I love surgeons. I think they are amongst the most awesome people on the planet. Frankly, I would be dead without them.
So it was without hesitation that I accepted an invitation to, in effect, become an exam question by attending a Fellowship of the Royal College of Surgeons (FRCS) examination day so candidates could have their knowledge, professionalism and skills tested with a real patient.
A serial surgical neurofibromatosis patient
Some of my earliest memories are of being in hospitals, as a surgical inpatient and as an outpatient to review the last admission or plan for the next. This has continued throughout my life. Medical and surgical students have been ever present. And often the consultant tells them something like “Pay attention ‒ you might not get to see this very often.”
I was born with a condition called type one neurofibromatosis (NF1). It causes ‒ usually benign ‒ tumours called neurofibromas to grow on nerve sheaths amongst many other potential symptoms. NF1 led to me needing multiple surgical procedures on both legs from the first year of my life up to the age of 13 to treat a rare complication.
I still have a left leg because of the persistence of the surgeons involved. Later in life, in my 20s and 30s, I had numerous neurofibromas removed, mostly for cosmetic reasons but with a definite positive impact on my confidence and self-image.
Lifesaving operations
At 36, I developed a large tumour that became malignant. Over the following two years I had surgery four times to remove the primary tumour and local recurrences. This included having my left arm, shoulder and a number of ribs amputated. These procedures were quite literally lifesaving. Four years later a prosthetic rib plate ‒ inserted after the amputation ‒ became infected, introducing a significant risk of sepsis. The solution was again surgical and again lifesaving.
Last summer I had an unplanned hip replacement following a fracture; the subsequently diagnosed osteoporosis is a known increased risk for those with NF1. It was during a consultation following this surgery that I was invited to take part in the exam day.
Trainee surgeons’ exam day planning
A taxi was sent to pick me up on the day. Patients were being greeted like royalty at the entrance to the medical school and escorted to the area where candidates would be put on the spot. I don’t think I’ve ever been thanked so effusively, so many times within a ten-minute period than after arriving at that entrance.
The day was organised with great precision. It was a huge event, with dozens of patients, over a hundred candidates, and many more examiners, some themselves in training for the examiner role. One section was allocated for upper limb cases and another for lower limb and spine. I was in the upper limb section, but in my case lower limbs and spine were in play too.
Several groups of examiners familiarised themselves with my case before they introduced candidates, who had 15 minutes to take a history, give the examiners a summary, then do a physical examination and give a further summary. Consultations were strictly timed, beginning and ending at the sound of a bell.
If candidates hadn’t concluded at the end of the 15 minutes they had to leave, even if in mid-flow. I could imagine them having nightmares featuring that bell sounding in the days that followed.
Future surgeon heroes
I saw around 10 candidates over the course of the day. Their nerves were palpable, but they were personable, showed great humanity under stress, and largely got to grips with my complex history impressively well, given the rarity of my condition and the even more unusual complications I have experienced. Indeed, some of the examiners said they had learned more about NF1 during the day.
Amongst the candidates there will, I’m sure, be surgeon heroes of the future. Given the unpredictable nature of my condition they may even be fixing me someday. If they do, I am sure the love, respect and outright awe I feel for surgeons will be boosted once more.
If you, or someone you know is affected by nerve tumours and needs support, please contact Nerve Tumours UK.
CLICK HERE TO DONATE TO OUR CROWDFUNDER
HELP US BECOME STRONGER SO THAT WE CAN CONTINUE TO DELIVER POWERFUL CITIZEN JOURNALISM!
