Fighting the stigma of facial surgery
Jayaratnam Jayamohan is a paediatric neurosurgeon specialising in craniofacial conditions
Jayaratnam Jayamohan is a consultant paediatric neurosurgeon at the craniofacial unit of the John Radcliffe Hospital in Oxford. He was brought up in Liverpool and London, and studied at St Mary’s medical school in London. Jayamohan and his colleagues appeared on a BBC2 documentary called Children’s Craniofacial Surgery, which followed seriously disfigured children through life changing surgery. The Oxford Craniofacial Unit is one of four specialist centres in the UK that are licensed to undertake complex surgery involving the face and skull. The unit has developed a global reputation for the excellent psychological and practical support provided alongside the revolutionary surgery.
What inspired you to pursue a career in paediatric neurosurgery?
I have always been interested in neurology so I was initially going to be a neurologist. I did my elective at Queen Square (The UCL Institute of Neurology), and was alarmed by the lack of treatment options for many neurological diseases. I spent time with the neurosurgeons and thought “this is what I want to do.” I got into paediatric neurosurgery while I was a trainee, primarily because the patients were so much fun to look after, but also because of the huge breadth of subspecialties within this field.
What is your average day like?
My day starts at 7:45 am and finishes around 6 pm. I operate on one or two days each week, spend one day in clinic, and the rest of the time is spent attending multidisciplinary team meetings and doing paperwork. Each day of surgery is accompanied by a huge amount of ward work, which involves explaining diagnoses to families, discussing the operation, and showing them test results. That’s the big difference between paediatrics and adult medicine: there is more interaction with family members when caring for children.
What conditions do you see most often?
The craniofacial unit in Oxford is one of four centres in Britain that cares for children with craniofacial conditions. These patients comprise half of my job, and the rest involves children with tumours, hydrocephalus, trauma, spina bifida, and spasticity. Increasingly, antenatal diagnosis is creeping into my remit, which involves discussing options with pregnant mothers whose ultrasound scans have revealed some major abnormality. This is quite stressful but rewarding.
You recently appeared in the BBC2 documentary Children’s Craniofacial Surgery. What were you hoping to achieve?
Our primary aim was to increase the public’s knowledge about the unusual conditions that we deal with daily. Although children with such conditions can have a good quality of life, they look and behave differently and can therefore be severely affected by society’s reaction. You hear horrendous stories where people in the street stop and stare. Once, an adult told one of my patients that they “look like a monster.” This is not something that children and their families should have to deal with. We were hoping that by demonstrating these children are just children, despite looking different, it might remove some of the stigma. I think it did.
Do you believe it is necessary to remove yourself emotionally from your work?
No, I don’t think you should, but there’s a fine line. You need to be able detach yourself to the point where you can accept that what you do to a child might make them worse. However, you can only logically accept this if your aim is to make them better in the long run. This decision about what’s best for the child has to originate not just from clinical but also from emotional and moral factors. So when deciding whether to operate or not, or when talking to families about whether to withdraw treatment, you must keep the child at the forefront of your mind. To do this, I think you need to maintain an emotional link with your patient, but equally you can’t let it compromise their treatment.
What has been the proudest moment of your career?
Every time you come out of surgery and you’re waiting for the patient to come round, particularly if the surgery has been challenging, it’s a hugely proud moment when they wake up in a good condition. Similarly, when a test confirms that a patient has been cured of a problem, I feel incredibly proud.
Is there anything that you dislike about your job?
The thing that I dislike is the unbelievable, relentless grimness of it. Having to tell parents that their child has a malignant condition or that their child is going to die is awful. I have three children of my own, and, since I became a father, it has been even more of a wrench because I always think “what must it be like?” It makes me feel sick, but, although horrible, it’s part of my job.
Do you ever miss working with adult patients?
No, never. My kids [patients] are just amazing and I love looking after them. I do look after adults in that the patient’s family are part of the disease. We have to try to keep the mums and dads in one piece while we’re steadily chipping away at their lives. I guess we’re sort of psychiatrists for the parents while being neurosurgeons for the children.
What qualities are needed to be a successful paediatric neurosurgeon, and what advice would you give to students wanting to work in this field?
In terms of personality, you need to be robust. You have got to be able to interact with children and their families, and make them relaxed. You must be good at handling difficult situations and breaking bad news on a regular basis. You also need to be physically strong to be able to cope with the lengthy operations, which can last up to 12 hours. It’s the best job ever, but it isn’t for everybody. I advise students to really think about exactly what they would be good at and what they would enjoy. Factors such as what society or families expect should not come into play. Everyone considers their specialty to be the best, which is a reflection of the fact that most medics have managed to find a career that suits them. That’s the great thing about medicine: there’s something for everyone.Emilie Green, Clegg scholar, BMJ
Correspondence to: firstname.lastname@example.org
Competing interests: None declared.
Provenance and peer review: Commissioned; not externally peer reviewed.
Cite this as: Student BMJ 2012;20:e6035