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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  • http://www.thehappymd.com/ Dike Drummond MD

    If I accept your premise that surgery is not about empathy, but rather an act of controlled violence to root out a problem that has no other solution. If we accept that as true

    … can you accept the simultaneous truth that a surgeon without empathy is not a “healer” … but simply a technician, an automaton.

    There is a balance to be struck here and two ways of being for the surgeon

    … one when the patient is on the table, sedated and you have the knife in your hand

    … the other when you are face to face as conscious individuals where empathy and understanding carry the same power as your scalpel.

    My two cents,

    Dike

    Dike Drummond MD
    http://www.thehappymd.com

  • LBENT

    The act of doing the surgery requires one set of skills the surgeon needs, and the act of total care of the patient–understanding the disease, how it affects the patient/family, helping them to heal–requires another set of skills. If you cannot do both, you probably aren’t going to be as good a physician/healer as you could be. Empathy comes in very handy. As a surgeon of 30 years for kids, it helps to care, even when you are operating. Makes you that much more cognizant that someone is under that drape who really trusts you. The idea of professionalism and how physicians should behave needs a fresh look.

  • http://twitter.com/Dad_2_Dad Dad2Dad

    I’m a patient who recently underwent a bowel transplant in the UK. I was the 11th to have this at a hospital in Oxford. Whilst i will never know what was going through my surgeon’s mind when he operated the empathy and then in turn the way he continues to care for without doubt makes him a truly stand out medic. There may well be a need to distance yourself from the person at times but showing empathy and caring must make you a better surgeon in the long run.