Surgical Tools

The years surgeons spend huddling over operating tables gives them a dank curvature of the spine that falls somewhere between disease and masochistic self-harm. It’s a characteristic stoop that makes them more at home over a gasoline fire under a Los Angeles bridge than in the OR. Much to our collective chagrin, there are times when the egomaniacal trolls of surgery horror stories ascend from beneath their bridge to remind us of their continued, polarizing existence. There was one such surgeon who stood out for me on my first surgical rotation of medical school. He had chastised me for interrupting his conversation with a colleague who I wanted to apologise to for missing one of his tutorials, shocked at the gall of a medical student for interrupting two surgeons as if the idle chatter amongst the two was akin to the final draft of the Magna Carta. These weren’t just your run-of-the-mill physician doctors who simply titrate doses of heparin and hope for the best. These doctors had attended 7am meetings more than other doctors during their careers and were thus entitled to their air of superiority. This was all coming from a man who wore a knee-length, cream-coloured overcoat during the summer end of Autumn in Sydney, Australia, with the hope that clicking his brown loafers together and whispering “there’s no place like home” would transport him back to cobbled streets of London. I apologized and walked away, of course, but the moment coloured my perception of him thereafter.

Two weeks later, numerous attempts at caffeination and eight hours of sleep the night before was still not enough for me to resisted bleary idleness when the morbidity and mortality meeting began at 7am on the third Wednesday of my vascular surgery rotation. This meeting was a regular fixture for the general surgical teams, a chance to gather in a single room and explore the inevitable complexity of operations. The name is fairly macabre, but it is made up for by its delectable abbreviation, a mind-trick probably aimed at the somnambulant medical students who so reluctantly attend. Meetings are generally run by a different doctor each week, presenting a patient with complex injuries whom the hospital has, for one reason or another, generally failed to stave off the ill effects of their initial injury. HP was this weeks case, a 44 year old man brought in by ambulance at 5am one morning with a few cuts on his head, some bruises, and multiple internal injuries on account of falling eight stories onto concrete from his apartment building in the city. BP crashing, GCS 3, and with an unknown source of internal bleeding, the on-call surgeon was summoned for an immediate exploratory laparotomy. The surgeon who had berated me was the on-call and was present at the meeting to give his version of events and help in deciding what went wrong. His demeanor discussing HP came as no surprise; loud, arrogant, and critical of the nursing and ED staff who defied his orders by sending the patient to CT rather than the OR. He sent constant verbal reminders to the audience of how his decision-making was correct, and that a surgeon should not be contradicted in any situation where he makes the calls. The impression I got was of the surgeon validating his role in the management of the critically ill patient. He is the one with the skills and clinical experience to be in a position to make the call, and so the chain of command needed to be followed.

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I found this incident a curious indictment of the profession, yet at the same time it offered a profound insight into the mind of a surgeon. My personal misgivings coloured my negative perception of him, with little chance for retribution. Yet by sweeping this aside, the decision-making that surgeons are entrusted with seemed to validate his obnoxiousness so that it was necessary as to fortify his position and to help get things done. Decisions are the cornerstone of surgeries; fine motor skills and suture ties can are learned physical attributes, but it is the intangible constellation of logical deduction and clinical acumen that plays a much larger role in the operating theatre. This was said logic at work; the unrelenting, uncompromising veneer of a surgeon who had weighed up all options within ten seconds of being roused from his sleep by the beep beep beep of the on-call phone and come to a decision. Its no wonder the surgeon’s personality in some instances borders the obsessive and aggressively defensive. Confidence need not be mistaken for arrogance, but the two don’t necessarily dislike each other.

In spite of the cosmetic issues surgeons face, the profession still stands as a goal-oriented, patient-centered activity. Professionalism dictates that the surgeon performs at his or her best, regardless of the consequences. What does the on-call surgeon care if a room full of junior doctors, 5 minutes out of medical school with one eye on the exit door, think he is a jerk?