Sid Schwab is a retired surgeon who blogs at Surgeonsblog and is the author of Cutting Remarks: Insights and Recollections of a Surgeon.
The medical director of my clinic once gave me a book on burnout. I never read it. Didn’t have the time or energy.
Because a young reader considering a career in surgery referred to stories he’s heard of depressed and disappointed surgeons and asked for my thoughts, I’ll try to address it. Parenthetically, I’ve heard from more than a few readers that my blog and/or book has inspired them to consider …
Referring to the idea that, like athletes, surgeons are engaged in demanding physical work, I wrote about having an “off-day.” Another side of the same coin is having a tough day: as distinguished from not being on one’s game, here I mean to describe what it’s like to face an exceedingly difficult and danger-filled situation.
Notwithstanding having one’s faculties and wits gathered and finely honed, as in command of yourself as you …
The potential to do dramatic good, as is the case with surgery, means that sitting and staring back at you at the other end of the see-saw is a grinning dysmorphic ogre. He keeps his eyes locked on yours, staring with the smug certainty that you can’t toss him off, up when you’re down; down when you’re up. The ugly little sonovabitch never goes away. It’s an issue for every healthcare provider. Were it …
There’s something irresistibly horrifying about doing an amputation. I did several during training, and a few in practice, before eventually turning such cases over to people who did it more. In a way, it’s a microcosm of the perversity and beauty of surgery; of the screaming contradiction that one must somehow accept to be a surgeon. Removing a limb is so many things: failure, tragedy, cataclysm, life-saver, life-ruiner. Gratifying.
Stark and …
When Tiger Woods addresses the ball, he’s focused like a cat that heard a rustle in the leaves. He takes a few practice swings, moves up to position, adjusts his feet, steadies his shoulders, locks his eyes onto the target. He waits until there’s absolute silence, brings his breathing under control, funnels all his energy into the impending swing; takes the club back, and explodes in an immensely balletic movement. …
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Would you know what I mean if I describe whistling without whistling? Barely pursing the lips, making little quasi-audible windy sounds while inhaling and exhaling, in tune yet nearly silent? Unless there’s music playing, that’s what I do when I operate. And for reasons about which I have absolutely no clue, I nearly always “whistle” The Caisson Song. I’ve always wondered if anyone …
Next in a continuing series.
Let’s make it easy on ourselves. I haven’t yet established why — other than liking the particular operation — we’re removing this nice person’s colon. So since our patient has agreed to remain exposed and to do so for all to see, I declare s/he has diverticulitis. (Were it cancer, the operation would be largely the same, taking a bit more out.) Most likely …
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There’s a reason for the cliche — surgeon barks out the name of an instrument, scrub nurse whacks it into the hand. The reason is this: when you are focused on a particular area — especially if it’s one in which danger lies — you don’t want to look away. If you need to change …
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Inside the belly, everything is slippery. The peritoneum is a glistening layer of self-moistening plastic wrap, enveloping the surfaces of all the organs, and the inner aspect of the abdominal wall. Undisturbed, the intestines coil and slither, reptilian. Watching waves of peristalsis makes me smile: there’s something always entertaining about those moving contractions, following one upon another, gurgling, surprisingly tight bands of tension moving …
Next in a continuing series.
Traction and counter-traction: along with maintaining excellent exposure, that is one of the fundamental principles of operating. It’s Newtonian: equal and opposite. In nearly all forms of surgical dissection, there’s a need for some pull in the opposing direction: tissues that are a little stretched-out, that are under some tension, fall open more easily when dissected. Plus, it’s a form of stabilization, another obligatory …
Next in a continuing series.
The preliminaries are over. Sponges, needles, and instruments have been counted and checked, their number recorded on a whiteboard on the wall, as well as a clipboard. The checkoff is a comforting hum of words; the tuned machinery of the workplace. As the bottle of local is opened and poured into a sterile bowl on the …
First in a continuing series.
With as much detail as is useful, and as descriptively as I can manage, I’d like to relate what it’s like to do an operation, from before laying knife on skin to after placing the bandage. I’m a general surgeon, so I choose sigmoid colectomy as my prototype; it’s always been one of my favorites, although the particular …
When I think of Big Joe, I see his overalls, and how he filled them. And how a couple of months after I operated on him, there was room for both of us in there. Big Joe: farmer, salt of the earth, tough, stoic. On the day I met him, if it’d been Halloween, I might have tried to stick a candle in him. That’s how orange he was. My …
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I first met her when I consulted on her hospitalized son, who’d been in and out several times with transient abdominal pain. He’d already been through various tests and consultations, each time improving before a diagnosis was established. When I was asked to see him he was once again on the mend, but I concluded that he likely had the uncommon …
I’m certain that if I hadn’t been just finishing a midnight appendectomy, Daphne would have died. Not fully balancing all the bad luck in her life, she fortuitously chose to exsanguinate when a surgeon and OR staff were immediately available. Nevertheless, vomiting all that blood, she damn near died before she got to the hospital.
Niceties like passing a scope to find …
“You can’t just let me bleed like this, Doc. I need to get out of here.” So said John, a man in his seventies, with kidney cancer spread to his Ampulla of Vater. Renal cell cancer is among those that sometimes behave in very strange ways. John had had his removed, along with his left kidney, about nine months earlier. At the time, it was thought likely to be …
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Sturdy and thickly-built, long since widowed, cheery in a sardonic sort of way, tough and opinionated, Flora’s European roots ran deep; she’d been an Italian farm girl, and she’d rather be in her garden than anywhere else. The only reason she agreed to come inside and go to the doctor was that her bowel movements had finally gotten too painful, and too bloody to ignore. Which she had been doing, …
I didn’t know her name until it was over, much too late.
What I knew was she was thirteen and that on this winter day someone in her family had been pulling her behind their car, on a sled. No doubt laughing and looking in the rear-view mirror, the person driving had whipsawed around a corner, and the young girl — probably screaming (fear? delight?) — held onto the sled as …
She was a Korean woman, spoke passable English. We always exchanged pleasantries, and she called me “doctor” when I picked up my laundry. This time she was notably quiet, distant.
I didn’t figure it out until I got home and hung up my jacket, on the inside of which I noticed she’d pinned an envelope. It contained a photo I’d taken months ago, left and forgotten in one of my pockets. …
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“Musta been the ham sandwich,” he said as he leaned onto the operating table and belched a couple of times. We were half-way through a thyroid operation and Doug, my partner, didn’t look all that good. I’d been in practice for all of a year, and Doug, ten years my senior, was my guardian angel, my guide through the vagaries of the world of private practice, and the best surgeon …
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