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Speak, But Don’t Tell The Truth

I thought of not telling this story at all. Recently when it was in the news here it seemed wise to rather bury it altogether. But it is something I experienced and, after all, this blog is about my experiences, so…

Six years in a department gives you enough time to do a few things that can be legendary (like this story). This was one that most at the time thought was one. However, at the time it impacted me on a different level.

The surgery department had a fairly intensive academic session every Tuesday. The highlight was a discussion delivered by one of the registrars on some or other topic. He was required to reference the absolutely newest literature and the standard was very high. It was a big deal. Most guys spent a few months putting their talks together.

On the day in question the discussion was going to be about bariatric surgery (surgery to help obese patients lose weight). What was interesting was that the consultant (a private guy with a part time post at the university) who was designated to be the moderator of the talk was a surgeon whose practise consisted of quite a lot of small bowel bypasses. Now the literature was extremely condemning of this particular operation. At the time I was rotating with the laparoscopic guru who did a fair number of gastric bypasses (an operation which the literature favoured for obesity). In passing I mentioned to the boss that it would have been more fitting if my senior had been designated the moderator of this particular discussion for obvious reasons. The boss seemed to give it some thought.

The day before the discussion the boss took me aside. He told me that he thought I was in a good position to make a comment about the gastric bypass operation verses the small bowel bypass operation because I was the one registrar at the time who had been involved in the favoured operation. He then basically instructed me to comment during the discussion. The command had been given. What could I do but obey? That night I reviewed the literature.

During the talk the registrar dedicated very little time to the small bowel bypass. He simply stated that it was an operation that has been relegated to the history books due to its dangers and the fact that there were better operations available. His moderator didn’t flinch. I noted that he didn’t add that the literature also stated it was unethical to even do that operation. On the whole, his talk was good. Then came time for questions and comments. He fielded most questions quite well. Finally the room fell silent. I stood up. I had been instructed to do so.

I started by mentioning the literature was more condemning of the small bowel bypass than the registrar had stated. And yes, I did use the word unethical. I then went on to explain that a gastric bypass causes a change in lifestyle because the patients can no longer eat so much and that their sugar intake is also curtailed whereas the small bowel bypass causes exactly the opposite. Because it causes a malabsorption the patient has to make sure he eats just as much if not more just to maintain baseline health. My choice of words could have been better.

“With this operation you are actually giving the message to the patient, you are a pig and now you must really eat like a pig.”

All the registrars squirmed in their seats. They seemed to be trying to quietly slip under their respective tables to avoid the accusing eyes of all the professors and consultants. They needn’t have bothered. Even the consultants could not maintain eye contact with me. They looked around uneasily. Only the moderator maintained his steady gaze directly at me. I remember thinking I’m quite glad that looks can in fact not kill. Otherwise I’m sure I would have gone up in a puff of smoke. My task was done. I sat down.

One of my colleagues leaned over.

“What have you done?” he asked. “Are you completely mad? Do you realise these are the guys that are going to be in your final exam in just a few short months?” I looked around. The registrars whose heads still protruded enough from behind their desks to be visible seemed to all be shaking said heads slowly. The room was absolutely dead quiet. I held my head high and gazed forward. But I also started hoping that the meeting would adjourn so that I could flee. Although looks couldn’t kill as I had just demonstrated maybe they could maim to within an inch of life and I wasn’t willing to find out.

The next morning meeting went as morning meetings go. But just before the prof dismissed everyone he turned to me.

“Bongi, you stay behind!” Again the heads of all the registrars shook almost imperceptibly. Sh!t!! I thought.

“Bongi, Dr. D took me to his practise yesterday. There are fat people that he is trying to help.” I considered saying that help and exploit can sometimes easily be confused with one another, but I thought better of it.

“Never again will you or for that matter anyone in my department speak badly about or against any one of my consultants, in public or in private.” Again the thought went through my mind that I should defend myself and say that the literature backed me up with everything that I had said. I also considered pointing out that he himself had instructed me to speak and I’d just assumed he wanted me to tell the truth. Fortunately I remembered something about the better part of valour and that I could not win this fight. Even though it was a setup, I had hurt one of the good old boys and they would stand together, right or wrong. All I could do was hold my head high and once again prove, this time unfortunately, that looks can’t kill.

*This blog post was originally published at other things amanzi*

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