WAYNE: Hello again, everybody and welcome to our live play-by-play coverage of surgery! Today, we will watch two old adversaries battle it out under the bright lights within the storied confines of Operating Room 11. Glad you could join us! Larry, this promises to be quite a battle. What are you looking for in this match-up?

LARRY: To be honest, Wayne, not much has changed since these two rivals last met. The Surgical Team – led by the 20-year veteran – will take on the Growing Tumor. Overall, the surgeon seems to be holding up pretty well, but he has become progressively intimidated by the technological bells and whistles entering the game. I’m certain that he also feels pressure from the younger surgeons waiting their turns. Fortunately, the team has great depth at several key positions here in the operating room and it is usually able to cover for his weaknesses.

WAYNE: Larry, I was checking the scans just before airtime and the Tumor seems up to the task today. It is a real up-and-comer – full of surprises – and could prove to be a real competitor. It certainly has been displaying confidence and plenty of attitude lately. Final preparations are almost complete, so we will take a quick preoperative timeout. Back in a moment after this word from America’s favorite beer.

[COMMERCIAL]

WAYNE: Welcome back, everybody! We’re ready…there’s the incision! The surgeon makes a nice move, lifting the skin flap neatly and securing the extra instrument in his palm. Outstanding hemostasis! Let’s watch that again in reverse-angle slow-motion…great exposure and every corner of the field is completely under control! As in each of these match-ups, the first several moves are scripted. It looks like the team’s strategy today will be to “circle the tumor” rather than going right after it.

LARRY: You know, Wayne, I like this approach. See how the surgeon “squares up” to the table and works from a balanced stance? Classic foot work. It’s fun to watch an “old pro” go at it. Notice how he keeps his eyes focused on the field even as he tracks all of the activities in the room? Those skills take years to develop. He’s off to a good start.

WAYNE: Right you are, Larry! A big vessel just came into view and he’s moving confidently to control it. Slick dissection then “clamp, clamp, cut, tie, tie!” Perfect! That’s another $500 for “Arteries for Charity” from our lead sponsor, America’s Blood Banks!

[SPONSOR MESSAGE]

WAYNE: We’re ready to go again. Uh, oh. Look at that, though, Larry! Really poor technique there – far too much wasted movement. The lights are all wrong. His elbows are too high and the resident’s hand is blocking his line of sight to the target. It’s all about discipline. The surgeon must direct the assistant in that situation. Unbelievably, he just yelled at the scrub tech and threw a hemostat on the floor! There’s a flag! It appears that he is claiming that the hemostat merely slipped, but I believe his arm was moving forward when the instrument left his hand. Despite his experience, his head is not in the game right now. Very poorly played.

LARRY: I agree, Wayne. Wisely, he’s calling for another timeout before he stumbles yet again. Reset the retractors; turn down the music.

WAYNE: There’s plenty of time to get things under control. While the last play is under review, we’ll take a break. Back in a moment after a word from America’s favorite line of full-size pick-up trucks.

[COMMERCIAL]

WAYNE: We are deep into the second half now. Things have turned around and the resident has really stepped up her game. You can sense that the surgeon and resident are in complete sync now. Several great moves with barely a word spoken between them. Whoa! Oh my goodness, Larry! Suddenly there is blood all over the field again! We are four hours into this thing and the Tumor is roaring back! I don’t think the Surgical Team was expecting that, at all! The momentum has shifted and it is time to discard the textbook. It is all about defense now. The team must concentrate on bringing consistent pressure and looking for opportunities to turn things around.

LARRY: Y’know, Wayne, that move by the Tumor was COMPLETELY predictable. The surgical exposure remains suboptimal and his technique has become sloppy. Other teams would have employed the Lone Stars long ago or brought in another set of hands on the Army-Navys. He needs to switch dissection techniques and go back to working from “known-to-unknown.” Look at the surgeon: his posture has deteriorated. Clearly, fatigue is becoming an issue. Not a pretty picture.

[NETWORK MESSAGE]

WAYNE: We’re back again. Limping toward the final moments now! Yes! The tumor is completely separated from its blood supply! The last cuts are complete! AND THERE IS YOUR SCALPEL!

[COMMERCIALS]

WAYNE: Whoa-boy! The Surgical Team defeated the Tumor but I gotta tell you, Larry, this was a nail biter right up until the final moments. My sense is that they will have to rethink their entire approach before the next case – this one could have gone either way. Not the surgeon’s greatest performance, don’t you agree?

LARRY: I’m totally with you, Wayne. There will be hard questions about several of the decisions they made today. I mean, they got the desired outcome, but – c’mon! – it wasn’t pretty. The bloggers and the commentators will be brutal tomorrow.

WAYNE: Right you are, Larry! So, that’s it from the OR! We’ll be back in just a few minutes with our “Postop Show” with your comments and interviews from the locker room. We will also take a first look at the crop of young surgeons coming out of fellowships and check our experts’ predictions on the upcoming draft. Thanks for joining us for this live broadcast! So long, everybody! This is the Surgical Radio Network.

 

Edited slightly (for the benefit of my fellow Packer fans) from a version previously published in the Spring 2012 issue of The Examined Life: A Literary Journal of the University of Iowa Carver College of Medicine.

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About the Author

Bruce Campbell, MD, grew up in the Chicago area, graduating from Purdue University and Rush Medical College. He completed an otolaryngology residency at the Medical College of Wisconsin and a head and neck surgery fellowship at M.D. Anderson Cancer Center. He was a faculty member, ENT specialist and surgeon with Froedtert & MCW health network from 1987 until his retirement in 2021.

Katlyn Leshko

I really like how you described surgery the way that football commenters would describe play-by-play actions! You really gave us a new perspective on something that many of us have not experienced first hand. It is easy to forget what could have happened/might have happened or went wrong when all we usually see is a recovering patient. I myself work on a surgical unit and see many patients come and go quickly as they recover and gain their strength to return home. I don't get to see the "behind the scenes" action that your post describes. While it was humorous text, you bring up many issues that can and do arise in surgery from time to time including...
- technology actually being an obstacle for veteran surgeons who are used to their ways without such machinery. Even in general healthcare, we all have to be kept up to date on the latest technology and procedures with training, inservice, and continuing education beyond our typical degrees
- the pressure veteran surgeons feel from younger surgeons who want to replace them. For example, hands are precious to surgeons, and if they lose their nimbleness, it could cost them their job or a patient's life
- simple operating room blunders that are often overlooked ("off lights," residents who unknowingly/accidentally get in the way of surgeons, and a lack of synchronization between everyone in the OR)
- sometimes having to deviate from "textbook" answers/procedures and having to rely on the surgeon's gut instincts and defense
- fatigue! Surgery can be long, and we often don't think about the physical and emotional wear operations must have on surgeons
- and finally, surgery is full of surprises and are not predictable, cut and dry (or cut and stitch!) procedures that we may think of. Things can and do go wrong, but surgeons are trained to expect the unexpected.

Thank you again for an insightful and delightful post!

Krista Johnson

I would prefer watching THIS event to ANY football game EVER! More entertaining and WAY more relevant! Thanks for this amusing perspective, Dr. Campbell!

Jessica

This is brilliant. Such a clever way to describe a surgery and to keep us laughing. Loved it.