I Am a Surgeon
Surgery is more than a job or even a profession. It is a vocation and way of life.
The year was 1984. I was a chief resident in general surgery at the US Naval Hospital, Oakland, CA. I and my two co-residents were finishing the last of five years of training in general surgery. By now, we were functioning as nearly independent surgeons, operating on our own patients and helping train the residents behind us. We were allowed to operate without an attending surgeon present most of the time, but were expected to request assistance if we needed it on complex or difficult cases. By this time, we had enough knowledge and surgical experience to feel fairly confident in our capabilities.
Surgery is a seemingly contradictory blend of confidence coupled with humility. Confidence is a must in a profession where you are cutting people open as a matter of routine. Humility is equally important. People and the human body are simply too complex to be approached without some trepidation and with great respect. There has to be a balance, however. The over-timid surgeon is just as dangerous as the over-confident one.
One of the traditions of our program, indeed, of most surgical training programs, was to send off the graduating residents with a banquet. It was attended by all the residents and attending surgeons, and spouses. The graduates were toasted and roasted in equal measure in funny and, sometimes, embarrassing ways. For that evening, the general surgery service at the hospital was covered for emergencies by another the other surgery services so that everyone could attend and the day’s surgery schedule was shortened as well. For the graduating residents, it marked the transition from resident to attending surgeon and was highly anticipated.
I had a perplexing patient on the medical service. 37 years later, I cannot recall all the clinical details, but several things remain clear. He was admitted with abdominal pain. He did not have an acute abdomen, i.e. he did not have physical findings that warranted immediate, emergency surgery. His blood tests were equivocal. His x-rays were also inconclusive. CAT scans had become widely available in the early 80s but were still in their infancy and not as reliable as they are today. For a couple of days, I had rounded on him with my team and was not convinced that he needed surgery.
The afternoon of the day of the senior resident’s banquet, the Chief of Surgery, Dr. Robert Abbe, came to me after rounds and said, “Rick, let’s go take a look at that patient of yours.” Abbe was a highly experienced and excellent surgeon, and an excellent teacher.
We went to the bedside, looked over the chart and lab work for that day and pressed on his abdomen. Nothing really had changed. Abbe looked at me and said, “We should take him to surgery. He isn’t worse, but he isn’t better either after several days. We’ve given antibiotics enough time and I think we should operate. Get him scheduled.”
“Now?” I asked. I am ashamed to say that my first thought was that we would be late for the banquet rather than about the patient. After all, what difference would one evening make? I am glad I did not raise this objection out loud.
“Sure,” said Abbe, “We are surgeons. It’s what we do.”
I called the operating room and put him on immediately. Abbe scrubbed with me, since all the other residents and attendings were on their way to the banquet. My patient had a smoldering appendicitis. Antibiotics kept it at bay but would never have cured him. At some point, he might have ruptured. He needed surgery. I was an hour late for my graduation banquet.
I learned several lessons that day, which was officially the last of my general surgery residency. It drove home the importance of developing surgical judgement, which is knowing when to operate and when not to. Non-surgeons often tease surgeons about their urge to “heal with steel”, but sometimes surgery is the more “conservative” and safer option. Abbe also impressed on me that the patient came first- before banquets, personal life, and other plans. If you cannot commit to that order of priorities, it is best to seek some other area of medicine. For too many young surgeons today, surgery is what they do, not what they are. In other words, it is a job, not a vocation.
I am a surgeon. Abbe taught me that lesson and I have never forgotten it.
Abbe passed away on February 23, 2021. At 84 he was, as they say, full of years, and good years at that. He left a legacy of family, friends, and several generations of surgeons who benefited from his expertise and wisdom. I hope I have lived up to his standards.
Richard T. Bosshardt, MD, FACS