Naomi Davis
Consultant in Paediatric Orthopaedic Surgery
Booth Hall Children’s Hospital, Manchester
Like many decisions, it can be difficult to analyse why I went into surgery, but I think it was probably a mixture of what I felt I was good at (or at times, least bad at) and the subject in which I received the most encouragement from excellent teachers.
I left Nottingham University Medical School in 1988 with an idea that I was going to end up in one of the surgical specialities. I hadn’t thought of orthopaedics at that time, we had only had two weeks experience of it as under-graduates and I wasn’t a rugby player. I was also vaguely aware that it was still considered somewhat unusual for women to go into surgery, although I didn’t see why.
I did my surgical house job in Colchester in a small and friendly hospital and after my first night on call, when I got a full, undisturbed eight hours sleep, I wondered what all the fuss was about. I soon learnt, but we did a good job of burning the candle at both ends. It was here that I was first told I would never make a surgeon, it wasn’t the last time, but I have chosen to concentrate on the opinions of people I respected.
I sought out a medical house job that was known to be one of the busiest in the country, figuring that this was going to be my last opportunity to get any medical experience. Long periods of 1 in 2 on call over the summer months made an Anatomy Demonstrator’s job at Liverpool seem very quiet, after this. These jobs are designed to help you study for the old Part 1 fellowship exam, which I summarily failed throughout my demonstrator year and far beyond. If anyone asks, some of the best surgeons I know have taken that exam more than 10 times. I eventually passed it after ignoring the books for many months. This was not on the occasion that I was asked ‘What’s the difference between a clot and a thrombus, apart from the fact that you are a clot and not a thrombus?’ (True story.) I went on to six months in Casualty and then Plastic Surgery at Sheffield. It was on the burns unit that I first treated children on a regular basis and learned that getting involved with your patients isn’t necessarily a bad thing. I also began to understand that I was not cut out for operations that lasted for more than a day. After this, I decided to take some time off to study and although I did some locums during this time, oddly, no one has ever commented on this gap in my CV. I finally passed the exam shortly after starting as an Orthopaedic SHO in Stockport. This was my first real exposure to orthopaedics and I was allowed, under supervision, to perform a knee replacement. The encouragement I received from Phil Turner and his colleagues was fantastic and the decision was made.
After 3 years as an SHO I finally took up what is now called a Basic Surgical Training Rotation at North Manchester. I wouldn’t advise telling General Surgeons that you want to do Orthopaedics, it doesn’t seem to impress them! The rotation also included Neurosurgery, a subject previously considered important for an aspiring orthopaedic surgeon, but not for the faint hearted. More relevant to me was the time spent in Paediatric Surgery at Booth Hall, where I encountered the delights of getting a smile (and sometimes a cuddle) from your patients every day. I was also supported by Miss Doig, now retired Consultant in Paediatric Surgery, who looked at me, said ‘ Ah, another tall woman’ and promptly took me under her wing. On such chance occurrences are careers formed. I passed the Part 2 of the Fellowship (first time, this time) just before entering the Orthopaedic Department at North Manchester. Peter Kay was actively encouraging research there and allowed me to become involved. This is something expected much earlier for SHO’s now, for better or worse. Either way, having a research group of interested consultants giving support to juniors is invaluable and something I would hope to emulate.
I was briefly appointed as a locum registrar at North Manchester, before getting a substantive SpR post in the North West. I was a time expired SHO by then as a good proportion of women surgical trainees tended to be. This rotation is one of the largest in the country in terms of trainees and at the time I joined there were three women. I made the decision not to join WIST (Women in Surgical Training) as I didn’t really see that women should be treated differently in surgery – in fact there are some ways to use it to your advantage and as a junior, qualities of organisation and the ability to think ahead are valued. So we started our own group WOT (Women in Orthopaedic Training) and despite never getting round to having the T-shirt made ('WOT – no balls') we had many a night down the pub moaning about this and that. We resisted offers from the men to come and join us, even after it became apparent that they go through the same periods of doubt and insecurity.
Did we ever want to jack the whole thing in? Oh yes, but there comes a point when you can’t do anything else, so you battle on through. Then someone decides that another exam in your mid thirties is a good idea, so you hit the books again and wonder how you ever got it right. Then suddenly, at a RITA assessment someone says ‘ We could do with another Paediatric Orthopaedic Surgeon’ and things look up.
I did a year at the Children’s Hospitals in Manchester as a Fellow then a couple of months at the Hospital for Sick Children in Toronto, Canada, then came back to start the best job in the world. Treating children with orthopaedic problems can be scary, the results of your interventions may not be known until long after you retire. Making decisions for a child as an individual and part of a family is a real challenge and there are still large areas of our work that would benefit from closer examination. It is hard not to be emotionally involved; who can look at a child admitted because of a non-accidental injury, without being so.
It is true that surgery is an art as well as a science. There is no doubt that it is demanding on time and energy and I have been fortunate to have the support of a man and family who understand that. The pressures can seem immense, especially when setting up your own practice and suddenly you need to draw on management skills you may not have realise you had. Most people would advise, that for the first couple of years of your consultancy, you keep your head down and just do the work. In fact, I have started a new service at Booth Hall, treating children with club feet by the Ponseti Method. This involves serial casting, minimal surgery and splinting. The dedication of the clinic team and the parents in making this work has been inspiring and we are about to run our second international conference to train others in the method and set up a national database. If surgery is a choice you have made, you will never listen when people tell you how hard it is. Just as well, I wouldn’t have missed this for the world.