Sep 17, 2011

Surgeon Sacrifice

I once came across a notion that the sexiest profession are masked - dentists, surgeons, burglars? Never figuring out why, but I would strongly agree surgeons being a difficult person to work with. Generally, they are stubborn, defiant, ill-tempered, and hence definitely not, sexy.
Nevertheless, one-third of my rotation consists of surgery. Except in the event that I become director of medical education tomorrow and successfully abolish rotations consisting of surgery, I have no choice but to endure the politics and showbiz of surgery - the scrubbing in, the smell of povidone-iodine, the stick-to-everything OP-sites, and every surgeon's obsession - sterile techniques.
I dread my week in General Surgery. I'm scheduled into surgical oncology and insiders will know they are famed for day-long exotic-named surgeries - Hassab's, Whipple, Bilroth - and the magnum opus of every oncology surgeon - transplants. Much as I admire the great work of bringing life back to the dead with a switch of organs, I cannot imagine myself standing on a 2 x 2 foot plank for 36 hours with no food or water. I'm not that noble yet.
With Murphy's law working on me this week, my attending Dr. Lee scheduled a Whipple procedure today. I was foretold two days before and dreaded the arrival of Friday - usually my laziest. I made sure I get enough sleep, ate double breakfast and drank enough water to last the entire day before entering the OR. Clerks like me are not required to scrub in, but as an observer it is common courtesy to ask permission to leave. I have no guts to speak throughout the entire procedure. Dr. Lee was swift and precise in action. My instincts told me if I broke the silence with questions such as "can I go for lunch?" he'd fling a scalpel at me. Rumors had it that he did exactly that back in his young hot-blooded years, earning him the nickname "flying dagger Lee."

So I stood there obediently as the clock ticks till 2pm. Then the resident was sent to another OR to help out and I was asked to scrub in. When I was just a casual observer I have the liberty of leaving whenever I wanted. Now I'm stuck! My mind protested but I still obediently doused my arms with sterilizer and don the hideous blue gown.
It was interesting observing an extensive procedure. It's quite rare and almost extinct nowadays, an assistant told me. As my inner protests died down with hypoglycemia and leg cramps, I started noticing the undivided commitment of Dr. Lee to his surgery. 6 hours into the procedure and we're struggling with a stuck vein. I was thinking of how to scratch my nose without using my (sterile) hands, while Dr. Lee was faithfully freeing millimeter after millimeter of tumorous pancreatic tissue. Navigating the punch-sized surgical field with utmost tenderness and stopping every 2 minutes to kill an active bleeder. There was a moment when the bleeding became almost uncontrollable. Panicking, the assistant started throwing orders but Dr. Lee calmly instructed everyone to perform and quickly stopped the bleeding.
As the surgery comes to the final steps, the assistant casually asked how much it the NHI pays for a Whipple and he replied about NT$40,000 (USD1200), minus surgical consumables. After the hospital cuts off a share of the profits, a surgeon will probably be left no more over NT$20K (USD700) for 8-hours of suspense and undivided attention. That money may seem a large amount for some, but a lot of less demanding and risky procedures are definitely better paid.
At the end of the day it boils down to sacrifice. The NHI dictates monetary returns of each and every standardized procedure, but most of the time they don't take into account the process of one. A simple hemorrhoidectomy is equal in monetary terms to a liver resection, for example. But the latter definitely requires more tedious workup and care during surgery. For the same amount of money these doctors are discounting their stress hormones and mental concentration. It may not be fair, but they had done it and earned patients' respect over the years. My guess is they do it anyway for sacrifice's sake. Somebody has to do it. And I deeply respect them for this.