Everything That Makes Us Human

by Jay Jayamohan

  As competition was super stiff I followed the work. I didn’t have a PhD, which put me at a distinct disadvantage when it came to applying for jobs. Nineteen forms went in with no interview. I had become so disillusioned with my chances to the point where I had wondered about other options, like retraining to become a barrister. I didn’t want to end up a bitter doctor doing a job I didn’t like. Plus, I have a penchant for arguing. It stood me in good stead in the years ahead, but more of that later.

  Then Glasgow had a vacancy for a registrar in neurosurgery, so I went for it and was invited to come up. The interview was totally different compared to filling in forms. I could put forward my argument about why I hadn’t taken three years out to do research. I didn’t know which sub-speciality to devote my career to, so I would just be doing what the academics told me to do. But I didn’t want that – I wanted to treat patients. I wanted to cut, to help them get better, just as I did all those years ago as a student in London. They actually understood that view and, at long last, with almost the last roll of the dice, I got the job. I sold my flat in London and I headed up to stay there for the next five years.

  I discovered just what an amazing city it was. Bars, restaurants, clubs and a population that knew how to party. It was fun central – and the guys at work were simply fantastic. From top to bottom, we really were a family. But I also realized that, sometimes, Glasgow was driven by more negative emotions.

  For those unaware of the city’s sporting history, there are two football behemoths fighting each other for supremacy. And when I say fighting, I do mean it literally. Like so many places in the world, religion is at the heart of the divide. Glasgow Rangers are, historically, linked with the Protestant faith, whereas their counterparts Glasgow Celtic are predominantly Catholic in fan base. It shouldn’t matter. Faith is about positivity and love. Football is about escapism and fitness – messages that sometimes don’t seem to have filtered through to Scotland’s second city.

  Each football match between the two clubs – known as an ‘Old Firm derby’ – has the police on overtime. If sporting rivalry doesn’t kick off a riot then sectarianism is waiting in the wings. Basically, you’re always just a conversation away from a bloodbath. Or, as stupid as it may sound, the wrong colour car can land you in hot water.

  On my first day in Glasgow, I arrived full of the joys of spring. My first shift was perfectly fine. I left late and happened to walk down to the car park with one of the other senior trainees. We were still chatting as I stopped outside my trusty old blue Honda.

  ‘Is this yours?’ he asked.

  ‘Yeah. It’s no Aston Martin, but it gets me from A to B.’

  ‘It’ll get you to A&E if you’re not careful.’

  ‘What are you talking about?’

  ‘Seriously? It’s blue. It’s the colour of Rangers. Approximately half the city is going to want to smash it.’

  ‘Don’t be ridiculous. My shirt’s blue as well. Am I in danger because of that?’

  ‘It depends where you go.’

  It was hyperbole, of course, but not as far from reality as you might think. The young man who we’d brought back from the dead on the operating table was a case in point. Attacked for being in the wrong football shirt in the wrong part of town. Pathetic, really. But some people weren’t even safe at home.

  Glasgow has its fair share of tenement buildings and, because of its weather, few air-conditioning units. One hot summer Sunday, a bunch of ‘fans’ were watching the Old Firm match on TV with the front door open. The game had just finished – not in their team’s favour – when one of them saw a flash of colour pass by on the landing.

  ‘Get him,’ he said, and ran for the doorway. His mates weren’t slow in following. In the stairwell they found a young man wearing the familiar strip of their mortal enemy and, because they were morons, they just leapt on him. One of them ran back to the flat and returned with hammers, bats and a golf club. They really went to town on the poor sod. And all because of his fashion choice that morning.

  By the time I laid eyes on him, he was barely recognizable as a man. The CT scan revealed a massive brain injury. It also gave some clues as to the cause. I could make out individual dents in the skull that looked remarkably like hammer marks and at least one made by a five iron.

  ‘The weapon of the coward,’ my boss said. ‘A lot of these toerags carry golf clubs as weapons because if police stop them they say they’re going to the driving range. Get used to it.’

  He was pretty much dead on the table before we’d got moving. But we had a go at operating because he was young. No life should be more valuable than another’s, but this young man had so much more to live for. And the way he’d died was just so … avoidable.

  There was a room next to the theatre where the lad’s family were waiting. My boss saw me wavering outside the door. She could tell I was really stressing out – it was the first patient I’d attended to who had died on account of the colour of his shirt. I couldn’t get my head around it.

  ‘I’ll tell them if you want,’ she said. ‘No one will judge you.’

  ‘I’ll judge me,’ I said. ‘I want to do this.’

  Inside were people whose son, uncle or brother had died needlessly. As the surgeon in charge of the operation, I felt it was my responsibility – my duty – to impart the news.

  I thought long and hard about what I was going to say. In cases like that you have to be prepared for them to turn on you. ‘Why didn’t you save him?’ You see it all and you can’t blame them. But it turned out words were unnecessary. The second I walked through the door, the mum burst into tears. She could read it on my face.

  ‘Not my bairn. Not my wee bairn!’

  It was heartbreaking. I sat with them to go through the events of the day in detail, but really no one was listening. When I finished, the young man’s brother shook my hand.

  ‘Thank you for trying,’ he said. ‘It means everything.’

  Sometimes it wasn’t the colour of your clothes that got you in trouble. It wasn’t even your choice of car. It was your skin.

  A guy was admitted after having been thumped around and had suffered significant head injuries. Casualty had given him the once-over and they’d sent him to us. He had an open wound to his head that needed surgery, as well as a fractured cheekbone. He was a total charmer. The moment I walked into the room, he said to the nurse, ‘I don’t want that Paki operating on me.’ Even his broken face wasn’t enough to stop him from spitting his venom.

  She didn’t bat an eyelid. ‘Well, since he’s the only surgeon here, you’ve got a choice: him or death.’ Sure, not strictly true on any of those points, but she was pretty cheesed off, and I wasn’t going to correct her.

  I thought that once we got him unconscious that would be the end of it. In fact, he was more angry and vile when naked than when he was awake. Every inch of his torso was inked with Nazi imagery or propaganda. I’ve never seen so many swastikas in one place. Of course, he wasn’t all bad. To prove his softer side, he had the words ‘All for you’ tattooed above his groin with a downwards arrow pointed at his knob. A lovely chap.

  I managed to clean his head injury and suture it up, and my maxillofacial surgeon colleague rebuilt the mashed bones so he no longer had ‘a face like a melted welly’ as they say in Scotland. We couldn’t have done more. Likewise, his wife couldn’t have been more grateful.

  ‘I apologize for him being such an arse,’ she said. ‘I can’t do anything about it.’

  I don’t just hang around to deliver bad news, so I wanted to tell the guy that he was, in all likelihood, going to make a near-perfect recovery and be back on his racist feet in no time. Which I did.

  I wondered how long he could hold his tongue … About ten seconds, as it transpired.

  ‘Get the fuck off me,’ he yelled. ‘I don’t want you lot touching me.’

  ‘My lot? You mean neurosurgeons?’

  ‘I mean Pakis.’

  ‘No Pakis here. I’m fr
om Sri Lanka.’

  The nurse laughed. His wife said something ineffectual. He twitched like he’d been electrocuted.

  ‘Oh, I wasn’t the only one who touched you,’ I said. ‘I’d like to introduce you to the person who reconstructed your beautiful face,’ – and I beckoned in my colleague who, for maximum effect, made sure his Star of David necklace hung prominently over his smock. ‘And of course you’ve met your nurse?’ Netty, the most amazing Jamaican angel, blew him a kiss.

  The fury on his face. I could still hear him swearing as I reached the end of the corridor.

  We took solace from the fact that the so-called ‘master race’ disciple required help from black, white and all colours in between to wipe his nose, drain his pee from the catheter and wipe his bum. But it soon wore thin. I think I hoped he’d see the error of his ways. That he’d come to acknowledge that without the very people he detested, he’d possibly be six-foot underground. No such luck. He hated us with as much venom from day one until discharge. We got to the stage where he’d pretend to be asleep rather than watch a ‘foreigner’ touch his body.

  ‘I suppose we could go back in and cut out the racist part?’ my colleague said to me, with a wink, one day when we were in our office. ‘Perhaps,’ he said, ‘you could make him love brownies.’

  Even a specialism like neurosurgery has sub-specialisms and, by the time I finished at Glasgow, I’d be expected to focus on one. The only problem was, I loved the lot. Every single aspect. As with junior doctor training, you get moved on rotation from one specialist department to another, from spinal surgery to epilepsy surgery to tumour surgery to trauma surgery, all the big guns and various others. Within days of seeing each new set-up I’d think, This is amazing. This is what I want to specialize in. This is what I want to spend the rest of my life doing. Then six months later I’d be somewhere else and change my mind entirely. And so it went on until I reached neurosurgical paediatrics.

  There was an instant connect, and for several reasons – some more altruistic than others. The first thing I noticed about the department was how they really kept the family involved in every decision. Whatever the children were in for, the consultant did his or her best to make sure the family were up to speed. It was such a pleasure to see this after some of the shoddy pastoral care I’d experienced in London. So why was I still not happy?

  You can be a bit of cock when you’re a registrar, thinking you could do better than your boss. I was, and I did. It took me no time at all to realize that some of the consultants weren’t just talking to the family – they were only talking to the family. What about little Nancy or Kevin tucked up in bed? The kids were the real patients – so why were they being ignored?

  Full disclosure: I think I’ve always had a healthy relationship with my inner child. Possibly too healthy. I love video games, PlayStation, reading comics like 2000AD and Calvin and Hobbes, and almost any cartoons. I love slapstick humour, I love The Simpsons. Yes, I’m basically immature. But you know who else are? Kids.

  You can sometimes see adults talk to children in a smarmy politician ‘Hey, kids. What’s happening?’ sort of style and it smacks of fakery. Kids know when they’re being spoken down to. They really don’t go for that. They are very good at sensing when an adult is trying too hard to be their friend and just think, I don’t really know what you’re doing or what you think you’re doing, but you’re not fooling me in any way, shape or form. Fortunately, I realized that I could relate to my tinier patients very easily and talk to them on a level they could identify with. I wouldn’t say it’s a skill, more just me. I felt I knew what they needed. And what they needed, more than anything, was some level of honesty.

  If you’re the one lying in bed with drips coming out of your arm and a pain in your head that you can’t scratch, you’re going to be terrified. Imagine watching Mum and Dad huddle in a corner, whispering to a stranger in a white coat (we still wore them for lots of my training). You know they’re talking about you. What are they saying? Am I going to die?

  Of course, if you don’t talk to that child and explain to them what’s going on, their imagination will kick into overdrive and what they come up with will probably be double or triple as serious as what’s actually going on. Kids aren’t stupid. They know when something’s wrong. They know that there’s something not quite right with them. They’re in a hospital, for Pete’s sake. You need to be able to explain the situation to them to ensure they feel comfortable and understand what’s going on in a way they can process. What you mustn’t do is treat them like they’re invisible, which some of my colleagues appeared more comfortable doing. To be honest, so did some parents. They occasionally hated it when we were honest with their child. They thought they were protecting them by withholding the truth. There were fraught times, but my consultants always had my back.

  With my time at Glasgow coming to an end, I needed to make a choice. There was only one real candidate. I realized I had a level of attachment to paediatrics that went above anything I felt for the other departments. I honestly believed I could do some serious good in that world.

  But, if I’m honest, that wasn’t the only reason I elected to go down that path. In my time in paediatrics I saw myriad different cases, watched consultants scratching their heads, and then got to open up the hood of babies and 6-foot teenagers. No two cases were the same. And it was thrilling. I pictured a life specializing in adult spine surgery. Yes, practice makes perfect. Yes, after a while I could become the go-to guy in the field. I could become the top man in the industry. But, oh my God, the tedium. The prospect of being pigeon-holed in one tiny aspect of my training. The idea of doing the same thing every single day crushed me. Whereas with kids, you never knew what you were going to find.

  Decision made, there was only one place I wanted to go. I booked a flight to Canada.

  Known as ‘SickKids’, the Hospital for Sick Children in Toronto takes patients from a huge swathe of Canada, numbering about nine million people. If I was going to get up to speed on paediatric neurosurgery, it seemed the perfect place to go. It had to be – I was gambling a lot on it working.

  At the time, my then fiancée was doing a research degree in Glasgow, so she couldn’t travel. We couldn’t sell my flat because she needed somewhere to live. So I took a pretty hefty loan from Barclays and packed my bags. Spoiler alert: it was totally worth it and probably the best investment I have ever made (other than marrying my fiancée!).

  I arrived as a ‘Fellow’, ostensibly to work alongside more highly trained seniors and consultants and learn from them. Mostly it worked out that way.

  The set-up at SickKids was fantastic. As you can imagine, covering the entire east coast there was a lot of opportunity for daily operating as everyone was kept very busy. The consultants were among the world’s most well-respected experts, comprising academics as well as clinicians. I wasn’t the only visiting Fellow. They get people from all over the world coming to work for them basically for free (I had been awarded a £500 per month scholarship to help towards rent), just because it’s the place to go and train. Even the juniors, like me, are actually very experienced by the time they arrive at the end of their training, so the whole environment is on another level. I’d have paid to work there.

  Lots of the work that came in was tumour-related. You can never work too many tumour cases. Certainly never relax. The risk of devastating failure is always a hair’s breadth away. You need a very specific knowledge of 3D anatomy, excellent hand-eye coordination – what is often called a ‘visuospatial skill subset’ – which I, like everyone else there, was trying to learn at breakneck speed. Even so, every operation I performed, either as lead surgeon with supervision or helping a consultant, was a challenge. Albeit a very rewarding challenge.

  Outside theatre I found dealing with Canadian kids and parents just as straightforward as in the UK. I knew I was on to something. I knew I could make a difference back home. As it turned out, I soon made a difference in Toronto.


  You don’t automatically become a ‘consultant’ – there’s a formal job application and interview process. Once successful, you finish your last training day and then essentially move offices and get a new shiny ID badge. But going from registrar on a Monday to consultant on a Tuesday doesn’t necessarily imbue you with any more experience. I worked with a couple of bosses who were barely a year older than me. One had literally returned from his year’s fellowship the day before I arrived and now he was suddenly expected to step up to the top level. It’s all about how you handle it and he handled it brilliantly. They all had great attitudes, totally inclusive in the way they worked, always asking questions of their juniors. Not a ‘see one, do one, teach one’ in sight.

  I learned a phrase from one of them that I have stolen for myself. Jim would say, ‘Now, if you see me doing something stupid, for f***’s sake please say something straightaway. Don’t wait for me to screw up. You’re my backup.’ This, coming from one of the most experienced paediatric neurosurgeons in the world to a baby like me, was a really brilliant attitude that I try to emulate.

  One day a head trauma came in and the senior surgeon asked for comments. I’d seen and worked on tens of trauma cases in Glasgow. It was basically the bread and butter of the department. So I was full of suggestions.

  ‘Perhaps you’d like to lead on this one, Jay?’ he said.

  And with echoes of a previous professional exchange, once again I replied, ‘It would be my pleasure.’

  It says a lot for the cultural differences, I suppose, that I, a relatively junior import from Glasgow, had significantly more trauma experience than the home-grown consultant in Toronto. But I’m not one to look a gift horse in the mouth and absolutely relished the extra responsibility whenever one of these terrible cases came in.