Subscribe to The Podcast by KevinMD. Watch on YouTube. Catch up on old episodes!

We sit down with William Lynes, a urologist and author of A Surgeon’s Knot, as we delve into the captivating narrative of the highs and lows of a surgical internship. Join us as we unravel the intricacies of the surgeon’s knot and navigate through the tangled complexities that come with it. Through tales of suspense, tragedy, and occasional humor, William paints a vivid picture of the challenges and triumphs faced in the medical profession. With a blend of real-life medical experiences and meticulous research, William offers a compelling portrayal of the realities of a medical internship. So grab a seat and get ready to be inspired by the resilience and dedication of those in the medical field. Don’t miss out on this insightful conversation that sheds light on the demanding yet rewarding journey of a medical intern.

William Lynes is a urologist.

He discusses his book, A Surgeon’s Knot.

Our presenting sponsor is Nuance, a Microsoft company.

Do you spend more time on administrative tasks like clinical documentation than you do with patients? You’re not alone. Clinicians report spending up to two hours on administrative tasks for each hour of care provided. Nuance, a Microsoft company, is committed to helping clinicians restore the balance with Dragon Ambient eXperience – or DAX for short. DAX is an AI-powered, voice-enabled solution that helps physicians cut documentation time in half. DAX Copilot combines proven conversational and ambient AI with the most advanced generative AI in a mobile application that integrates directly with your existing workflows. DAX Copilot can be easily enabled within the workflow of the Dragon Medical application to bring the power of ambient technology to more clinicians faster while leveraging the proven and powerful capabilities used by over 550,000 physicians.

Explore DAX Copilot today. Visit https://nuance.com/daxinaction to see a 12-minute DAX Copilot demo. Discover clinical documentation that writes itself and reclaim your work-life balance.

VISIT SPONSOR → https://nuance.com/daxinaction

SUBSCRIBE TO THE PODCAST → https://kevinmd.com/podcast

RECOMMENDED BY KEVINMD → https://kevinmd.com/recommended

GET CME FOR THIS EPISODE → https://earnc.me/SZFFI8

Powered by CMEfy.

Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast, and get CME for this episode by clicking on the CME link in the show notes. Today we welcome back William Lynes. He is a urologist, and we’re going to talk about his book. It’s called “A Surgeon’s Knot.” There’s an excerpt from that book on KevinMD. William, welcome back to the show.

William Lynes: Thanks for inviting me, Kevin. It’s nice to be back.

Kevin Pho: So William’s been on many times in the past. Go to KevinMD.com/podcast, search for his name to hear his story and prior episodes. But today we’re going to talk about his book, “A Surgeon’s Knot.” So before we talk about the book, just tell us what led up to you writing it.

William Lynes: Well, I’ve been writing medical fiction now for, well, 20 years I guess. There’s a book called “The Making of a Surgeon,” which I read even before medical school, that chronicled an internship by this young surgeon, and I always had that in the back of my mind. And so it’s sort of written in the same fashion. It’s a story of a one-year surgery internship in a teaching institution. So that’s sort of how I came about doing it.

“A Surgeon’s Knot,” the title refers to a knot that’s used in surgery, of course, but it also refers to sort of the tangled web that the protagonist, his name is Jackson Cooper, gets in during his internship.

It’s set in Northern California, in a teaching institution, a mythical teaching institution called University Medical Center. It goes from June of 1981 until June of 1982, this Jackson Cooper’s internship. It’s a story of the difficulties of a surgical internship in the 1980s, and I hope it still has some relevance today. It talks about his difficulties practicing medicine and learning to be a surgeon.

It also brings in sort of a dark edge to him, in that he unfortunately is a Percocet addict. He got started taking Percocet in medical school, and this sort of progresses throughout his entire internship, to the point where he’s stealing fentanyl out of the anesthesia cart. And so that’s a troubled aspect of it. But it ends on a good note, with him going into rehab and making it through his internship.

Kevin Pho: So for those who aren’t familiar, tell us literally what a surgeon’s knot is, and how is that a metaphor or a motif in your story.

William Lynes: Well, a surgeon’s knot is a simple double throw knot which is used to secure several knots, and every surgeon uses it. And in this particular story, like a lot of surgical trainees, Jackson excessively practiced learning to throw knots, and surgeon’s knots. So that’s sort of where the name came.

But if you read the story you’ll see interesting characters, difficulties, the problems, and I think sort of it’s sort of like a knotty world. So it has sort of a double motif to it.

Kevin Pho: You mentioned that the protagonist had to overcome obstacles about surgical training in the 1980s. Tell us about some of those obstacles that trainees during that era would typically face.

William Lynes: Well, it’s sort of an overwhelming situation of every other night call, typically long days in the operating room and on the surgical ward, sleepless nights in call rooms, frightening, terror type episodes with major trauma in the emergency room and the operating room. So it’s a long, long course for an intern and a resident, and that’s what I try to portray in the book.

Kevin Pho: So regarding the issues that face your protagonist, his name I believe is Jackson Cooper, is that right? So tell us specifically what issues of training affected your protagonist.

William Lynes: Well, it begins with a situation where he is in his very first day of being called a doctor, his first day of internship. And he happened to get a few minutes of sleep in the call room, but he’s woken up out of a deep sleep by a nurse named Julie who’s screaming on the phone saying, Mr. Simpson is bleeding and he’s going to die.

And so he, this young intern who really hasn’t the experience with things like this, goes running to the surgical ward to find a patient who had a carotid endarterectomy several days before, but now has what’s called a carotid blowout, where the wound has dehisced and there’s blood all over the place. And unfortunately Mr. Simpson, that is the name of the patient, expires after being resuscitated for quite a while by Jackson and by the staff of the hospital.

And the surgeons who were really responsible for this man’s care were really unavailable. And so the detail of having to tell the family, who were in the waiting room, about the unfortunate death of their husband and father, falls on this young intern Jackson. And he has to go out in the waiting room, and there’s a very touching, I think, situation where the crying widow gives Jackson a wedding ring to put on the dead man’s finger. And so that’s the end of the first chapter. So that’s a good introduction to it.

Kevin Pho: So you had your protagonist Jackson Cooper undergo a character arc of self-destructive behavior, drug abuse and whatnot. So what was the reason for that? Are those informed by some experiences that you’ve seen throughout your own career?

William Lynes: Luckily I never have had a substance abuse, but Jackson Cooper is in a lot of ways myself. My internship was at Stanford University Medical Center. If you trained in that era, you’d recognize it.

I never had a substance abuse, but it certainly was a problem and is a problem in the medical profession. And I put it in there just because it’s a common thing, and it’s something, people are struggling to try to get through their training and they often turn to substances, and they don’t help, they only make things worse.

Kevin Pho: Now, what are some of the other themes that you explored in the book?

William Lynes: Well, I guess a theme is surgical training and the difficulty associated with it. I have mixed feelings about the overwhelming responsibility given to young inexperienced surgeons, so there’s a theme with that. We talked about having to tell a family of loved ones about the death, and here you are in your very first day, it’s the first day he was ever called doctor. So that’s sort of a theme.

I am a Christian, as you know, and towards the end of the story, Jackson’s girlfriend, her name is Patrice Summers, who is a born again Christian, leads him to Christ. So there’s a Christian theme in the story as well.

Kevin Pho: The time of this novel is back in the 1980s. So how has surgical training evolved since the time frame in the story?

William Lynes: I retired in 2003, have to understand that, so I have no personal knowledge in what’s happening. I only have, I have colleagues and I have personal discussions and things like that.

I’m not sure it’s changed a whole lot. I think that we still suffer under the idea of see one, do one, teach one philosophy. I think that still exists today. I think that there’s been a loss of the patient doctor relationship in the last 20 years, and that’s made things even worse in surgical training.

So it’s still very, very difficult. And I think that there’s sort of like, I did it, therefore you should be doing it, you should be on call, you should be in the hospital 100 hours a week. And it’s dangerous sometimes. We have certain things built into the system to try to make sure that bad things don’t happen, but they do occasionally, because of that overwhelming stress that is in the training system of surgery.

Kevin Pho: Now, even though the story is a work of fiction, what are some of the messages that you want readers to come away with?

William Lynes: I want people to realize that medicine is a noble profession, that people are very dedicated, that they struggle with human frailties, but the majority of, there are few evil characters in the book, but the majority of them are noble, hardworking, well-intentioned people. So that’s sort of what I would like people to come away with.

I think I would also like them to come away with some respect for what a surgeon, and it’s not just surgeons, it’s emergency room physicians, it’s family practitioners, what sacrifices these physicians make in their training. And would like people to come away with a respect for that.

Kevin Pho: We’re talking to William Lynes. He’s a urologist, and his book is titled “A Surgeon’s Knot.” William, as always, we’ll end off with some of your take-home messages to the KevinMD audience.

William Lynes: Well, “A Surgeon’s Knot” is a novel that chronicles the surgical internship of a young surgery intern in a large teaching institution in the 1980s. It deals with the very difficult job of surgical training. It describes very interesting patients, colleagues, physicians, nurses. And it also introduces a dark side with substance abuse problems. But it has a good ending, in that the protagonist and the people around the protagonist have come to salvation.

Kevin Pho: William, thank you so much for coming back on the show and sharing your perspective and insight.

William Lynes: Kevin, thank you.