Extract: On Call, by Ineke Meredith

The world of surgery is strange, messy and intense. From a man presenting with fishhooks in his stomach to being punched in the face by a patient, it's all in a mad day's work for a female general surgeon. Even with emergency operations in the wee hours and constantly being mistaken for a nurse, there are still moments of laughter and tenderness amid the chaos.

When Ineke's parents in Samoa fall ill, she becomes torn between her roles as a surgeon, a daughter and a single working mother, leading her to ask: are the sacrifices of a life in scrubs worth it?

Extracted from On Call by Ineke Meredith, published by HarperCollins New Zealand. A 35-year-old woman came to see me in clinic with an anal problem. The referral letter said that she had a large fleshy growth at the anal verge, and it was impairing her ability to work. I could understand that a large fleshy growth at the anus would impair one’s ability to work. It sounded awfully uncomfortable.

We had a brief conversation about how long it had been there, if it was causing her pain and if it was bleeding. Then I asked to examine her, and instructed her how to position herself on the examination table: pants down to her knees, buttocks placed exactly at the edge of the table so they are just hanging off it, right shoulder forward, knees to her chest and feet forward. It is always a delight when someone is limber enough to position themselves like this independently. For a man in his eighties with a stiff back, it is never easy or quick.

I spread her buttocks apart in search of the large fleshy growth, but was disappointed to find a tiny little tag at what I would call the 12 o’clock position. She had a bit of extra flesh at the top of the anal verge, just behind the perineum. I completed a thorough check to make sure I was not missing anything. Gloves, lubricant jelly over the index finger, gentle internal examination of the anal canal, digital rectal examination, then a tube to examine the rectum and another tube to look inside the anal canal and check for haemorrhoids. The examination revealed no other findings. Just this small, pathetic bit of extra tissue at 12 o’clock.

‘Is this what you are worried about?’ I asked her. ‘I would leave that well alone.’ I then went on to explain that the procedure to remove the tag was not worth the trouble because it was so small and it was benign. It was barely worth mentioning.

‘But I can’t work,’ she said.

‘What work do you do?’ I asked.

‘I am a high-end escort and I’ve been losing work because of this.’

I pushed down my absolute astonishment and, although I definitely did not see how she could be losing work because of this tiny tag, I filled out the booking for an excision under anaesthetic.

* * *

It was back when I was a registrar in urology that I had first become aware of nether-region preoccupations. In particular, I discovered that some men seem to like placing foreign bodies in their urethra – the tube that runs from the tip of the penis to the bladder. Men ejaculate and urinate through this hole. Why would someone want to push solid objects up there? One man let barely a day go by after being sent home before he put his toothbrush back into his penis – and not handle first. This guy’s penis had been forced to swallow a toothbrush whole, brush first. Why? But, even more importantly, why not the handle first? Still, maybe he was marginally saner than the razor-blade guy. Yes, razor blades into the penis. Do not ask me how, or why.

In general surgery, it is more common to encounter foreign bodies in the rectum. This was a highlight for all young surgical registrars, largely because of the storytelling.

Most of the time, the foreign body is retrievable simply by putting the victim to sleep – thanks to the anaesthetist – so that the voluntary sphincter mechanism of the anus no longer puts up a fight. I can honestly say I never had a female patient present with a rectal foreign body, whereas the male is a true victim because he has usually just been walking through the house minding his own business. It is always so unfortunate that he was going down the stairs naked and unaware of the Barbie doll lurking at the bottom until he slipped and fell on top of her. Or that the broom was standing upright when he slipped from the porch. Or that there were knitting needles standing on the bathroom floor when he hopped out of the shower. I learnt that some homes are incredibly dangerous, especially for men walking around naked in the presence of fruits and vegetables, light bulbs and jars. Stairs are the worst. You never know what is lying, or standing, at the bottom of them.

Mr GP (for Great Party) had come from one. He was in his twenties and presented as a little confused. He had been at said great party the night before, and now more than 12 hours later entered the acute assessment unit dressed casually in jeans and a T-shirt.

‘What brings you to hospital?’ the registrar asked. This was the sort of standard, open-ended question we are taught in medical school to ask so as to allow the patient to partake freely in the discourse.

‘I think I have vegetables in my rectum,’ the man replied.

After a moment of unimpressed silence (the days are difficult enough without people trying to be mysterious), the registrar repeated, ‘You think you have vegetables in your rectum?’

‘Yes,’ the young man said, as if it was of no consequence, and apparently unwilling to divulge more than was asked of him, even though he had presented voluntarily to the hospital. ‘What makes you think that you have vegetables in your rectum?’ the registrar asked patiently.

‘I went to a party last night, and some vegetables went missing.’

More silence.

‘What vegetables went missing?’ the registrar asked.

‘A cucumber and a carrot.’

‘And what makes you think they are in your rectum?’

(Sometimes, it is like pulling teeth.)

‘I don’t remember the end of the party. All I know is that vegetables went missing because I counted them before, and I am pretty sure they are in my rectum.’

Yet another innocent victim of a cucumber. It was not even a full moon.

* *

Read Himali McInnes' review of On Call on Kete here.