Slice Girls

by Joan Arakkal

  ‘Brilliant, though it means long hours and hard work. But from what I know of Sanjay, that should not be an issue.’

  The bell tinkled as the door closed behind me, and I thought of another Patel, my friend and colleague Jyothi Patel. She was an anaesthetist and her gentle manner and uncompromising efficiency had made her a favourite among surgeons. If Dr Patel was ‘gassing’ their patients, they knew they could expect minimal fuss and a smooth transition between cases. With her ‘work is worship’ attitude, she reduced the trauma for patients whose bodies were surgically invaded.

  The Patels are the Smiths of the UK’s White Pages. This surname is the twenty-fourth most common one in the UK – they even have their own directory. These enterprising people have travelled to the distant corners of the world and it is joked that they can even be found in the most sparsely populated regions of the world. Known for their extraordinary determination, hard work and family solidarity, the diaspora of Patels left their farms in the north-eastern Indian state of Gujarat to settle all over the world. The first generation had flourishing small businesses and their children grew up to be doctors, engineers and other professionals. Today, thanks to the award-winning actor Dev Patel, the surname has even made it to Hollywood.

  Cathy Lennox was an orthopaedic surgeon at the Hartlepool General Hospital, and she was to become one of my strongest allies in England. When I first met her, I did not know that she had gone through the hard yards before she made it into the male-dominated world of orthopaedics.

  Although few women had chosen to do orthopaedics in India, I had slotted into the world of bones with relative ease. It was no more challenging to me than it had been for my male colleagues. During my period as an orthopaedic trainee at the Calicut Medical College, I was made to feel special for having ventured into an arena where few women had chosen to go before. The male registrars displayed a fraternal affection and concern for my wellbeing. After late evening classes at the hospital, they would walk me back to the women’s hostel. The senior consultants held me up as a good example and gave me confidence in my work. Male trainees were asked to emulate my enthusiasm and efficiency. I took as a compliment the comments of one of my referees, a respected consultant, ‘Joan was a sobering influence on the male-dominated orthopaedic department.’ Having a woman in the department had worked to everyone’s advantage. When I completed my training and examinations with merit, I felt ready to face the larger world of orthopaedics. I had enjoyed a smooth and happy, albeit arduous, period of training in India.

  My experience in England was very different. ‘She can’t be normal if she is doing orthopaedics.’ ‘Doesn’t she want a family?’ ‘What is she trying to prove?’ Comments like these baffled me. For the first time, I wondered if I had done something freakish in choosing a career in orthopaedics. One male consultant took great pleasure in belittling me in front of patients. He would deliberately page me when I was at lunch and make denigrating comments about my attire. I had never been subjected to bullying at work before, so I was slow to recognise it for what it was. Why, I wondered, was my confidence beginning to shake?

  Around this time, I was summoned to Dr Lennox’s office. The nurses had found the male consultant’s treatment of me disturbing and they had reported their concerns to Dr Lennox, who was also the head of the department. She told me that she had been made aware of the consultant’s unprofessional behaviour and that it was unacceptable and not to be tolerated. She talked about the harassment she had experienced in her own career and her battles with male colleagues. She said that the next incident of what was now officially deemed ‘bullying’ was to be reported. I left the room buoyed by the conversation and felt my confidence return. Typically, after the threat of action, the consultant backed off and I completed my term at the hospital with no further incidents.

  I was starting to realise that some men would try and displace women who made inroads into traditionally male arenas. Women needed to stick together if they did not want to be hounded from the playing field. Though the political suffragette movement had begun decades earlier, the need for orthopaedic suffragettes remained.

  Once, in the early hours of the morning, I was called in to attend to an inebriated Scottish man who had driven headlong into a tree. When he was brought in by the ambulance crew, he did not seem in the least bit distressed. His slurred Scottish ballads kept us amused as we did a primary survey of his injuries. We were relieved to discover there were no life-threatening injuries. He had rammed his knee on the dashboard and his shortened and bent limb attested to a dislocated hip. X-rays confirmed our diagnosis. Without further delay, I took him to theatre to be anaesthetised. A muscle relaxant would allow me to manoeuvre the dislocated ball back into the hip socket. The theatre nurse noted with amusement that the girth of his thigh was possibly the same as my body. With the patient lying on the lowered table, I stood on a step stool and knelt on the table. I bent his knee and guided the joint back into place. Placing the straightened limb on the table, I stepped down from my lofty perch.

  ‘You made that look simple,’ the anaesthetist remarked.

  ‘And it was,’ I replied. ‘Thanks to your anaesthetic and my Watson-Jones textbooks.’

  The idea that orthopaedics is unsuited to women has no place in modern orthopaedics. Effective anaesthetics, efficient muscle relaxants and precision instruments have made it more a battle of skills than of strength. Yet this notion seems to have been kept alive. In contrast, I am intrigued that obstetrics has traditionally been seen as a speciality well-suited to women. When a woman falls pregnant, those involved in her care are essentially caring for two lives. Two for the price of one! Two lives that could potentially run into trouble. The nine months of pregnancy are not always smooth sailing. The obstetrician is faced with unexpected events at all hours, often requiring immediate action. When complications arise, two lives are in jeopardy. The stress levels are high and the hours are long and uncivilised. Yet women obstetricians have worked alongside men for decades without so much as an eyebrow being raised about their suitability to this role.

  For doctors who love to use their hands, orthopaedics offers a great outlet. I recall a trainee registrar operating on a fractured bone of the hand. Sitting on a stool in the theatre, he exposed the small bone through a neat little incision. He then placed a tiny perforated steel plate across the fracture site and held it in place with a small clamp. Using a small drill, he made holes in the bone and inserted mini-screws using a teeny-weeny screw-driver. As he finished the job, he said, ‘I can’t believe I’m having so much fun and I get paid for it.’ He is now a hand surgeon and continues to play deftly with his miniature toys.

  Orthopaedics is a rewarding branch of medicine. Something breaks and you fix it. The lame throw away their crutches and walk. They smile at you in gratitude. You feel like a miracle worker.

  ‘Beauty is but skin deep,’ a friend once grudgingly remarked about a curvy, high-cheekboned senior student when we were in medical school.

  ‘Nobody says that of ugliness,’ I had replied.

  We had laughed, secure in our eighteen-year-old skins and cheekbones. When I looked in the mirror, I understood why my grandmother called me ‘Big Eyes’. I liked the colour of my skin and didn’t think it needed to be bleached or baked.

  But now I overheard the nurses in Hartlepool comment on my ‘olive’ skin. Never having seen or tasted olives, I was confused. I was even more confused when I saw them behind the counters of the hospital cafeteria. Neither the deep purple kalamatas nor the smaller green ones looked brown to me. I wondered if the nurses were colourblind.

  The bleep of my pager interrupted my musings and summoned me to the emergency department. An elderly lady had tripped on a loose brick in the pavement. Below her knee-length skirt, her left ankle looked stumpier than the right. I placed her leg on a pillow and looked at the X-rays. Everything was in place, except for a neat line running across the bone knob on the inner side of the ankle. The fracture would heal ni
cely in a cast.

  When the plaster trolley was set up, I knelt on the floor and counted the handspans between her toes and her knees. Like a seamstress, but with less finesse, I popped the plaster of Paris rolls out of their packaging and measured three hand-widths of the stiff, white sheets. I layered them like pastry and, when I had enough thickness, I cut the excess off. Again, I knelt on the floor, this time to roll out cotton over her leg, making sure there was extra padding over her knobby bits. I did not like nasty surprises, and I had had a few in the past. Ulcers sitting atop hard bony areas had greeted me as the plaster was removed, much to my dismay, teaching me the value of careful padding before applying plaster.

  Mr Nair’s plaster room technique from my training days in India came to mind as I soaked the layered sheets in a shallow basin of tepid water. Gently squeezing out the excess water, I cradled her leg in the moist plaster sheet. A junior nurse’s helping hand allowed me to apply the bandage over the soaked plaster. Starting at the feet, I overlapped each layer, hearing Nair’s voice in my head. ‘Not too loose, not too tight.’

  Sitting on a footstool, I placed the sole of her plastered foot on my plastic-aproned chest so it would set in a neutral position. I had warned her that she would experience some warmth in her leg as the plaster set. With her knees bent and her foot planted on my chest, my elderly patient looked like she could be a belligerent child throwing a tantrum, trying to kick me away. As the warmth enveloped her legs, she smiled.

  ‘I like Indian doctors,’ she said. ‘My father was posted in Madras for many years with the army. He told us stories of the natives there. Are you from Madras?’

  ‘Not Madras, but in that general direction,’ I replied.

  She continued in a sing-song Geordie drawl. ‘God made the little niggers, he made them in the night. He made them in a hurry and forgot to paint them white.’

  The young nurse beside me looked uncomfortable. Amused, I tried to look through the eyes of the lady in the wheelchair. History had not caught up with her. I understood that this woman’s blinkered world was stuck in a past that was mistakenly glorious to her. I let her be.

  I settled into work. Apart from gaining experience in the UK, I also planned to sit the examinations that would earn me a Fellowship of the Royal Colleges of Surgeons (FRCS). This would both formalise my training and further my career. When not working a hectic schedule, I attended courses run by the Royal Colleges, read and took notes. In the evenings, I met up with other doctors who were also intending to sit the exam to discuss various topics. The bearded German doctor used to be a cabinet-maker before he decided to hone his skills on bone rather than wood. The sharp Nigerian doctor was the one with all the answers.

  My days and nights were busy. Francis had enrolled in a Master’s program in offshore engineering. He drove to the University of Newcastle each day and when he returned home we would cook and enjoy a meal together before we both returned to our books.

  We hadn’t intended to start a family, so when the nurse rang with the results of my blood test and told me I was pregnant, we were surprised and delighted. Early scans confirmed a healthy baby, although I asked the sonographer not to tell us the baby’s sex, as I wanted to retain the magic of the unknown. Secretly, both Francis and I were hoping for a girl. I waited for morning sickness to find me but instead I developed an appetite that would have put a hungry bear to shame. I sneaked leftover baked potatoes from patients’ food trolleys and gobbled down uneaten desserts. The orderlies laughed at the large portions of food on my tray at the hospital canteen. As my pregnancy advanced, I dreaded the one-in-three rostered nights that I was on call. My exam preparations stalled. By the thirty-sixth week, I was ready to stop working. I looked forward to having a few weeks’ rest before the baby arrived. But the baby had other plans. To celebrate the start of my pregnancy leave, Francis and I made a trip to Middleton Beach. It would have been lovely if we hadn’t decided to walk down the steep sandy slope to the water’s edge. Climbing back up, I could barely move my hips. Francis pushed me up the slope and I tumbled into the car, with a heaviness in my pelvis. The pains began in the small hours of the next morning and we went to the labour ward, where the efficient and caring midwives took charge. Our daughter arrived later that evening, three weeks earlier than expected. We had tossed around a few names in anticipation but hadn’t decided on one. When the nurse asked what the little one was called, I was surprised when my excited husband unhesitatingly said, ‘Sonia’.

  We were far away from close family and friends, but Sonia’s arrival was celebrated by our new friends and the staff at the hospital. Cathy Lennox visited me with gifts for me and the baby.

  Caring for Sonia while working at the hospital and preparing for the examination was going to be challenging. My parents stepped in to help. They looked after Sonia while I ploughed through my books. I went to Edinburgh to spend time at the Surgeon’s Hall, attend classes and throw myself into the preparation. A few days before the exams, I went to the Royal College of Surgeons Library to look up a journal. I was greeted by a stern woman who asked if I was a Fellow. When she unsmilingly indicated the correct door, I realised I had blundered through the hallowed door that was exclusively for Fellows.

  A week later, with the written, clinical and oral examinations behind us, a group of nervous doctors gathered outside the library to find out the results. The tension was palpable as the names were called and each worn-out, bedraggled candidate was given an envelope containing their results. For many, this was not their first attempt, and they were wise to the fact that it was better to receive a thin envelope than a thick one. The thick ones also held an application for resitting the exam. I caressed my thin envelope and savoured the moment before walking to the red public telephone booth to wait my turn in the long queue and convey the news to my family. The FRCS belonged as much to them as it did to me.

  That evening, the successful candidates were welcomed into the library for celebratory drinks. I walked in through the Fellows’ door and there was no-one to stop me this time.

  When I eventually left the UK after nearly three years, I was sorry to leave the hospital and the warm Hartlepudlians. This time, I had no difficulty understanding the taxi driver who dropped us at the bus station, and he understood me. A whiff of the Geordie twang had crept into my speech. I still treasure the sapphire pendant on a gold chain that was a parting gift from Cathy Lennox. I cherish the warm memories of that woman who not only loved and practised orthopaedics but was also keen to support and guide other women on the same journey.

  WHO IS AN AUSTRALIAN?

  In 1995, Francis and I stepped off the plane in Canberra. After collecting our suitcases from the carousel, we ventured out into the warm, sunny expanse of our new home. As the taxi drove along the wide roads that led to our temporary suburb, we saw our first kangaroos. When Sonia, now almost three years old, hopped around excitedly at the sight of them, I felt a stirring in my womb – our unborn baby was sharing in the excitement of this new land.

  The bright sunshine and February heat made England and its grey skies seem miles away. I smiled to myself and I thought I would never again suffer through the winter blues that had plagued my years in England. Initially, going from the sunny southern states of India to England’s postcard-perfect landscape had fascinated me, but that turned to despair when the cold and sleet and the short days of winter chilled my heart.

  My time in England convinced me that India was where I wanted to live. After our three-year UK sojourn, we had returned to India where Francis was working as a superintendent for a major shipping company. He was initially posted to the US but, seeing how keen I was to go back to India, he asked to be posted to the company’s Madras office. It became increasingly clear that Francis’s work would keep us in the port cities of India. However, I was no fan of the big metropolis with its crowds, congestion and traffic. Bombay, Madras and Calcutta were all good places to visit for a few days, but they were not where I would choose to live. When
Sonia was two years old, Francis suggested we apply to migrate to New Zealand or Australia. I too thought the move would be good for our family.

  We investigated New Zealand first. I arranged a meeting with a senior orthopaedic surgeon to discuss my intention to continue my career. He looked me over and, after a pause said, ‘Don’t they need orthopaedic surgeons in your country?’

  After a stilted discussion he went on to suggest that Rotorua needed General Practitioners and I should head that way. My dream of working in orthopaedics in New Zealand ended before it even began.

  A year later, the Australian government decided that Francis’s skills and qualifications were needed by their shipping and offshore industry, and he was granted permanent residency. Despite me being seven months pregnant with our second child, we decided to give it a try. Now, cruising through the streets in the taxi, I looked for people and saw none.

  ‘Not many people in Canberra,’ the driver informed me. Although the landscape looked desolate, I felt secure with Francis and Sonia beside me. Here we were, in a new land, equipped with two suitcases plus ample qualifications, plenty of hope, good health, the anticipation of a new child and a buoyancy for life. They called this the ‘lucky country’ and I was determined to make luck find me.

  Our son, John, was delivered on a crisp April morning, two months after we arrived in Australia. A plump dove was perched on the windowsill of the hospital room. I glowed with happiness as I looked into my swaddled son’s honey-brown eyes. He had been conceived in my homeland and delivered safely into my adopted country. Lady Luck had indeed found me. The obstetrician’s professional courtesy also went well beyond my expectations. Aware that I was a new migrant, he did all he could to make my hospital stay pleasant. I felt safe and cared for. In later months, when I joined the same hospital as a registrar, he welcomed me warmly and thanked me for the professional skills I brought.