Humans of Surgery

The core surgical trainee interview course was excellent and beneficial. It was run by current trainees for aspirant trainees which really helped to provide relevant insight. The feedback provided was very useful and all for a small nominal attendance fee!

I have been an affiliated member of the RCS since I was a medical student; it helped me enormously with surgical skills training, interview preparation as well as preparing for the MRCS exam. It also provides me with a platform to engage with fellow surgical trainees as well as the public. An example of this was speaking in the RCS webinar series on how to write surgical papers. This opportunity not only allowed me to engage with the surgical community but it provided me the chance to understand a more in depth approach to surgery from hearing different perspectives. I found this type of learning to be truly invaluable. Other examples are public engagement activities such as career events with 6^th form students from local schools, and ‘Surgical Speed-Meets’ which gave members of the public a chance to interact 1:1 with surgeons, to humanise and de-mystify surgical practice. 

It is no secret that surgery is a challenging career. I think what has been valuable to me was to have a number of individuals who have been kind enough to mentor me along my career. I cannot overstress the importance of finding mentors, whom you admire and identify with, and who are willing to take an overall view of your career and offer impartial support. They have helped to guide me through the various stages of my career and not least offer inspiration when the going gets tough, and who have also been there to share my joy of success.

Being an RCS member has allowed me to develop my research interest in 3D bioprinting. I was able to attend a course in Utrecht University on a Norman Capener Travelling Fellowship, and therefore focus my PhD in this field through an RCS Research Fellowship and postdoctoral studies at Harvard University on an RCS Fulbright Scholarship.

It has also been invaluable for my clinical career. I was able to attend the RCS Intermediate Skills in plastic surgery courses prior to starting specialist training, thanks to the Needlemaker’s Educational Bursaries. The Ethicon Travelling Fellowship allowed me to visit Australia to learn new surgical techniques, further augmenting my clinical experiences.

The RCS Research Fellowship provided salary and consumable support during the early stages of my research on 3D bioprinting of facial cartilage and allowed me to gain enough laboratory experience and preliminary data to be in a position to apply for an MRC Clinical Research Training Fellowship, which funded the rest of my PhD. This, together with the opportunity to present my work internationally through a variety of RCS travelling fellowships have acted as a springboard to an RCS Fulbright Scholarship, to work on biomimetic tissue engineering research at Harvard University. 

The RCS offers bursaries, fellowships and grants for every stage of training. So keep an eye on deadlines and apply for things even if you think you might not get them, you just never know!

One of the most rewarding aspects of being an RCS member is how the RCS encourages engagement from trainees. Participating in discussions on Twitter and publishing articles and letters to the editor in the Bulletin have allowed my voice as a trainee to be heard on matters I care deeply about, particularly with respect to diversity and inclusion.

The Royal College has been an invaluable resource in my training since I first joined as an affiliate member during my foundation training. During my core surgical training in London, I attended regular teaching sessions at the College, as well as the fantastic MRCS preparation course. I have also attended many practical skills courses including the laparoscopic skills course. Access to the RCS Annals, Bulletin, newsletters, and political updates have allowed me to stay informed about current events and issues affecting the surgical community.

During my academic pursuits, I make regular use of the RCS library and its online access to surgical journals. I first joined the Women in Surgery (WinS) forum early during my higher surgical training, and have enjoyed attending WinS meetings, and engaging with the WinS community online. These are wonderful opportunities to network and to be inspired by senior surgical colleagues, as well as to discuss and promote important topics that affect diversity and representation in the surgical profession.

Remember that life is about the journey, not the destination. Working hard is a vital part of surgical training, but that does not have to come at the expense of enjoying your life along the way.

My interest in surgery was prompted after attending the RCS Anatomy Summer School as an affiliate member in my 2^nd year at medical school. Over the course of five days, we received teaching from eminent clinicians who marvelled us with their accounts exemplifying the extraordinary breadth and depth of surgery. Since then, being an RCS member has allowed me access to a multitude of practical courses (BSS, ATLS, CCRISP) that were tailored for each stage of my training and supported by excellent faculty.

The scope of RCS education bursaries is unparalleled in allowing members to pursue specialist courses in their area of interest. I was fortunate enough to secure the Needlemakers Award to attend the Speciality Skills in Emergency Surgery and Trauma course which would not have been covered by my mandatory study budget. Finally, with regular developments in surgery, staying up to date is key and this is facilitated by the RCS providing access to a vast collection of e-journals and online resources.

As one of my mentors often says - “Not all surgical learning takes place inside an operating theatre.” Time spent on-call and in clinic helps to improve clinical acumen and allows for improved decision making as we progress through our surgical training.

I remember the exact moment I decided to pursue a career as a cleft surgeon: I was 21, studying medicine at Oxford University and assisting in the theatre of an eminent cleft surgeon. As I observed him meticulously restore the facial anatomy of a baby born with a cleft lip, I contended with the complex aesthetic, functional and psychological consequences of re-establishing facial integrity and knew that this was the varied impact I wished to achieve in my career. Not long afterwards, I undertook my elective placement in South America with a charity mission specialising in cleft lip and palate. I felt a tangible energy and unified sense of purpose from the nationally-diverse, multidisciplinary team that would see me participating in such missions on an annual basis throughout my training. With each mission, my experiences remained permanently imprinted by the humbling resilience of patients and by the bonds that transform strangers into lifelong colleagues.

As a surgical trainee, I had to decide which specialty to pursue in order to train in cleft surgery. After an inspiring post in oral and maxillofacial surgery (OMFS), I determined that OMFS was the route for me given its breadth of training focussed on the face. I then became enrolled in the first cohort of the Dental Programme for Medical Graduates at King’s College London, during which I gained a comprehensive understanding of the relationship between intraoral and extraoral pathology. I subsequently gained a place on the Pan Thames higher specialist OMFS training scheme and was actively encouraged to cultivate my academic aspirations. After being mentored by another cleft surgeon who taught me to question seemingly established cleft surgical practices, I started a clinical PhD under his supervision midway through higher surgical training. This research was generously supported by both the RCS Surgical Research Fellowship and the RCS Dental Research fellowship – and logistically – by my Training Programme Director when I proceeded to have three daughters in the space of four years! 

The significant challenges I have faced in combining motherhood, surgery and academia have developed my resilience and resourcefulness over the years Through shared experiences, I have benefitted immensely from the supportive networks of Women in Surgery (WinS) and the Society for Women in Maxillofacial Surgery (SWiMS). Only now as I write up my PhD thesis as a senior trainee am I able to appreciate fully that optimal work–life balance is a work in progress. Moreover, I have learned that surgical training need not be a direct journey, but one that you can adapt to your personal and professional goals – whilst still maintaining your destination.

I was interested in neurosurgery as a medical student. One day, I pitched up to the theatre at Addenbrooke’s Hospital in Cambridge and told them I would like to know more about the specialty. Before I knew it, I was observing treatment of an aneurysm, which is an out-pouching of a blood vessel in the brain. The surgeon was planning to place a metal clip across the neck of it to prevent it from bleeding again. The excitement, the high-risk nature and the immediacy of the task ahead had me hooked.

That was the beginning of my career, when I decided neurosurgery was my specialty of choice. As a medical student, I tried to align my CV and experience with neurosurgery so that I could improve my chances at national selection. If I were to start my career all over again, I would try and get as much exposure to as many different specialties as possible. That way, you can find the one that best suits your skills and personality and begin to align yourself to achieving the factors that you need.

As I progressed through my training, I learnt more about how technology is integral to modern surgery and I realised how interested I was in these advances. I wanted to marry that interest with my passion for robotics, to discover whether they could make a significant impact to a patient’s treatment. My work has now included translation of software for computer–assisted planning, helping us to calculate the safest trajectory when targeting different locations in the brain. This software enables us to treat patients with conditions like epilepsy more safely and much more quickly. It’s a very good feeling to know that these technological developments are ultimately improving patient care.

I’ve come to realise through my work that advancements in surgery don’t just come from medics, and it’s not all about blood and gore. I hear people say, ‘how could you operate on someone’s brain, aren’t you scared of damaging them?’ And I say, ‘surgery isn’t like what it was 50 years ago, it is much more refined’. We can now do complicated things in a minimally invasive fashion. Students can bring different degrees and skills into medicine to help diversify the specialty and improve our understanding. Surgeons couldn’t make these advances without collaborating with specialists like engineers and other scientists. We have to work together with a broad range of professionals in order to improve care. It used to concern me when I was a student that surgery could make people worse. Now I know, surgery can have complications and things can go wrong, but the aim is to do your best to alleviate pain and suffering.

As a consultant paediatric surgeon, I am part of a big children’s service (we refer to ourselves as a family) at Imperial College NHS Trust looking after infants, children and teenagers. My work is sometimes very straightforward, such as a curative pyloromyotomy operation in a baby with pyloric stenosis (when the muscle that opens and closes to allow food to pass through the stomach becomes enlarged and begins to block food). 

More often, it is complicated and complex, caring for chronic incurable conditions. For these patients there is often no right or wrong plan, and you just find what works best for that individual. But you do this as part of a team, forming tight relationships with the family you are caring for. There isn’t just one patient – the parents and siblings are every bit as important.

Every day as a team we make decisions, which are never black and white. You never hear about that at medical school or in textbooks, and the uncertainty is sometimes difficult to reconcile – as a profession aren’t we supposed to know what is best? But that honesty and investment creates a therapeutic relationship with families, which is at the heart of good care.

Some days I think I am good at my job and other days that I am not good enough. That is part of being a surgeon. I don’t really have strong memories of successful operations, but I always remember the name of every baby and child who I have looked after who died. They stay with me forever.

I love my job for all its imperfections, for the friends and colleagues I work with, but most of all for the little people whom I get to look after on a daily basis. It is a privilege to be a consultant surgeon, and it is our responsibility to drive our practice to a patient-centred NHS.

My father had a renal transplant when I was 12 and I was able to witness what a transformation surgery could make to the lives of our whole family. This is when the first seeds of pursuing a career in surgery were planted. I gained as much exposure to medicine and surgery as possible while at school through work experience, volunteering in hospitals and researching relevant literature. Throughout medical school and during my junior doctor placements it was clear that surgery was the specialty for me. I was excited and scared by it all at the same time. Fortunately, I had the right mentorship and support along the way which has led me to where I am today, an ST5 surgical registrar, pursuing a PhD at Imperial College under the guidance of Professor Ara Darzi. 

It is fairly common that surgical trainees pursue a further degree such as an MD or PhD. Surgery is always adapting and evolving with much of this occurring through the latest research and technologies. Breaking huge research questions into bite sized pieces is often the way forward. A typical day for a research fellow can be varied, including teaching, recruiting patients into trials, laboratory based work, studying and balancing clinical commitments too. What is great about surgery is that every day is different. The days can be long, recruiting patients for studies in the day and on–call clinical commitments at night. However, knowing that we are contributing even a small amount can be incredibly rewarding. 

My advice for anyone wishing to pursue surgery is to spend as much time as possible shadowing, observing and following surgeons to understand what the specialty is really about. As a doctor it is important to take time with your patients – those extra few minutes can make all the difference to an individual and their family.

Surgery will require dedication. The hours are long and it can be both physically and emotionally draining. I have found keeping in touch with peers, trainers and mentors really useful as they can be a great sounding board when facing challenges as well as a source of inspiration.  

I feel privileged to be a surgeon. It was not until the late 19th century that women were allowed into medical school. Today, more than 50% of medical students are female.  I find surgery to be hugely rewarding, fulfilling and incredibly enjoyable. The key for any chosen specialty is that one must enjoy it. I love being part of a bigger team with the common goal of helping patients. What inspires me? My patients, peers, lifelong learning, pioneering research opportunities and meeting incredible mentors along the way.

On 22 March 2017, a terrorist mounted the pavement of Westminster Bridge, hitting a number of pedestrians before making it on foot to the Houses of Parliament. More than 50 people were injured and six people killed that day, including the terrorist. Three miles away, Morgan McMonagle was the trauma consultant on call at St Mary’s Hospital, the receiving hospital for the incident.

It was a very quiet day. I was sitting on the trauma ward writing another chapter for my trauma book, Trauma: Code Red, when I noticed the BBC news alert on my phone. Within two minutes we had received the call confirming a major incident in central London. Downstairs in A&E, there was the same controlled confusion that often arises when a major incident may be declared. Minutes can often feel like hours. When we finally heard there had been a terrorist attack, we didn’t know much more. Within 40 minutes we had 8 casualties and numerous armed police in the hospital.

We are always prepared for any major trauma, as we have a well-tuned trauma response team in addition to mass casualty preparedness programmes – but you can never feel totally prepared for an event filled with unknowns. An attack like this is different to a typical major trauma and that feeling of the unknown creeps in. We didn’t know if another attack was planned, the potential numbers of those injured or if others were coordinating.

As with any major incident, there is a fight or flight response, but this is controlled when professionally trained. The adrenaline kicks in, and whether the casualty is the attacker or not, I am ethically obliged to treat. On this day, however, the attacker was brought in among the injured and I pronounced him dead almost immediately. There wasn’t much time to consider this further, as five bays were now taken by severely injured casualties and the teams caring for them. Those who needed surgery were taken upstairs to theatre so we could operate immediately and time began to move very quickly.

Returning home after a day in trauma is a bit like coming out of a major rock concert. You’re running on adrenaline for a number of hours and suddenly the curtain is drawn. Then there is this period of overwhelming fatigue. When you’re feeling that emotional slump, as I did with Grenfell, when there was so little I could do for so many, there is nothing more important than the support of your peers. Your family and friends do support you, but an important part of the healing process is the shared experience you have with your colleagues. You need to maintain your comradery when you are in battlefields like this. Even when there is only one victim. It also makes you more prepared to deal with a major incident. 

When you look back, do you have that sense of achievement that you did your best? If the answer to that is yes, you can allow yourself a comfort in that. We worked together to the best of our ability, to deliver the best care, and that is all that we can do.

My advice for any trainee surgeon is to get broad experience across all areas of surgery, including elective operating, as well as trauma and emergency surgery. Then, when you do experience tragedies like this, whether you are a foundation doctor or trainee, you have a wide range of experience to call upon. As you progress in your career, handling major incidents like this becomes easier. The difference between an amateur and a professional is that a professional will make judgements based on training and experience rather than emotion. They will be guided by their experience and skills. We still have empathy and a personal opinion, but it will be contained, and should not interfere with best practice. We do our duty as the surgeon. 

Networking is also important throughout your training, and building rapport with patients and colleagues alike. Through my networks I was able to call a surgeon friend in Utah ahead of one of the Westminster Attack victims returning home. I had trained with him in trauma in Philadelphia, and this connection meant that I could call him directly ahead of time to explain the situation. This created another special bond and solidified the holistic experience.

You also need to build a rapport with your patients. We became part of the shared experience of the victims from Westminster, and they a part of ours. There is an indescribable and undefinable connection between groups of people bonded by a shared experience, especially one so emotionally charged. An unspoken bond. We use these bonds to help us heal and to start the next day, whatever it may bring.