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Fellow contribution
Deux et deux font cinq (2 + 2 = 5) When things do not add up The equation – part II
The first ‘Equation’ article in December 2020 in Surgical News recounted the principles implied in the expression, ‘when things do not add up’; in particular, when dictates and dogmas need to be questioned, and modern insights supersede entrenched clinical practice. George Orwell’s statement about ‘Big Brother’, one of the most quoted phrases in the 20th century, is evident throughout this essay. Orwell was an Eton graduate and became a war correspondent during the Spanish Civil War, opposing Franco and fascism. His wartime experiences reflected his opposition to totalitarianism and his support of democratic socialism. Dick Galbraith, renowned eye surgeon, had his own experience of the ‘big brother’ quote in an episode when flying in a twin engine Cessna back to base from one of the Fiji islands, when he was operating in the Pacific. The aircraft became engulfed in the dense cloud of an approaching tropical storm. Visibility was zero. Nothing was said, but the mood was ominous with anxiety. An SOS was radioed and, thankfully, received by one of those stratospheric American surveillance aircraft almost 50,000 feet above – part of a global peace initiative.
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7.30am – one of the first of their kind in Melbourne to discuss major head and neck problems in a consultative capacity. The late Brian Fleming, who trained under Howard Eddy in head and neck surgery, was ‘Chairman of the Board’. Hugh Millar and Steve Kleid were part of the ear nose and throat contingent; and Dick and David Kaufman were part of the ophthalmological team. John Hueston, in the Plastic and Reconstructive Surgery field, initiated these meetings. Incidentally, it was John who invited me to attend on my return to Melbourne in 1974, after three years working in head and neck surgery in London and the Marsden. Who would have thought that Orwell would have been quoted at a Head and Neck meeting at the RMH. Needless to say, I only realised its significance later. Now let me turn the page over to the clinical domain, where ‘when things do not add up’ bells should ring – sonnette d’alarme. These clinical cases recall the Munchhausen pattern of fabrication.
Their immediate response guided the Cessna to the closest landing site. As Dick recounted, “What a Godsend”. The Cessna crew conveyed their grateful thanks, but the response from above came back cryptically in an American drawl, “big brother is watching you.”
The Baron Munchausen was a soldier in the Russo-Austro-Turkish War of the 1730s. He survived and returned to publicly reveal his experiences of daring exploits and heroic deeds – all fictionalised. Baron Munchausen was, in fact, a creation of German writer, scientist and con artist Rudolf Erich Raspe. He would falsify and fabricate while entertaining the masses. As Mark Twain said, “Never let the truth get in the way of a good story”.
Dick told this story at the Head and Neck meeting at the Royal Melbourne Hospital (RMH) on his return. These RMH meetings were held every Monday morning at
However, when fabrications and falsehoods occur in a treatment environment, these patients show psychological tendencies that can
The Surprising Adventures of Baron Munchausen by Rudolph Eric Raspe
border on psychopathy, including Machiavellian scheming. Cognitive dissonance creeps into the equation when actions and behaviour do not match. Note, my findings are based on observations without any psychiatric qualifications. Here’s a worker’s compensation case where bells should have rung earlier, before the operations reached double figures. A patient rotated between consultants orchestrating and even suggesting future procedures to improve function – all under workers compensation. A mallet finger splint failed, as did the K-wire, as did the tendon graft that became infected. This produced septic arthritis of the distal interphalangeal
