A Path to Become a Surgeon

It is necessary that a surgeon should have a temperate and moderate disposition.  That he should have well-formed hands, long slender fingers, a strong body, not inclined to tremble and with all his members trained to the capable fulfillment of the wishes of his mind.  He should be of deep intelligence and of a simple, humble, brave, but not audacious disposition.  He should be grounded in natural science and should know not only medicine but every part of philosophy; should know logic well, to be able to understand what is written, to talk properly and to support what he has to say with good reasons.

Guido Lanfranchi

Chirurgia Magna (1296)

We, as surgeons, quite often dramatically influence people’s lives.  Most of the time for better.  Sometimes not.  We are privileged to see on the operating table organs which even their owners cannot see.  For a time of surgery,   patients sign our rights to their bodies to us, trusting that whatever will happen will be done in their best interest.  Our reimbursement is (well, it was) substantial and surgeons were held in high esteem by society.

Why do people feel we deserve this honor and privilege?

Let’s describe the training and the life of a surgeon.

It takes a length of medical school, internship, residency and subspecialty fellowship if we elect to do so.  For those of us, who were trained and educated in other countries, it is almost twice that long.

In Poland, I was recruited and educated under the tutelage of prof Jan Nielubowicz, who was one of the most prominent Polish surgeons, innovator in general, vascular and transplant surgery.  He knew 4–5 languages, was a broadly educated “renaissance man”.

In this country, I was invited by another well-rounded, highly educated innovator, au courant with arts, music, theater and archeology, Dr. Francis Robicsek from Charlotte, N.C.  He also speaks several languages and is an avid arts collector. Part of my surgical training took place in Cincinnati under Dr. William Altemeier, who was a student of Dr. Roy McClure, who in turn was educated by the father of American surgery, William Halsted.

I wish they were tests to select which medical students will be good surgeons.  There is none.  Also we know that not everybody has mental and motor skills to become one.  So far, it is a trial and error process.  Some can’t make it, and it is a tragedy to see a senior resident in surgery being told he is not going to make it or that he will, but his privileges will be restricted. I have seen both things happen. Surgical residency is tricky.  You can’t just go to a library or on the internet and find teaching cases there.  Nor can you learn from the books how to operate.  Didactic cases come to hospitals around the clock and quite often in the middle of the night.  Future surgeon just has to be there, and getting involved in the care of a particular patient is seen as a privilege.  Having an attending physician calling you for that purpose is an honor, and having him as a teacher means even more.  When I started being involved in open-heart cases in 1975, operations were 10–12 hours long and there were no breaks for snacks nor coffee.  When I was talking to my Father during a visit back to Poland the very next year, his first question was, “So when do you have time to go to the bathroom?”  I didn’t know what was he talking about.  Now I do.

Training is very demanding physically and mentally.  There is no room for whiners.  There is a movement to limit residents’ hours to prevent them from feeling overworked. It was said, that tired residents make more mistakes.  Time of work was restricted to 80 hours per week and no more than 24 of them continuously on duty.   The followup study was done 30 years later and showed that the rate of errors has not decreased and extra time taking from the stay in hospital was used not for rest and studying, but for other extracurricular activities. Obviously, there are reasons other than being tired for residents making mistakes.

Role models and mentors are critical and play a crucial part in the final forming of a surgeon.  Not only as a doctor, but also as a person.  One is very lucky to meet an extraordinary personality and to have him as a teacher.  They are hard to find, and being accepted to be his student is like winning a lottery. I still remember statements made by some of them.  They guided me through quite a few difficult moments in my career, and many of their quotes and anecdotes were very entertaining in social encounters.  All the teachers were memorable, but some were more than others.  Memories come with appreciation and respect.  At least, most of the time.

Better surgeons quite often are seen as individualizes, “stars”, sometimes as prima donnas.  There is some truth to that.  But most people don’t know that surgery really is a team sport.  Even the best surgeons can’t do well without excellent operative room crew, recovery room nurses and well-trained CCU/ICU units.  If they are good and excellent, they can make even a mediocre surgeon look like a star.  To find a group of people, train them and work as a team is a big achievement.  It makes working in the operative room feel superb, almost artistic experience.  After a good case, the surgeon takes his gloves and gown off, says thank you to the operating room staff and in his head hears applause.  Just like on the opera stage after an exceptional performance.  That is the artistic part of surgery.  The use of science in its highest form.

To be continued