A surgical life by Donald E. Low
4 May 2023
16 September 2022
What made you decide to become a surgeon?
I was the sixth child of a South African surgeon, a veteran of WWII, whose commitment to his patients, large family and community impressed me from childhood. Aged ten, he helped me stitch up a (brave) friend of mine who has gashed his forehead. I was hooked! But I wonder what his medical defence organization would have said in 2022?
Who were your influences?
My eldest brother was a dashing sportsman, medical student and a golden boy until he was killed on his 21st birthday when I was six. He was my hero, and my career choice was made. A much loved, older sister became a nurse, won all the prizes and, aged 22, emigrated to England. She finally retired two years ago after a remarkable NHS Community Nursing career for which she was acknowledged with a citation for a palliative care programme she established in her last few years.
On a year-long Fellowship, I was hugely influenced by Glyn Jamieson in Adelaide. He was kind, intelligent and a persuasive teacher. Very different to the standard Consultant Surgeon caricature of the 1980’s NHS. I still wear a virtual wristband with “WWGD” on it. There were several others, Brian Dowling and Alan Berry in Northampton, Harvey Ross and Bob Galland in Reading, Averil Mansfield in London, Mike Kettlewell, Neil Mortenson and Peter Morris in Oxford. Wonderful people.
What were your training highlights?
It sounds trite, but I loved every job (and there were plenty), except one where I worked for 18 months in a DGH in London for a locally famous but callous and dishonest vascular surgeon, who spent his days at the private hospital removing varicose veins. After 12 months, a young GI surgeon was appointed to the hospital and given a House officer and no other staff. He needed a middle grade and I was desperate for training, so I did two jobs and hardly went home for the last six months. In turn, he was grateful and trained and mentored me in GI surgery and developing surgical life skills. But remember, if you keep your composure, one can learn a lot from a surgeon you don’t admire.
Tell me about a surgical triumph
Each and every patient that recovers without a complication and has good outcome is a triumph. So is supporting the fading patient towards as gentle a crossing of the river Styx as possible. My career timing was perfect for me to introduce (in the face of much local scepticism) “Watch &Wait” for rectal cancer in my country. Providing so many of these patients with a non-operative long-term, stoma free cure was immensely satisfying. Operating takes courage; not operating often takes more.
Tell me what you learned from a surgical disaster
There were too many. We all say that, and it’s an inevitable truth. But I learnt that if you stay loyal to your patient, stay accessible and never give up, your biggest disasters can, ironically, earn you the affection and great gratitude of the patient and family. This rich irony helps one cope with the inevitable self-doubt and surgical guilt.
What was your proudest achievement?
Like many surgeons, there were some brilliant operations, some proud publications, invited lectures and presentations and presidency of this association and that society. But the real pride stems from the affection of many trainees and leading a cheerful, united operating theatre team for over 20 years – same few anaesthetists and scrub sisters. What a privilege. When my wife developed a fearful abdominal tumor, it was three of those trainees who did the heroic eight hours of surgery and saw her through six weeks of a challenging in-hospital recovery. A fine example of that wise maxim: “Be good to those on the way up – you will meet them on the way down.”
What are your hobbies outside surgery?
I have worked at staying fit and physically active, so am still playing decent Masters field hockey at 65, multi-day hiking and trail running. Intellectually, I enjoy reflective writing, the kitchen, poetry, birding and a recent botanical fascination with the Fynbos floral kingdom.
What advice would you give a young surgeon?
Starting with the point above, a disciplined, regular exercise routine (it doesn’t have to be tough but must be regular) is worthy advice for the busy young surgeon struggling to balance work, relationships, family, academics and life.
Choose a good life partner, seek out mentors, keep up to date, and read history.
Never be the first with a technique, nor the last.
You don’t have to be the best surgeon in the world, just be the best surgeon you can be. And remember, good surgeons know how to operate, excellent surgeons know how to deal with their own complications, but the best surgeons know when not to operate.
What would you be, if you had not been a surgeon?
Hard to imagine. In my fantasies– a Shakespearian actor, movie star, celebrity chef, top pro golfer, author of blockbuster novels. Not much humility there!
In reality, I would probably have headed to Law School aiming to become a Barrister/Advocate.
I have been too hard on myself too often. Surgeons often are. Forgive yourself more. Accept that perfection is unattainable.
Also … I could have been kinder to some who irked me. Aldous Huxley said it best “It is a little embarrassing that after forty-five years of research and study, the best advice I can give to people is to be a little kinder to each other”
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