They were fused at the skull, their brains a hair’s breadth apart, connected by a small collection of blood vessels. Will Rodgers was part of a team separating the six-month-old conjoined twins, Rital and Ritag Gaboura, at Great Ormond Street Hospital in 2011. His role was to make the shared area of scalp grow new skin, by inserting an inflatable expander, which is like a balloon, and periodically, over several weeks, injecting a saline solution into it. This gradually stretched the covering skin so it could be drawn across the wounds.
The twins were separated, creating two separate little girls. The chances of survival for twins joined at the skull are one in 10 million. “It was amazing: one day they were lying head to head and the next they were lying side by side,” said Rodgers.
Rodgers had been on the point of giving up medicine. Having completed his degree and two foundation years in regional hospitals, he was still unsure of his place in the medical picture. As a last-ditch attempt to resolve his dilemma, he responded to a call from a charity named Facing Africa. They were looking for doctors to go to Ethiopia to treat Noma, a gangrenous infection that ravages the face and mainly afflicts children.
There he discovered he had the qualities required for the high precision surgery involved in facial reconstruction. Was Rodgers scared, performing surgery for the first time? “No, I was excited. It felt great to be able to make a practical difference with my hands.”
The hands are a constant preoccupation. He avoids coffee because of the infinitesimal tremors it gives him.
It takes about 18 years of training to acquire the necessary skills to be an oral and maxillofacial surgeon, which treats mouth, face and jaws. This specialty is unique in requiring medical and dental degrees as well as an alphabet soup of other qualifications. For all this investment, Rodgers still rides a motorcycle to work every day. “If I smashed up my hands I’d be really pissed off.”
He has a sleepy, laid back smile that belies the huge responsibility he holds at his fingertips. He is an expert at zoning in on the small details – each slice of the scalpel or stitch of needle. This is his secret to remaining undaunted by the vast complexity of the operations he performs. “If you stopped and thought about exactly what you’re doing, you would have a hard time carrying on.”
For Rodgers, one distorted face is no more shocking to confront than another. He is in the privileged position to have learnt to see his cases objectively as physical facts; for many of his patients their alarming appearance can effectively remove their ability to participate in society. “We are masters of reading faces. The human brain is unbelievable at understanding or at least thinking it can understand a huge amount about a person by the way that they look. We can tell the most subtle of changes. People can’t help but notice someone walking across the street who looks a bit weird and you can see how that would have a massive impact on you if you were that person.”
Gaining the trust of patients and their families is important. “There is an art to it. You often can’t tell them exactly how they’re going to look, and if you could it still wouldn’t be quite how they imagined it. You try to encourage people to come to terms with the validity of their expectations.” He realised the importance of communication when he faced nearly insurmountable difficulties in Ethiopia, where there are over 77 spoken languages.
Rodgers points out that in those cases where too little of the facial structure remains, current techniques can do little to help. Oral and maxillofacial surgery is evolving. Each case is different and surgeons are constantly expanding the frontier of what is possible. Rodgers is working on improving procedures for a disease called hemifacial microsomia, in which the lower half of one side of the face is underdeveloped and grows abnormally, mostly affecting the jaw. He says: “At the moment there are treatments to make the jaw longer. We’re trying to design a procedure that will give a more normal shape. Instead of moving it in one plane, we will be able to move the jaw around in several planes. That’s the plan anyway.”
It is when Rodgers contemplates the precision and drama of being in the operating theatre that his excitement is most palpable. “There’s a calmness that you never find elsewhere, because you can’t let anything else in the world bother you. You have to be completely in the moment. It’s relaxing somehow, because you know that all you need to do after that is the next step. ”
Qualifications: It takes about 18 years to fully qualify as an Oral and Maxillofacial surgeon at consultant level. The journey starts with a first degree in either medicine or dentistry, which takes five years. This is followed by two years in foundation training, and then a further degree in medicine or dentistry – whichever has not yet been done – which takes three to five years. Trainees must complete the MFDS (Member of the Faculty of Dental Surgery) and MRCS (Member of the Royal College of Surgeons) diplomas, one of which can be gained during the second undergraduate degree, and the other shortly following. Following this is specialty training, which takes three to four years. This can be followed by one to two years in practice to sub-specialise.
Hours: “Up to 84 hours in a week if I’m on night shifts, but then I might be off for a week.”
Salary: £30,000 – £50,000 as a trainee. £75,000 – 101,000 as a consultant.
Best thing: “The privilege of never being bored.”
Worst thing: “Jumping through hoops and box ticking to get the required training.”
The British Association of Oral and Maxillofacial Surgeons: http://www.baoms.org.uk/