Performing surgery is not about empathy

The Surgeon had been handicapped by a burr in the plantar aspect of his left foot.  All summer it had been causing discomfort on jogs, during soccer games, and,eventually, even just walking barefoot across the hardwood floors in the morning.  There was something lodged in the thick skin of the strikeplate of his foot— a splinter, a piece of glass, whatever the hell— and it was really starting to cramp his style.

His wife tired of his frequent moaning and groaning and dutifully instructed him to “see a podiatrist.”  The Surgeon considered this.  Why would I do that, he thought.  I’m a surgeon.  I can take the damn thing out myself.

So one Friday evening after finishing up the weekly charting/computer work, he gathered some Lidocaine, a hemostat, a scalpel, gauze, and Betadine swabs.  He situated himself on one of the exam tables and directed the light on his foot.  He prepped it sterilely like he had done a thousand other times for other people.  He drew up the local anesthetic.  And then he paused, staring at the needle.  Five minutes of silence elapsed.  There was a disconnect between what he was about to do and the consequences of said actions.  Normally, he jabs these needles into people all the time without hesitation.  Every time he moved to inject, however, the realization that the target was his own foot made him draw back.  He felt foolish and cowardly.  It’s just a 25 gauge needle, he thought.

Ultimately, he pushed the needle into his own flesh.  The pain was a surprising white hot sear that arched his toes. The skin went white and turgid and a dull numbed warmth spread across the bottom of his foot like a low fog.  He poised the scalpel over the area.  And then he sunk the blade into the anesthetized skin.  The plan was to excise an ellipse of tissue around the foreign body.  The red blood that trickled down and saturated the gauze was strangely perplexing.   A lightness descended upon him, as if he had lost all density, all connection with gravity, and his head spun and a sucking sound filled his ears and everything went white and unreal and he realized if he didn’t STOP RIGHT NOW he was going to fall off the damn exam table.  For 5-10 minutes he lay on his side, short rapid breaths, the world spinning, desperately trying to hold off nausea.  He calmed himself.  His foot was a bloody mess.  There was nothing left to do but finish the distasteful act.  He deposited the hunk of flesh in the trash.  Unsteadily, he wrapped the wound in Kerlix and put his sock and shoe back on.  He staggered out of the office.

Now the lesson here is not some sappy sentimental reminder about how surgery “is a painful business and one must be especially cognizant of what the patient is going though and be more mindful of his/her feelings.”   This is not a lesson about empathy.  To operate on another human being is a controlled act of violence.  In order to inflict surgery on someone, a certain disembodiment must take place.  This is part of the reason for draping off the surgical site and isolating the target.  The person ceases to exist as subject and is reduced to mere object.

It is not John Smith whom you press the knife blade into.  John Smith is gone.  He is now “the gallbladder” or “the lipoma” or “the mass.”  When you operate on yourself this transformation is impossible, mentally.  The pain brings you back.  The subjectivity of the target is insurmountable.  No, performing surgery is not about empathy.  It is the utter opposite of empathy.  Being able to successfully cut on someone without being overcome by nausea requires an absence of empathy.  Otherwise, to empathize too much, to feel the patient’s pain even as the blade penetrates and the blood runs red is to descend ever too deeply into sadism.

Jeffrey Parks is a general surgeon who blogs at Buckeye Surgeon.

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