What, exactly, is Surgery?
At its most basic, much of Surgery is a goal-oriented process by which something that is detrimental to the patient is removed in a way that will improve the patient’s well-being. The surgeon’s task is to accomplish the goal while carefully balancing the risks and benefits.
On a practical level, however, much of Surgery boils down to this: The surgeon must decide where to cut between something that is coming out and something that is staying in. The surgeon repeats this process until all of the tissues have been separated, whether it takes ten minutes or ten hours. Once the operation is under way, the surgeon and the assistants work hard delivering as much light as possible to a place where light might rarely penetrate. The surgical field must be dry, well-illuminated, and as accessible as possible. That’s it.
When all goes well, the procedure develops a momentum and moves along steadily. Once the problematic area is exposed, each movement has a purpose; each activity makes the next one possible. No matter how simple or complex the operation, the surgeon is always preparing a number of steps ahead.
When Surgery goes poorly, the surgeon is unable to smoothly complete the necessary tasks in a logical sequence. Using this definition, even “simple” surgical procedures can go poorly. My worst days in the operating room occur when each step of a procedure requires a specific instruction to the assistants:
“Put a retractor there and pull that way,” “Get the suction and clear away the blood,” “Leave that area alone for a while and help me expose this,” “Move your hand so I can see better." Objectives that appear obvious to the surgeon can seem to be lost on the trainees.
During my best days in the operating room, my resident and I are in sync. We anticipate each others’ actions. While one of us is blotting the field, the other is adjusting the lights or the retractors. While one of us is dissecting a delicate structure, the other is carefully widening the exposure. Few direct technical instructions are needed; we might talk about the anatomy or the cancer, but there is rarely the need to say, “Retract this,” or “Put a clamp on that.”
Years ago, I realized that Surgery sometimes resembles Dance. Just like beginning students of the tango or the waltz, young physicians tend to focus on the “steps” needed to get from Start to Finish. But learning the “steps” is only the beginning of learning how to operate.
You see, Surgery, at its most glorious, is a form of choreography — a whole team that seems instinctively aware of each other’s movements and focus. When the “Dance” goes well, surgeon, assistant, and technician all drive the procedure forward.
Just like the action on a dance floor, Surgery can be exhausting and, at the same time, totally exhilarating. When things go well, the process is very special. When the Dance feels effortless, I cannot imagine any other line of work.
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The following is feedback received for this blog:
Well "choreographed" surgery can also be beautiful to watch. Just like dance.
- http://sterileeye.com
Hi -I found you through Dr Rob's recent post.
Just want to say that I enjoyed this eloquently written post and the idea of surgery being analogous to synchronized dance.
Great blog and I am blogrolling you! :)
- SeaSpray
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