A more mellow Mellow

By LIBBY MIDDLEBROOK

You get the feeling Cary Mellow is quietly considering the characteristics of your face, even when you're discussing his fishing boat. He probably can't help it.

The Auckland plastic surgeon has been nipping, tucking and repairing limbs, faces and skin for more than two decades, in the public arena and the lucrative private sector.

But last week he suddenly quit his high-profile job at Middlemore Hospital, saying he could no longer tolerate the lack of funding in public health.

His resignation, as head of plastic surgery for the Counties Manukau District Health Board, came as top orthopaedic surgeon Bruce Twaddle was reprimanded by the Auckland district board for his public criticism of bed reductions, a reprimand later withdrawn.

Mellow does not seem the sort of person who gets fiery about much.

One of his private practice colleagues fondly said he would "be asleep" if he were any more laidback.

Yet he gave away his job, resigning quietly in an email and then publicly condemning the funding package received by his department.

"We all feel that Middlemore has been severely under-funded for decades. It's all very tiring and there's a great deal of frustration that it takes so long for anything to happen," he said.

His short figure rocks from side to side as he walks. A gust of wind once blew him out of a tree he was pruning, injuring his leg and leaving him with a limp. He also had his face rebuilt five years ago after a disgruntled patient attacked him with a mallet.

At 46, he is not old, but he feels it. "I'm old and tired. When you've spent a weekend at Middlemore you feel very old and very tired."

On the day he resigned, he was working on call and struggling to meet his elective surgery schedule. It was no different to any other day at Middlemore. It is always busy. Patients are always waiting.

"I think I just got really, really frustrated on that day. I was on call, people were waiting, the frustrations just came to a head. There was a feeling of 'why am I spending all this time doing this and not achieving as much as I'd like to achieve?"'

Mellow left the office and was home by 4pm. Over a mug of tea he calmly came to a decision.

What followed was an email of resignation to three of the hospital's senior managers and his department staff, outlining the difficulties of his job and what he saw were Middlemore's problems.

Remaining as mellow as his name implies, he quietly and firmly defends his decision to quit.

It was not a financial decision, he says, to allow him more time in private health.

"I've worked in public health for 14 years. If you work in the public hospital system you're certainly not high-priced. We work there because we want to achieve things."

He has largely dedicated his career to public health until now, because he wanted to "repay" the training he'd received, help teach new recruits and care for patients who could not afford private treatment.

"I think I've paid my debt. It's very tiring and there's a great deal of frustration that everything should take so long. It's a piecemeal thing, it's been a matter of keeping on going back to the well and getting little increments."

He is conservative in his use of language but the word "frustrated" occurs a lot. The only physical sign of emotion is in his thumbs, which busily pick at each other as he talks.

Mellow said the frustration had been mounting, mainly because of poor funding, but also because of problems recruiting and retaining staff and long patient waits for elective surgery. He knows these are problems common to many hospitals but no longer wants to put on a brave face.

"It's frustrating that you're trained to do very special things and you have difficulty doing that when there are people who have the need."

He is quick with examples. There was the woman due for a breast reduction operation last week, who was sent home from hospital hours before surgery because of a more urgent case. She will have to bear the weight of her breasts, which require the backing of a 24G-sized bra, for at least another fortnight.

There are also the young boys with penises deformed by a condition called hypospadias, which means their urethra opens on the underside of the penis, rather than at the tip. Two surgeons trained to carry out the corrective surgery used to perform the operations at Middlemore but when one quit there was no money for a replacement.

"Ideally they're operated on aged 3 to 4 so they are normal little boys when they go to school. Now we're getting children in who are sometimes 6 years old. It's very hard."

Middlemore Hospital said it was disappointed at his resignation.

But Mellow's family couldn't be more delighted. After the announcement his children - Sarah,14, and David, 16 - sent him a bunch of flowers and a message saying, 'We're pleased we're going to see you again, daddy'.

"Working in a public hospital means a huge commitment and it impacts on other aspects of your life. It really was a life thing. A lot of people think I'll be a happier and healthier person now," said Mellow.

It will not be easy for him to say goodbye. His working career began at Middlemore in 1978. As an Auckland University student, he spent Friday and Saturday nights inside the hospital emergency department, stitching up skin under the instruction of plastic surgeons.

He worked overseas before returning to Middlemore in 1989, where he has remained.

Today he is known as the man who led pioneering surgery to reattach a 2-year-old boy's lip, severed in a dog attack in 1998, using leeches in the treatment.

For five days, while little Samuel Martin's body fed on hospital drips, a bunch of bloodsuckers fed on him. At the time there were only 10 documented cases of lips being "replanted".

Mellow already laments his departure from public health. Middlemore's reputation overseas helped him to find work in America in the 1980s, and he says he will miss the spirit of hospital staff.

"In a strange way I've enjoyed being head of department because I've wanted to make things happen."

He credits himself and other colleagues for raising the standard of Middlemore's plastic surgery department and hopes his resignation will speed the return of former Middlemore surgeons from work overseas.

"I'm not indispensable."

In less than three months he will leave the sterile corridors of Middlemore. There will be no more burns victims, with skin like pork scratchings, or limbs to reattach.

In his private Greenlane surgery there are floral couches in the waiting room and a trolley for coffee and cookies.

In the new year, most of his time will be spent on ACC-contracted surgery, congenital hand and eyelid operations, and surgery to improve the aesthetics of his patients' faces and bodies.

He says he is looking forward to the work, which will see him reshape eyes and vanquish wrinkles, seeking to improve what nature or age has dealt his clients.

He hopes to stay on teaching young doctors at Middlemore and at Auckland University, where he is a part-time clinical lecturer.

"Working at Middlemore is interesting and challenging. It [working privately] will still be very stimulating, but it won't be as frustrating."

His resignation will also mean more time for him to go fishing. He says he fishes "not very well" but you get the feeling he probably catches quite a lot.