming um
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you know sensitive to any sort of conversations and eventually you just have to stop
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i also think that for a long time there was a sense of shame about having depression um there's a stigma around it
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it exists still i'd like to say i think it's getting better and i think it is
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but for a long time there was a sense that having depression meant i just wasn't tough enough
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and you know not remembering for instance that members of my family had had depression and therefore i was probably a sitter to to get it as well
28:03
so and it sounds like you um had kind of like perfectionistic traits you really wanted to do the best you could but your
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parents were just supportive did they put pressure on you to do really really well or were they it's an interesting thing i mean mum was
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always very supportive dad was a very silent fellow so if you know i would take in a good report card
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with you know maybe straight straight a's it would be well that's what we expect
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right and you'd go good that's great well i'm glad i met your expectations i wouldn't say there was pressure on per
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se but there certainly was an expectation for instance if i played up
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it would be we expect better from you um if i was yeah and that was at school as
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well um you know that uh if i was like any other child and talks in class rather than you know quiet now
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it was we expect better from you and therefore i expected better from myself um so the pressure was was two ways i
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think and so i know that with with the depression it was if you have depression it means you're
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just not good enough you're not tough enough you're not strong enough and so i would beat myself up with that
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and i think it wasn't until i was actually coming towards sitting my primary and i
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really had a major breakdown going into that that i finally sought help and i was
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very grateful it was actually the head of ed at flinders at the time who i reached out
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to when i found myself being very vulnerable and who just provided not just
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mentorship but friendship and and support and facilitated me recognizing that this was
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an illness and that i was sick yeah i wasn't weak or useless or things like that you'd
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never say that to someone with a broken leg right of course you've got to toughen up it's a broken bone that's a broken bone and and so in a sense um you
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know i had a a broken soul if you like and i won't say that you know starting
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to get help then didn't um prevent the negative self-talk um
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for quite some years i would again try and outrun it when i could feel it coming on
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and it took a long time to start to recognize that this is something i would probably live with for the rest of my
30:17
life and i had to learn to deal with it better and i also had to learn to talk about it i had to learn to speak to
30:24
medical students and junior doctors and colleagues and anyone else to say you know what
30:31
i have a 100 record of recovering from depression very few people have 100 pass rate in
30:37
things um and that managed appropriately if you had crohn's and you wanted to be
30:43
an engineer or you wanted to be a doctor you can do that if you manage it well if you've got diabetes you can be a really good doctor if you have depression and
30:50
you manage it well you can be a really good doctor and by learning to talk about it more
30:55
openly i became more accepting of myself it's so with people who have chronic
31:00
pain for example it's funny because sometimes we can't fix chronic pain but if you say if we if
31:06
we treat if we teach acceptance therapy i accept that this pain will be with me for the rest of my life the people who
31:11
accept it versus the people who can't get to terms with it have very different intensity of pain so having that
31:17
acceptance of of a horrible situation it builds that long-term management skill
31:24
and being an intern with your team um you know back when i was young a couple months ago like the the mental health
31:31
aspects of trauma surgery i wasn't expecting to be so intense but the way you spoke with patients and you know
31:37
sometimes the team would leave and you would stay back and be like look like this can play on your mind and so i started doing that as well i started
31:43
being like look at common and i've done it just in the community as well when someone the other day i was at um pre
31:49
when pre-omicron search i was at a party and someone had a bad motorbike accident and ripped his leg apart and um was at a
31:55
trauma center and not this one though and no one had talked to him about ptsd but
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i just brought it up i was like look that's a serious injury that that stuff can intrude in your in your sleep and
32:06
yes and he cried on the spot he was so close to he just needed to get it off his chest yes i had never met him before
32:13
and he was just you know this is a tough guy who motorbikes right and then the second he had this doorway open to him
32:19
he he went straight for i've been waiting for this door to open uh so i can talk about it and i mean so being
32:25
aware of it in trauma surgery just seems well so important that's a really good point because you know i said to you
32:31
when i was giving you feedback that i recognized the empathy that you showed right at the
32:38
outset and i think we all need to i i'm very mindful of the work by brene brown that
32:44
a lot of people would know about um i was first introduced to her work um by a social worker that i met the one and
32:50
only time i was ever hospitalized with my depression and she's a mental health worker trained
32:56
and and i started seeing her regularly and she asked me to read this book and i
33:01
thought it's going to be about building a campfire sitting around holding hands and singing kumbaya
33:06
and the book was called i thought it was just me and it isn't and it was basically a title for a book indeed a
33:13
very good title and brene brown uh is a clinical psychologist and she did her postdoc on shame in women
33:21
and as i was reading this book i kept looking around to see where the cameras were because it seemed she'd had a
33:26
camera and a microphone on my life and she made she distinguishes shane from guilt where
33:33
guilt is i've done something bad shame as i am bad and she focused
33:39
initially on women and then men said you know why haven't you looked at shame in men and she said i didn't know that men
33:44
felt the same way and since that time her work she's very approachable i've
33:50
seen her talk live she's wonderful but her work is approachable she's a qualitative researcher and she's written
33:56
a number of excellent books and some of the ones that again have resonated with me are daring greatly
34:02
one that um you know i was only even recommending to my son yesterday is called the gifts of imperfection and
34:08
i'll i'll muck up the subtitle but it's along the lines of how to give up being who we think we ought to be and be who
34:15
we are and she talks i'm going to try and find all these books and put them in the links below in
34:20
the description definitely and and um it's about saying you know you look at
34:26
other people you think oh my god the life is so perfect you don't know what's going on and you talked about being a
34:31
perfectionist again judith who is my mental health worker said to me once
34:37
have you ever met someone who was perfect i said no have you ever been somewhere perfect i
34:42
said well no she said then why have you spent most of your life trying to go somewhere that doesn't exist and be
34:48
someone that doesn't exist and i was a little taken aback and then i recognized what she meant yeah i feel
34:56
like that's actually so i'm interested in emergency medicine i feel like it's a very good uh characteristic to have an
35:01
emergency medicine because you will never have perfect care and emergency and health care in general is a is a
35:07
system of infinite demand and limited supply you put a billion dollars into health care today tomorrow you'll have
35:13
you'll need another billion to meet the new demands absolutely and yeah we can't ever do everything but um we just do our
35:18
best and uh it's it's pretty good on the international standard and i think you know
35:24
you make a point about um you know mental health and resources but the one resource that's
35:30
free and that we can always give is kindness and and i try and remind myself even
35:37
when i maybe i'm frustrated with the patient or you know frustrated with a colleague
35:42
that if i can take that breath and and as judith says to me respond rather than react and think okay that colleague's
35:49
been a bit sneaky that responded responding rather than reading that's a good one yes
35:55
maybe that colleagues had a really really bad day today and maybe i'm just that final person
36:00
making a request and if i snap maybe that will be the thing that brings them down so if i can
36:06
take a deep breath and say why don't we talk about this a bit later or you know we'll just take that offline
36:14
and if i can remain kind in my interactions and i'm not perfect don't get me wrong there are times that i will
36:21
react rather than respond but i think my my way of of
36:27
wanting in my life is just to say if i've been kind to that person then
36:32
that may be the one thing they remember and whether that's just sitting in that moment and listening
36:39
i read a study once that said the average amount of time that a doctor listens to a patient
36:44
before they interrupt is about 20 seconds oh gosh that's so true and surgeons are worse i bet yeah okay and i
36:51
had five emergency medicine doctors probably aren't great either probably similar um and i find myself thinking if
36:57
a patient is talking to me now just listen don't want to come in you know yes i might be pressed for time but it might
37:04
be in that moment like listening to your motorcycle colleague that that real
37:10
moment of contact that empathy comes out that permits that individual to talk about what's really concerning them
37:18
and so that kindness that being in the moment is how i try and teach people working with me as
37:24
well because if we can remember to be kind then i think a lot of the rest of it
37:30
will follow outstanding on a bit of a separate note it would be probably interesting for medical
37:36
students um or junior doctors listening to to know how to become a trauma surgeon so what is the pathway
37:42
so first of all um you need to undertake set training which is surgical
37:48
education okay so you've gone through med school you've done internships you've done done residency and so you
37:54
then uh you need to be in your pgy3 postgraduate year three before you can
38:00
apply for set training you can register with the royal australasian college of
38:05
surgeons and as a preset trainee and if you do that that gives you access to resources
38:12
like a portfolio called jdox which gives you an idea of some of the prerequisites for various training programs and gives
38:19
you is that an unaccredited registrar this pre-set training yes um so so that
38:24
is what we might call a pre-vocational trainee so you can register with them fairly early but you can't apply for set
38:30
training until the year of your postgraduate year three to apply for the following year
38:37
it's unusual for people to get in that early some individuals do it's
38:43
quite competitive once you have been accepted onto the
38:48
surgical education and training program the commonest pathway is probably through general surgery for people that
38:54
want to do trauma however i have colleagues who are vascular surgeons i thought it was only through general
39:01
surgery but you can go by other yes you can training programs so i have colleagues who are orthopedic surgeons
39:07
as well and then within general surgery you will have people that have different
39:12
specialties i've got two colleagues who are actually breast surgeons in australia being a full-time trauma
39:18
surgeon is unusual um we perhaps don't see the volume of trauma that they do elsewhere like south
39:24
africa and the united states so a lot of people which i guess is a good thing oh
39:30
i i i totally agree um so people may undertake perhaps like
39:36
i did originally upper gi um training but then they may be on the trauma roster within the trauma hospital
39:43
in which they're working and that's really important it's important to have you know different colleagues in different specialties
39:49
in terms of i guess in in some ways saying trauma surgeon there are some models now where important parts of the
39:57
team are in fact trauma physicians if you like so for a period of time we had an ed
40:03
physician who worked with us as part of the service the head of the service at the alfred
40:09
is an ed physician so people can come to trauma from different specialties um and
40:16
we've had an anesthetist working on the service and i think that again reflects their very
40:21
collegiate and interdisciplinary nature i've always found trauma is like an orchestra you know
40:27
you need the violinist you need the trumpeters you need all these different perspectives and really the the head of
40:32
trauma is a conductor um that has to do thorough economies occasionally
40:38
indeed and in actual fact the the trauma team leader shouldn't be hands-on at the
40:43
time of resuscitation that was a very interesting uh observation that i learned with you and you know we saw
40:50
thoracotomies people's chest being opened up i've seen you give kayak massage and this this horrendous this
40:55
these chaotic things with 10 20 people around patients and and sometimes you know you're at the
41:01
head of the bed and you're just you do this you do that for ctc sound like no to unstable you're you're you're a
41:07
conductor and and you know what this leads to i really and i think people would be interested so it leads well into the next question
41:13
which uh i'd love to know does anything scare you now
41:18
in the moment probably no um for the simple reason that
41:25
you get the pre-hospital notification and you might be thinking oh crikey that doesn't sound good
41:32
but that's part of the planning so um a lot of people say that trauma surgeons are adrenaline junkies that may
41:39
be true but i think what and trauma positions i think what we have the ability to do
41:45
is to listen to that pre-hospital information and go right that individual doesn't sound well and then to working with
41:52
colleagues work out how you're going to receive that patient what you need to do
41:58
what your colleagues need to do what the nursing staff need to do and to have a plan and part of that is that we
42:04
rehearse those things so we know what's expected and that can come from doing particular courses or to
42:11
working and i've worked very intensively now with um most of the staff specialists in ed and we know each other
42:20
and you get into a rhythm and so in that rhythm you certainly might be concerned for
42:25
your patient you might be thinking you know this patient's very very unwell
42:30
there's not a fear per se because you know what you need to do
42:36
and i think the most important thing and i learnt this after beating myself up about you know losing that little fellow
42:42
in afghanistan is regardless of the outcome if i and my colleagues can debrief with
42:49
each other afterwards and say to the best of our ability to the best of our knowledge and the
42:55
best of our skills we gave everything that we could that was world-class care what that person received yep they they
43:02
received our compassion our skills and our knowledge then you can say and you know you do go
43:09
home patients live with you in your head but you can go home and say
43:14
if that individual was going to survive they had every possible chance because we responded appropriately
43:22
so while there are certainly some things that will make me go right oh this is going to be a challenge
43:29
within that when you've got good people working with you and one thing i would say to any junior doctors listening is
43:36
get a mate get help for instance if i know i've got someone with a really bad liver injury i
43:44
call david morris you know david's ahead of the peritonetic i trained as an upper gi
43:50
hypothyroid surgeon but if i'm going to theater with a bad liver i want david there and i will say he's always there
43:57
so the point i'm making is don't think you have to do it by yourself and and as you come to team work it is
44:03
the teamwork and whether that's you seeing someone on the ward that worries you or being down an e.d
44:09
you say i'm going to need a hand with this and even if that's just because it means you can bounce ideas off each
44:14
other and that's where trauma is so good because you've got your senior ed colleague i'll i'll
44:20
have one of my colleagues with me or i'll be there for them and you know that you are then working
44:26
as part of that team and that's such an important point thank you mary so mary we actually got some questions from
44:32
people on the discord server which is how we kind of communicate and um i have two interesting but we've answered some
44:38
of them already but uh one of the ones i wanted to ask uh actually that naomi sent in um hi naomi thanks for sending
44:45
it through him um was what have you found to be the biggest challenge uh the kind of as as director of trauma during
44:52
the pandemic particularly like what what how does covert affect trauma surgery at the moment
44:58
i think the effect that covert has had um is on the stress that everybody's
45:03
feeling so um our ed colleagues have just worked above and beyond our icu colleagues as
45:10
well and so in the middle of having a completely packed emergency department
45:16
due to you know seriously ill covered cases to have a major trauma come in
45:21
um puts puts a challenge on and certainly i know that my team and i want
45:26
to make sure that we're responsive that we're down there we're sharing our part of the workload and i am amazed at how
45:33
the staff down there can suddenly step away from managing very sick covered patients and come on and be responsive
45:40
to managing trauma there are challenges in getting a patient into intensive care
45:47
so we have a rip fixation program here at st george as you will be aware and we
45:52
usually like to have those folk in the intensive care unit um at least overnight
45:58
and we've had cases delayed because there simply haven't been icu beds available having said that
46:04
however it's led us to slightly modify what we do and and with discussion with the nurse
46:11
unit manager actually take a couple of those slightly fitter patients back to the ward straight away which has worked
46:17
well so we've had to innovate i think that one of the big things the
46:23
effect that it's had and this has not just affected trauma though is the ability for relatives to come in and
46:28
see patients that's been very hard and it's hard for us because we recognize how stressed
46:35
that families are particularly with trauma which as i said changes someone's life in an instant
46:41
and i had an elderly fellow who came in with a terrible brain bleed and this is going back just over a month or so ago
46:49
and it was apparent he was not going to survive and trying to organize for family to be able to to come and and be
46:57
with him as he passed and i will say you know i rang the hospital executive and
47:03
pointed out the situation and and they were wonderful and the staff on the ward were wonderful that's great but i know
47:08
that that's been a challenge so one of the things that that we've brought in as a consequence is that every day or every
47:15
second day now i ensure that at the end of the ward round the team rings relatives we have a list of
47:22
names on the board of the people and the numbers and it might just be just updating you to let you know what's
47:27
happening with john or you know your mum's doing well um that's meant a lot to people and i i
47:33
wonder why i hadn't thought of it before to be perfectly frank so i think my feeling is that the ability to
47:41
um practice that humanity has been affected the you know that that sense of comfort
47:47
of being able to put a hand on someone's shoulder or give a relative a hug or just hold someone
47:54
when you're masked up with somebody as well i think it's difficult to convey emotions and i think that humanity is so
48:00
important in what we do and i think that's been restricted by the pandemic
48:07
i agree and i find like it's it's been really useful as an intern to do these family phone updates um i feel like a
48:14
lot of doctors are worried that maybe that the calls will last too long but people are very uh sensible like people
48:20
are just grateful to be getting an update a lot of the time and they're mindful of your time yeah exactly they say oh thank you i know how busy you are
48:26
i really appreciate the time and then it makes you feel good as well you're connecting to the bigger
48:31
situation i think we're going to leave it there mary um for the only reason that everything's
48:36
running out of data out of space all the cameras have run out of space but thank you so much uh for being so open
48:43
vulnerable honest uh you're an incredible role model and director of trauma and i wish you all the best i
48:48
hope we can do this again um and uh yeah no thanks everyone for joining in um if you want to support the
48:55
channel leave the video a like and uh leave if you've been until now leave a comment of a stethoscope that i'll know
49:02
who stayed till the end thank you privilege bye for now