“Piss off! Don’t give me the shit!”

“Piss off! Don’t give me the shit! What are you waiting for? Just piss off! Get out of here.”

With that clear, unambiguous directive from Dr J.G, the student (let’s call him CN) stood up from his seat and walked out of the lecture theater.

I watched CN’s retreating back with deep-seated regret and profound sympathy.

That student could have been me.

It could have been ANYONE OF US.

Any medical student who is doing a surgical rotation, exhausted from the constant rush and the lack-of-sleep, could have fallen asleep during a lecture. And to be given a highly offensive remark such as “Piss off! Don’t give me the shit!” in front of a whole lecture theater full of the student’s colleagues, just because the student happens to fall asleep, is HARSH!!

But then, what do you expect from an arrogant surgeon, all too conscious of his intelligence, competence and authority, thus thinking he could embarrass anyone he likes whenever he is displeased?

Well I guess, I expect kindness. I expect the surgeon to display a sense of empathy and understanding that this could have been the first time CN had fallen asleep in a lecture. It could have been one of the student’s bad days. As a lecturer, you should only be annoyed if a student makes noise that interrupt other students and the lecture itself. If a student is quietly falling asleep, then why would you be so rude as to throw him out of the lecture hall with a very degrading, really humiliating and highly offensive remarks like that??

To me, there’s no reason to be offensive in that particular situation. If you want to scold the student, that’s fine. But what is it with the swearing and the cursing and the public humiliation?

***

What would I do if I were CN?

Well, I too will walk out of the lecture theater…but with a parting word that goes something like this, “Fine, I don’t want to be here, too.  Your voice grates my nerve endings.”  And then I will report him to the administration.  (I am famous with my propensity to complain. And my eloquence at voicing it. I had complained to  the Accommodation Administration last year about the attitude of my housemates who brought male strangers into our shared accommodation. When I was in my second year, I’d complained to International Student Support about the medical faculty, for which a special meeting was held. I have kind of gotten used to lodging a written complaint when I have some unresolved dissatisfaction about stuff. hahahha)

There is NOTHING I hate more than being subjected to UNFAIR PUBLIC HUMILIATION, unnecessarily.

If you are quick, you will immedicately think, is there a FAIR one? Or a NECESSARY one? (of course there is, or I wouldn’t have asked.) 

If you are a medical student, you will know how embarrassed you can get JUST for not being able to answer what is supposedly a simple question from your lecturer. You will know how publicly humiliating not to be able to present a case well. You will know how painfully, excruciatingly degrading when you feel like you have badly screwed up.

But those are necessary humiliation that you go through as part of the learning process. That kind of humiliation is a fair one because in all those circumstances, NONE of the doctors had looked at the students with contempt and say “How fucking stupid you are. Your head is full of shit, it does not have any room for real knowledge!” Now, if they did say that, then it would be an UNFAIR humiliation and an unnecessary one.

You can scold the student,  you can say “Go back and read up”, or you can even just roll your eyes the way Dr. Chen usually did when I did not know the answer…but DO NOT use offensive language and DO NOT make your contempt public!

A doctor can humiliate a student who had just finished answering a question simply by asking him/her, “What year are you in?” (implying that the student’s answers is not good enough for a 4th year medical student).  So if you want to teach the student a lesson you don’t need any public humiliation or swear words. You don’t need it!

A simple question like “what year are you in?” or “what medical book did you use?” would have been enough, and the student would learn the lesson straight away! Why be offensive when the same message can be sent across in a sarcastic (but at least kinder) way?

So, asking a student “What year are you in” or “Where did you get that very interesting answer?” or just with a raised eyebrow…those are fair humiliation. I would accept that kind of humiliation any given time. Yes, I would feel down and I would feel stupid, but I will work harder.  Sure, I would fear all future encounters with the surgeon, but I would not hate him.

 But when you start saying “What FUCKING year are you in?” or ” What kind of shitty answer is that?” …..you see, just adding the two words (fuck and shit), makes the whole humiliation so much more damagingly hurtful, especially when it is public! Sure, if the student is rational, he would not kill himself. (don’t laugh! Rate of suicide is highest among medical professionals.) If the student is rational, he would improve and improve and work harder. But he would hate the surgeon for the rest of his life.

Why make people hate you when you don’t have to? If your intention is sincere, and the reason you are really angry that a student has fallen asleep during your lecture is because you care about the student’s learning process, then you could achieve your noble intention just by saying, “CN, if I catch you falling asleep again in my lecture, I want you to walk out of this lecture theater, you got that?”.

To me, that is still quite harsh, but it is still within the range of acceptance. I certainly could accept that and would say, “yeah, fair enough.”

If you really, truly care about your student’s learning progress, you would do what any decent teacher would do; give him a scare. “CN, I am going to ask the next question to you. So, you better wake up”.

But when you PUBLICLY HUMILIATE a student with a string of curses and swear words and then you throw him out of the lecture theater, deliberately embarrassing him in front of other students (who would be his future colleagues) ….you don’t really care, do you? You just want to vent your anger and show off your authority and your power to your subordinates!

I HATE THAT in surgeons!

***

That’s why it has been said that “To know the true measure of a man’s kindness is to look at how he treat someone below him, someone who could not give him any benefits.”

Because it’s not surprising that you can treat your superiors kindly, because your career would depend on them liking you. It’s not surprising that you would treat your colleagues kindly, because you have to work with them day in and day out. But you have no reason to treat those below you nicely, unless it truly is your nature to treat EVERYBODY with the same kind of respect and dignity that you would give to any human being.

***

I have heard many other horror stories about Dr. JG; how he snapped at his scrub nurse. How he’d shouted “FUCK!” during one operation because something did not happen according to plans. How he used to be so abrupt and rude to his students. But until the incident with CN in the lecture theater, I did not really care one way or another, I was just glad that I did not get him as a supervisor.

But after that incident, I just really, truly dislike that man!

Oh yes, there was no doubt as to his competency, his brilliance and his authority in the surgical field. He is, in every surgical matter, a highly competent and experienced surgeon. But that’s not enough for a person to be likeable. Because when you are a PERSON, it makes sense that what counts most would be your PERSONALITY.

***

An autobiography of a surgeon: I recommend this book to all medical students.

I am sure everyone was born nice. Especially if you choose to become a health professional, you must at least have basic human kindness. And a surgeon is just like any other human being when they first started med school.

But then a surgeon (especially the old school one) may not have retained their kindness by the time they have finished their gruelling, humiliating, competitive training.

I recommend every medical student who is doing a surgical rotation to read this book, authored by Mohamed Khadra, a Urology Surgeon.

After having read the book, I understood why a sugeon who were trained 40 or 50 years ago would turn out to be a cynical jackass. In a way, I pity them. But ONLY in a way. Huhuhu.

Below is, an excerpt from this very entertaining but realistic book about the life of a surgeon. All the sweat, the pain and the humiliation they had to go through in order to become a surgeon. It is not a wonder why some of them never regained the compassion that they have lost during their training years.

Making The Cut: An Excerpt

For centuries, surgeons had been taught by fear and humiliation. The assumption was that you needed to learn by having your fear centres stimulated. Humiliation taught you to respect the adverse outsomes that are possible despite the best intentions and efforts, the unexpected deaths, the complication that you are blamed for where negligence played no part. The humiliation taught you about life’s unexpected end, and it was meant to give the trainee the realisation that every operation could very well end in disaster. The sooner you learned this lesson, the sooner you coud progress as a competent surgeon.

This process of training is a Darwinian method to ensure that ONLY THOSE WHO COULD COPE with the pressure of surgery survived. There is nothing on Earth worse than a weak, indecisive surgeon, and lying in wait to weed out the weak and the undesirable were 5 years of medical school, three years of basic training, then four years on the surgical training scheme – more on-the-job fear and humiliation than most humans will ever have to endure.

You cannot learn until you accept your own ignorance. I came out of medical school with an arrogance about my position and ‘title’ as a ‘doctor’, having passed final year at the top of the heap, as I had in the final year of high school and in the final year of primary school. As an intern, I now find myself at the bottom of a very large heap.

Tu pasallah orang selalu cakap surgeon ni ‘attitudish’. That’s why people always associate words like ‘impatience’, ‘snappish’, ‘hard-to-please’, ‘temperamental’ and so on with surgeons. Because they all were trained by their seniors in that manner too. And this is the only way they knew to educate and treat others.

Of course there are other positive good words associated with surgeons too. Words like ‘brilliant’, ‘competent’, ‘skillfull’, ‘confident’….these are all true descriptions; everyone would agree that it’s not easy to become a surgeon and they deserve every single praise sung in their honor. The training is too long and by the time they reach the level of skill needed in order to perform an operation unsupervised, they may have forgotten some stuff…

Could they have forgotten how it feels like to be a student and is always unsure of what to do and what to say? Could they have forgotten how it feels to always wonder whether or not their question is too stupid to be asked? Could they have forgotten that a student will never truly know anything, until the student has become responsible for the patients during his/her intern years? A student is just a  student, is just a student!

I find it hard to believe that anyone could ever forget how it feels like to be a student. I knew I would not, even if I have reached the highest level of my medical achievement. I would  ALWAYS remember the constant self-doubt, the panic, and the fight-or-flight reaction during ward rounds, the anxiety during clinical sessions with doctors you have only met that day.

However, when I think about it, I have certainly lost some of my sensitivities. When I was in my first year, I would avoid talking to cancer patients, because I don’t want to deal with the thought of death and the emotion associated with it. But now, I see cancer patients everyday, and I feel nothing. This patient is someone’s mother or someone’s sister…and I feel nothing. When Dr. Chen said “this patient would probably die today,” my mind just go “oh, okay. That’s sad.” but I moved on to the next patient easily enough.

I have done so many hernia examination, I am no longer embarrassed about asking my male patient to lower down their pants so that I can examine their scrotum for any possible hernia.  In fact, instead of asking their permission, sometimes I just go “All right, I am going to lower down your pants now to examine for hernia.”

Sometimes I forgot that people don’t talk about bowel changes and the different types of stools that exist, when they are eating their meals.

I have changed too along with my medical training…but I hope I will always remember to preserve my student’s dignity and self-worth.

There’s no excuse for being rude and offensive.