Surgery

My first serious surgical experience was on my second day as an intern (or “junior resident,” as we were called then). I was on call for the surgical unit in a regional referral hospital, and my surgical consultant had just returned from a tour of duty in Vietnam. He was always full of adrenaline, and to underline this fact wore his army camouflage suit around the hospital. I was just slightly afraid of him.

I was called to the emergency department in the early afternoon to assess a 9-year-old boy who had been brought in after a two-wheeled cart tipped over on his abdomen. There was no penetrating injury, but the boy looked bad—pale, sweaty, and scared. We stabilized him and arranged for him to go straight to the operating room for an exploratory laparotomy, suspecting that he had a ruptured spleen. Captain Camouflage was in his element, and more so when we identified that the boy had not ruptured his spleen but had somehow torn some mesenteric vessels. They were bleeding at an alarming rate, and as I was trying to clear the suction tubing I started to feel dizzy. 

You can probably guess the rest. To my credit I didn’t faint, but I certainly wasn’t much help for the rest of the procedure. Fortunately the surgical cavalry arrived, the bleeding was stopped, and the boy recovered nicely—faster, in fact, than my pride. Captain Camouflage never let me forget the episode. So he was mildly surprised when I told him that I had decided to go into a surgical specialty, and I didn’t do so to prove that I could handle five-alarm bleeding. I just liked obstetrics and gynecology. So I became an obstetrician-gynecologist.

I wasn’t too far advanced in my career when I began to enjoy performing microsurgery, and before long I was simply a gynecologist. The reconstructive work that we did was effective if done right, and there was professional satisfaction in seeing women benefit from their surgery. But selfishly, the real joy for me was the technical satisfaction of completing a complicated surgical procedure that few other people could actually do. There was also the whole ritual aspect of surgery—something that people outside surgical specialties cannot really grasp.

Performing surgery involves multiple rituals, each of them reassuring to the surgical team and, for the most part, to the patient. Entering the operating room, with its smells, its scrubbed cleanliness, its sounds, and its masked occupants, is a quasi-religious experience. The double-checking of the patient, the chart, and the equipment to be used, as well as the hush in the room as anesthesia is induced—all of these have a steadying effect on the surgeon and the team, and reassure the patient that all will be well. There is the professional satisfaction of being part of a skilled team, wherein everyone has a role and respects everyone else’s role. There is camaraderie and there is warmth. There is the glow of satisfaction when the procedure is successfully completed and the patient wakes up and is wheeled from the room. 

I’m going to miss all of this, because I have decided to stop performing surgery. It’s important to know when the zenith has passed, and I think mine has. A mentor once told me, “Get out while you can still do it.” So I will—but with more than a tinge of regret, and nothing but good wishes for the next generation of surgeons. Lucky them.
—TCR