Orthopaedic surgeon Shane Prodger grew up in Lismore and returned here after study to establish his career and connection to the community. He shared his story with Sara Browne.

I grew up in Goonellabah. My sisters and I went to St Carthage’s and Trinity. They still live around here and my folks are in Ballina which is nice.

I went to Brisbane and did PE teaching for a year and then I changed to Physio and finished it. Then I worked as a physio for four or five years. I wanted to do medicine in school but in year 12 I was more interested in things other than studying. But that thought never left my head so after working as a physio I thought I’d go back to study. I was in my late 20s when I went back to uni, I thought I was maybe not young enough for five more years of study, but saying that now – it’s clearly young enough. At the time, I wondered if I could go back and do this. It worked out well.

There are no medical people in my family. Dad drove heavy machinery and had a business with his brothers. Mum was a receptionist in a medical centre so I would spend some time there after school. Not that I really had any exposure to the doctors. I wanted to do something that helped people and I wanted to go to uni and I liked health sciences at school. I liked biology. It didn’t quite play out after school which was not a bad thing at all. I had time to do other things like travel. Then the time was right in my life to go back and do what I thought I wanted to do.

I lived in England for two years and did a working holiday. Every dollar that I earnt I spent on a holiday. We’d work for a month then go on holiday for a month, usually somewhere around Europe but other places as well. There were heaps of us over there at the same time, a lot of my friends that I went to uni and college with. We all ended up in the UK at the same time.

School Maths Camp at Lennox Head Surf Club, 1988

Studying medicine wasn’t hard, you’ve just got to be committed to doing it, the same as any uni course. I don’t think it prepares you for what you’re in for when you finish medicine. That’s when things become hard. You have to do some work at uni but when you get a job, like anyone, that’s when you start working hard.

When you finish medicine, everyone starts the same, at the bottom level, there’s a real hierarchy. When you start as an intern, you’re doing the most basic things – writing up drugs, putting drips in, taking blood tests etc – it’s pretty basic stuff. Then you make some minor decisions around patients but it’s the levels up and ultimately the consultant who looks after the patient and makes the main decisions. It’s a slow progression. I could not tell you the first operation I did by myself, it would have been something very simple like taking some metal work out of a fixed bone or something like that. Surgery, in the most part, is really well supervised so it would have been very simple and supervised by someone who had done it many times.

When I was a medical student, I was sure I wanted to be a physician, managing medical patients. It wasn’t until I was an intern and I did a surgical term that I liked the thought of surgery but I didn’t particularly want to do orthopaedics. Then when I did an orthopaedic term, I realized that was what I wanted to do. But that didn’t crystallise for a few years after I’d finished medicine. Some people start medicine knowing they definitely want to be a surgeon or a GP or a radiologist or whatever.

I liked the thought of surgery because if there’s problem and a surgical solution and everything goes well, that fixes it in a short period of time. There are times that it doesn’t go well and that’s hard. That’s something that I certainly didn’t appreciate, when you start down that path, you’ve got to be able to accept the bad outcomes with the good. That’s really difficult because sometimes the bad outcomes are really bad, like if a patient is much worse than when I first met them. That’s not common. Most people do well and get benefit from their surgery but some have a complication or don’t recover as you’d expect and they’re worse. That’s hard to deal with. No-one wants to make their patient worse. It’s a stressful part of the job. Accepting that is the first step, that was hard for me to accept, particularly when I first started. When I’d finished all my training and it was just me and I made all the decisions, I did the operating, I carried the can, I was responsible for everything that happened to my patient. It was difficult to deal with. I can remember examples of patients that had a joint replacement which got infected. One person I’m thinking of couldn’t go on their trip of a lifetime for their 50th wedding anniversary and I felt completely responsible for that. That probably wasn’t fair on myself but at the start of your career, you do carry that burden. It doesn’t really get easier but it’s easier to accept that it can happen to some people.

There’s nothing in training about stress management or emotional toll, that’s largely left to the individual. To be fair, I finished medicine just over 20 years ago. In surgical training now there’s much more emphasis on the things around operating on patients like how to manage the work life balance, communication skills, broad strategies to help manage when things don’t go as well as you planned.

Wadi Rum, Jordan, 1997

I think everyone has to work out their own way of dealing with that. That’s definitely the hardest bit, managing your patient’s expectations if things don’t quite go right. The best bit, fortunately, happens with more frequency which is when patients get better and in orthopaedics its largely quality of life operations that I’m doing. If someone’s got hip or knee arthritis, for example, and it’s affecting their quality of life – they can’t play golf, they can’t go for a walk, poor sleep – then they recover from the surgery and all of those things are better. That’s very satisfying and that happens most of the time. Being able to take someone’s pain away with an operation and improving their quality of life – that’s why 90% or more of patients come and see me.

I’ve got three daughters, they’re all at high school. I don’t think they have aspirations for a medical career. They’re in the sweet spot of their young lives at the moment where they have to do some school work but not a lot, they’ve got nice friends. They have everything that they need. None of them seem to have any aspirations, or maybe they do and they just don’t tell me. My eldest has aspirations not to be at home anymore, she’s got her license and wants to be out with her friends which is nice. I think she’ll go to uni.

I do work a lot, at most it would be 12 hours a day and then one in five weekends are on-call at the Base Hospital. I do public and private work. The public commitment at the Base is to provide an on-call service 24 hours a day. There’s five of us that share that. That’s for emergency surgery. Those weekends can be quiet, I might go in once or twice on a Saturday and Sunday, or very busy like a normal work day.

Largely I enjoy my work but I look forward to when I have a break too. Bec, my wife, is really good at helping me with the work life balance. We’ve known each other since we were teenagers, we met at uni. She studied occupational therapy. I was 18, she was 17 when we met, so we’ve known each other through this whole journey to now – as students, then starting work, then a young family. She’ll say we’re having a holiday and I’m booked off the calendar and not working those two weeks. I’m not good at that. If I didn’t have someone like that then I would just keep working. It’s just my nature. It’s what I saw my parents do. It’s not good or bad, it’s just how I work. I think a lot of medicos are probably the same.

We’ve got a small property so I like to potter around in the paddock and do work outside on the house. I really enjoy golf so I try to do that as often as I can. I really like listening to music so I’ve got a big music collection. I’ve got a broad taste in music, popular music from the 60s, 70s and 80s would summarise it, things like Led Zeppelin and the Beatles. Definitely not jazz or classical, I have zero records of those genres. We’ve developed a lot of friends here over the last ten years so I like to see friends on the weekends. I like all the simple things that everyone wants to do on the weekends.

I’m very connected to this area. When I finished my training, I started work as a surgeon in Brisbane and Bec and I imagined that I would finish my career there and then move back to Lismore at some stage to retire. We’d been in Brisbane for the best part of 20 years, that’s where I did my early work. We had strong roots there, all of my medical friends, most of our college and university friends. I’m not really sure what the turning point was. The choice was to establish a practice in Brisbane, invest money and time, and go along that path for the next 15 or 20 years there. We started to have some doubts as to whether that was exactly what we wanted to do, even though that’s what we had always planned to do. A job started to crystallise in Lismore and I applied for it and got it. It all happened really quickly. It’s been a great thing. I couldn’t imagine living in Brisbane anymore. We’ve got lots of friends in Brisbane and we’re looking forward to getting up there and seeing them soon but this is definitely where we want to be.

Christmas is busy. I think some people have jobs where they have downtime over Christmas, their business or their trade, so they have a period where they don’t work and can recover from an operation. Leading up to Christmas always seems very busy, coupled with the fact that theatres at the public and the private hospital usually close for two or three weeks.

When I’m on call for emergency treatment, the idea of people’s mortality crosses my mind. That’s more with elderly patients who’ve broken their hip, for example, and are getting toward the end of their life and there’s decisions around whether that person should or shouldn’t have surgery. With that patient and their family, there can often be spiritual questions. There are obviously moral questions as well, as to whether to offer patient’s treatment. I’m lucky, on a day-to-day basis in my rooms here, that’s largely not a consideration. I’m not dealing with anyone who’s facing those mortality decisions, it’s quality of life surgery that I do.

It can be a draining thing to keep caring for people. It’s easy to get compassion fatigue, particularly as the year passes. I don’t know why that is. I think, like everyone, you can see the end of the year and you want to have a break. There are some patients whose personality make it difficult to be compassionate. Fortunately, I have insight into that and can see if I’m headed down that path and am able to reset. It’s really hard to get a good insight into someone’s life when you meet them for 15 or 20 minutes and you’re talking about their sore knee. I think it’s easy to lose sight of the fact that this person has probably got so much else happening in their life that contributes to how their presenting on the day. I think that’s a function of what I’m focused on when they come to see me and the pressures of time and wanting to make a sensible plan for their management. I think that compassion fatigue comes out of probably not completely understanding the patient as well.

Doctors don’t talk about compassion fatigue, in broad terms, surgeons certainly don’t. It’s something that can worry me, that I’m losing some compassion for some patients. That’s the reason why ultimately, almost everyone does medicine, they care about other people.

I don’t worry about my hands enough. In fact, I fractured my left hand about four years ago playing sport. I’ve since given up that sport. I needed an operation on my hand, I was out for a couple of months. I got one of my best friends to do the operation so I put all the pressure on him. Like everyone, you put your hands a bit too close to the mower when you’re puling the grass out. I’d have to have a change of career. I actually don’t know what I’d do. I’d probably buy a small business. I like people. I like being around people. I used to say I’d buy a newsagent but I think a newsagent is probably not a great business anymore so…maybe I’d buy a coffee shop. I think I’d struggle to do anything else in medicine.

I think I’ve probably got another 10 years of good service and then after that, my wife and I want to travel. We want to be grey nomads and get a campervan and drive around Australia for a year and come back to live around here and play golf and enjoy this area.