Surgical Bravado
Day before yesterday, I was standing in the operating room with a senior anaesthetist. Like every surgeon anaesthetist conversations, ours was directed to talking about the patients we have seen. The senior anaesthetist,was narrating about a surgical bet. One of the busy laparoscopic surgeons of the hospital made a challenge that he would complete the cholecystectomy and appendicectomy within 15 minutes ( I am not aware of any situation when these two diseases are present in the same patient in the same time). He went on to do the surgery within the specified time. I was aghast. I politely told the anaesthetist that it is not a wise thing to provoke a surgeon to do so and as an anaesthetist, he should have put the brakes.
It is not unusual to find such bravado among surgeons. Samuel Mixter's presidential address to the American surgical association (Boston,1917)published in the Annals of surgery is an apt reminder to the times we live in. He calls these surgeons - "near surgeons". It is true that as in every profession, we do still find men who are careless, over enthusiastic and rash.
During my surgical training in the late 1990s, I was asked to supervise the work of junior postgraduates during emergency surgeries. Once I sent a couple of surgeons to do a simple perforation closure. They did not return for more than 2 hours, I went down to check. I found that they had resected a portion of the intestine and were reconstructing it by an anastomosis. Worried that the patient might have had a different issue, I probed into the matter. I was shocked to find out that they had done it on purpose, so that they can learn to do the anastomosis. Needless to say, those surgeons were never again allowed to operate independently.
Surgical bravado is hoping to perform an operation that is unnecessary or useless, just for the sake of performing the operation. It is common in India and it is sad indeed that among the commotion of commercial practice, the sane of voice of true surgeons are lost. The steel of surgery is not for play and its blades are not to sharpened for money. Yet, it has happened in the past and continues to happen.
"A true surgeon is never fearless. He fears for his patients, he fears for his short comings, his own mistakes, but never fears for himself or his professional reputation. His fear makes him a better man." Noble words from Dr. Mixter's address. It is so surprising that nearly a 100 years later,I find the same incorrigible sin among us.
Though done in the theatres, surgery is hardly a performance to watch. It is blessing to touch upon the very inner parts of man to heal him by the methods we know of and the sanctum of surgery is love and trust. A few near surgeons among us will destroy the very fabric of trust that is needed to cure.
Television and media are considered important for the business end of our profession. While the media (both television and the press) are unbiased, it is good to use them to reach the public for awareness and prevention. But good work has rarely been done in the glaring lights of publicity. One must realise that what we enjoy as benefits were brought home by men, who worked hard in the shadows of life and made changes that benefit mankind as a whole. These men, surgeons and physicians died in the shadows. Let it not be forgotten among us, that good surgery also has to go the same way. If we let the bravado go on, it may be that one of us or our children will be under "near surgeon's" knife sooner or later.
Years ago, when I was a young surgeon in practice, the senior surgeon who worked with me will operate on one appendix a day, while I would do the same surgery once or twice a month. One of senior management commented about my low statistic, I replied that I need to operate only on the right indications and would not budge. I earned far less, but I was a very happy man. In time, all the colleagues and the management would consult me for their personal surgical problems and take my advice even though I was only the junior most surgeon among the consultants.
Truly, surgical bravado must be watched for. It is rarely done in public, so awareness is important. It is probable that it is a training error. After all, it is an attitude issue and training can make only a little difference.
My prayers everyday are that I never stoop down to the level of a near surgeon even in abject poverty and pain.
It is not unusual to find such bravado among surgeons. Samuel Mixter's presidential address to the American surgical association (Boston,1917)published in the Annals of surgery is an apt reminder to the times we live in. He calls these surgeons - "near surgeons". It is true that as in every profession, we do still find men who are careless, over enthusiastic and rash.
During my surgical training in the late 1990s, I was asked to supervise the work of junior postgraduates during emergency surgeries. Once I sent a couple of surgeons to do a simple perforation closure. They did not return for more than 2 hours, I went down to check. I found that they had resected a portion of the intestine and were reconstructing it by an anastomosis. Worried that the patient might have had a different issue, I probed into the matter. I was shocked to find out that they had done it on purpose, so that they can learn to do the anastomosis. Needless to say, those surgeons were never again allowed to operate independently.
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| Under the knife - Esophagectomy in progress. |
"A true surgeon is never fearless. He fears for his patients, he fears for his short comings, his own mistakes, but never fears for himself or his professional reputation. His fear makes him a better man." Noble words from Dr. Mixter's address. It is so surprising that nearly a 100 years later,I find the same incorrigible sin among us.
Though done in the theatres, surgery is hardly a performance to watch. It is blessing to touch upon the very inner parts of man to heal him by the methods we know of and the sanctum of surgery is love and trust. A few near surgeons among us will destroy the very fabric of trust that is needed to cure.
Television and media are considered important for the business end of our profession. While the media (both television and the press) are unbiased, it is good to use them to reach the public for awareness and prevention. But good work has rarely been done in the glaring lights of publicity. One must realise that what we enjoy as benefits were brought home by men, who worked hard in the shadows of life and made changes that benefit mankind as a whole. These men, surgeons and physicians died in the shadows. Let it not be forgotten among us, that good surgery also has to go the same way. If we let the bravado go on, it may be that one of us or our children will be under "near surgeon's" knife sooner or later.
Years ago, when I was a young surgeon in practice, the senior surgeon who worked with me will operate on one appendix a day, while I would do the same surgery once or twice a month. One of senior management commented about my low statistic, I replied that I need to operate only on the right indications and would not budge. I earned far less, but I was a very happy man. In time, all the colleagues and the management would consult me for their personal surgical problems and take my advice even though I was only the junior most surgeon among the consultants.
Truly, surgical bravado must be watched for. It is rarely done in public, so awareness is important. It is probable that it is a training error. After all, it is an attitude issue and training can make only a little difference.
My prayers everyday are that I never stoop down to the level of a near surgeon even in abject poverty and pain.
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