Wednesday, April 25, 2007

Plumbing the Depths


Our shower has been acting up lately. It's happened before, but this behavior was different. Not wishing to hijack my own post, suffice it to say I came up with a clever solution. These little domestic victories, when they occur, find parallels in my mind with surgery. Finding solutions to unusual problems is very often what it's all about. Every once in a while I allow myself an inward smile, and tell myself I have a brain with certain kinds of software -- and feel surprise that I found my way to being a surgeon. It was, in the subject sense at least (and in others, not so much), a good fit. I'm able to figure certain kinds of things out with efficiency, and I think it's a talent not given to everyone. Not even every surgeon.

It's not unique, of course, and I'm truly not trying to boast. It's just that I'm sometimes amazed at having wandered into surgery from a series of serendipitous situations, discovering after the fact that I can actually do it, that my thought processes are suited to it. Given the body's amazing ability to heal itself and to withstand various insults, I'd say most people who don't faint at the sight of blood could be taught to do a large portion of what surgeons do. Nor is the talent, or whatever it is, to which I refer unique to people who do surgery. Artisans of all sorts surely have it. What I'm trying to describe is the ability to find ways out of unfamiliar situations. You can be taught how to use certain tools, how to accomplish a particular job. It's when encountering problems for which there's no road map that a certain (probably indefinable) way of looking at things is a great help. The body continually surprises; or, as I used to say, there's a lizard under every rock.

"We're bogging down, boys," was a thing I frequently uttered during a difficult operation. When working through a tough bit of anatomy, distorted by scar tissue or tumors or infection, if I sensed progress wasn't swift enough, I'd find a different avenue. That's in no way unique, of course. But it's critical that you get that vibe before crossing a line into tiger country. Likewise, there's some sort of spatial sense that allows some people to look at a surgical field and see what the perfect tool is; or to be able to position a needle in a needle-holder at exactly the best angle in a deep hole before trying it another way and having to change. Letting the scrub nurse know what you'll next be using, especially if it's not going to be something typical, far enough ahead that she'll be able to get it ready, is something not everyone does easily. When assisting, it frequently happened that I'd see where the surgeon was headed and assume a certain approach would ensue, a particular instrument would be called for, only to be surprised. And often, after watching futile diddling, finally see (or suggest) that other approach.

Only so much can be taught; only so much can be assimilated later. To some degree, it's about pre-existing wiring. I hope the reader will accept that when I say I think I had it, it's not for self-tooting. It's in abject amazement, because I had no reason to suspect it before I chose to be a surgeon, or even while I was in the early stages of learning. It's a "who knew?" sort of thing. (While in training, I first heard the quote from an unknown [to me] author, describing the necessary attributes of a surgeon: The eye of an eagle, the heart of a lion, the hands of a woman. I used to describe myself has having the eye of a needle, the heart of an artichoke, and the hands of a clock.)

For the life of me, I can't paint or draw anything that looks like something. I couldn't sculpt my way out of a canvas bag. Building a glob of clay into a recognizable work is a talent entirely out of my ken. Even more mysterious is the ability to hack a chunk of marble until it's the Pieta. (Who was it that said "I just cut away everything that doesn't look like a duck" -- or something similar? Might have been big Mike himself.) Given the choice, I'd absolutely, in a heartbeat! opt for that kind of art -- which is truly a gift -- over some sort of ability (real or imagined) to smooth out some surgical rough patches. But there have been times when I was glad to settle.

Update: the shower is acting up again.

11 comments:

SeaSpray said...

Good Morning Dr Schwab!

It would be great if all surgeons could/would perform surgeries with the same skill and insights as you have. "But it's critical that you get that vibe before crossing a line into tiger country." I like that.

Interesting post.

oh - I fixed our toilet a couple of weeks ago. Simple really and basic, but I was proud of myself for being able to pop the cover, identify the problem and fix it. Sometimes its just logical. :)

happyj said...

Dr. Schwab,
Excellent. One of the words I've used to describe my trauma surgeon was "innovative." Its something that comes with life experiences, I believe. When life happens to be full of challenges, I think the brain aquires new pathways by which to solve problems, and with those new pathways come more wisdom...like the gurus who stare at the sun or stand naked in the snow and artists who are known for having tortured souls:). Trouble is good for the brain!:)
I also heard about a study which was so interesting to me; in it, blood that had been drawn from a person reacted in its chemical makeup or something when the actual person it had once been in was in pain. I don't know if that's what they mean by cell memory, but I thought it was so interesting that maybe experience could be inherited...

Shauna said...

Dr. S.,
Just because you can't sculpt like Mike, doesn't mean you haven't an artistic skill. Your book and blog are both examples of your artistry.

This post reminds me again of how close art and science are to each other. You can't find one without the other. Art is science and vice versa.

And how many docs over the years have you met who unwind by playing a musical instrument?

Shauna

DisappearingJohn said...

I must admit, I my love is woodworking and working on cars... the problem is you get so dirty (especialy with the cars) that people look at your stained (but clean) hands like you have a pox!

By the way, you have been tagged with a "thinking blogger's award" if you are up for the challenge... I love reading you!

Anonymous said...

hu-lo-oh...
you forgot to tell us how to fix a shower!

Lynn Price said...

Yes, but do you do windows?

Greg P said...

When I was growing up, after I had said I wanted to become a doctor, people looked at my hands with their long fingers and were absolutely sure I'd be a surgeon some day. For a time my parents wouldn't let me do strenuous manual labor around the house for fear I'd injure my hands.

When I got to medical school I found I didn't enjoy being in the OR, so that was the end of that. If you don't enjoy surgery, what's the point of being a surgeon?

Paul said...

And what's with that sight of blood thing? I've never heard an explanation of it. I'd learned not to look when having blood drawn. Then at one point in my mid twenties I told myself it was ridiculous. Ever since I'd stopped looking I'd never had a problem, I probably wouldn't have one anymore...

But once again I came fairly close to passing out. Never have, but have come close enough and have returned to burying my head in the sand!

Sid Schwab said...

Paul: I've looked at it like this: if you're leaking blood, it's smart to lie down. It's what we do with people in shock. If you're not smart enough to lie down yourself, your body sees to it that you do.

Dr. Charles said...

you deserve a good deep breath and a gaze down the mountain road you've climbed. becoming a surgeon is about the hardest thing i can think of doing. i did 2 months as a surgical intern, working 120+ hrs/week and being on call (no sleeping) every other night for two of those weeks, every third night the rest, before the work hour restrictions. it hurts just to type those words now.

ERnursey said...

I disagree, the ability to operate on a person causing the minimum of pain and disfigurement is definitely an art.