Cutting people with sharp objects is generally considered socially inappropriate, and, outside of the operating room, reason for incarceration. I’ve often thought of this while slicing through layers of flesh in an effort to heal a patient. I’ve spent more than twenty years of my life devoted to surgery. A life of being on call through every birthday, holiday and ballet recital, for the unfortunate person to be hit by a bus, stabbed, suffer a perforated intestine, or any number of maladies that can’t tell time. My devotion to my work stems from the happy occasion of watching a patient walk out of the hospital to a better life. I am very good – no, great – at what I do. And I say this with a healthy dose of arrogance, humility, experience, and trust that my primary goal is in your best interest. Here are 5 things I would like all of my patients to know:
1. You want an arrogant surgeon
We might come off distant, cold, arrogant, and at times rude. But what you must realize is that every great surgeon should be arrogant. The mere act of tinkering within God’s greatest creation is an arrogant one and if your surgeon seems unsure of his or her own qualifications, then by all means find another!
Indeed, arrogance is necessary for a great surgeon, who has spent 5-6 years through the rigors of medical school studying and practicing every aspect of his profession so at the end of his time he believes he is properly trained. But, in reality, the practice of becoming a good surgeon, one worthy of a healthy dose of arrogance, is from a lifetime of learning. For the good surgeon to become the great surgeon he or she must also possess humility. With even the most routine of surgeries, a myriad of complications can arise, every surgeon must accept that even the greatest doctors cannot foresee everything. So, delight if you have a surgeon who is arrogant, he or she is confident in his or her profession! And perhaps ask them to share a story of a debacle early on in their career, if they do so you can count on an ounce of humility within their ego.
2. We’ve come a long way, baby
From trepanning, which is drilling holes in a patient’s skull to release evil spirits, to therapeutic bleeding, to amputations, surgery has existed in one form or another for thousands of years. There is documentation of extremely rudimentary surgeries being performed even in the prehistoric age, from the Neolithic times onward. During these dark times of surgical knowledge the “cure,” was often more detrimental to a patient, than the disease or infection! Since the discovery of microorganisms and the extremely great advancement of sterility in the OR, surgery has come a very long way. The advances of CT Scanners, MRI’s, PET Scans, endoscopy, laparoscopy and other new and emerging technology have provided a very low percentage of incorrect diagnosis. Particularly, when utilizing all the tools necessary, for instance a CT scan, to diagnosis acute appendicitis the accuracy of the scan is at a definitive 98%. And we rarely perform the extraction of evil spirits, at least not in my OR.
3. Be Grateful to your Omentum,
You’ve never heard of the omentum? I’m not surprised. An organ that is typically glanced over by high school anatomy teachers in favor of the liver and pancreas. And most often known by its pseudonym, the Beer Belly. But it’s high time we give credit to this unique organ that resides within our abdominal cavity as a constant and vigilant watchdog for invasive infections. Lying like a curtain draped over our intestines is the omentum–a sheet of fat, blood vessels, and lymphatic tissue that literally is an apron providing a protective cover to our abdominal viscera. Typically the organ lies dormant, until as if with a sixth sense, it moves to an offending infection or malady within the abdomen, sealing off diseased areas and keeping invading bacteria isolated. A good surgeon can follow the movement of this organ to the exact location of where surgery should begin, turning what could have been a massive infection, into a relatively minor annoyance. In patients with appendicitis, I will often find the omentum encircling around the inflamed, and gangrenous appendix, like a gift wrapped present waiting to be delivered to the proper recipient, in this case me the surgeon. So keep your omentum healthy, with fibrous foods and a little more exercise than walking to the fridge for a beer. It may be your best ally and best aid to your surgeon.
4. I am a Chatty Cathy that can save your life.
Unlike House, I don’t believe all patients lie. Thus, the bulk of my time is spent openly asking questions as simple as “What brought you here today,” which will give me the answers I need. I find that most patients are honest-because they want to get better. Nearly 98% of the time the patient will be able to tell me the information I need to provide a presumptive diagnosis that can then be officially diagnosed with the physical exam and appropriate testing. The element of humility comes to play with this pre-emptive diagnosis, too. I must assume I do not know everything, expect the worst and gradually come to a conclusion. For your typical physician he or she may routinely find that the ailment is an easily curable head cold, but for the surgeon, we must continually look at the body with an awe of possibilities that are both great and varied. If you find yourself stuck in a hospital bed with a surgeon that you can’t seem to get rid of, be thankful. He trusts your honesty, and will give you his.
5. The best way you can find out if you trust someone, is to trust them-Ernest Hemingway
I mentioned that I trust the patient to be honest, and it is in my best interest that the patient wholly trusts my judgment. A patient must literally place every aspect of their being into the hands of the doctors, nurses and technicians (indeed getting you well is a collaborative effort) that together must provide the utmost attention and care to a no doubt apprehensive individual. There are many, many other individuals involved in the surgical process from the floor nurse to the anesthesiologist and I must trust that each of them is just as capable and as obsessed with the cure for a patient as I am.
But how does a patient know this? Does an unfortunate survivor of a car crash have time to go over the resume and references of every nurse on duty? Absolutely not. As a patient, particularly one in the ER, whether or not you trust your surgeon will not only halt the procedure, but how you accept and process the work done will affect how you recover. To trust your surgeon, and all of the skilled individuals involved in your surgery and recovery, will alleviate any unnecessary stress placed on your body. To blindly trust anyone is difficult, particularly someone that plays with sharp objects, but it is in your best interest in emergency situations. We’ve all heard the rule to try and make your body limp before a car accident to reduce the risk of injury; this requires an element of trust within yourself. It would be wise to bring this same acceptance to your surgeon.
David Gelber MD is author of Behind the Mask; The Mystique of Surgery and the Surgeons Who Perform Them. In 2010, more than 45 million surgeries were performed in the United States alone. So it’s interesting – and a little ironic – that the mind of a surgeon remains largely impenetrable. By providing a peek into a surgeon’s world with his new release, Behind the Mask: The Mystique of Surgery and the Surgeons Who Perform Them (Ruffian Press, August 2011), Dr. David Gelber hopes to change that. Born in 1958 in upstate New York, the seventh of nine boys, Dr. Gelber attended college at Johns Hopkins University and medical school at the University of Rochester School of Medicine, graduating in 1984. He started his training in general and vascular surgery at Baylor University Medical Center in Dallas, Texas and finished in 1989 at Nassau County Medical Center on Long Island in New York. As a partner in Coastal Surgical Group he has practiced in the Southeast Houston area for more than 20 years. He served as Chairman of the Department of Surgery and as President of the Medical Staff at Bayshore Medical Center in Pasadena Texas and was named one of America’s Top Docs for 2008 by physician rating service Castle Connolly. Dr. Gelber is the author of two science fiction novels, Future Hope, ITP Book One and Joshua and Aaron, ITP Book Two. He lives in Houston, Texas with Laura, his wife of 25 years, three teenaged children, four dogs and 24 birds. Learn more at: www.davidgelber.com and at his blog, “Heard in the OR” at www.heardintheor.blogspot.com. .