OBSESSION AND COMFORT – FUNDAMENTAL REQUIREMENT FOR A SURGEON?
Dr. Geeta Sundar
We are all creatures of habits. Infinitely more so, if you are a surgeon. Surgeons like things in a particular way, in a particular format, and it irks us when it’s not kept that way. The following write-up exposes on some versions I see and perceive, and as they say, not all fingers are the same, they are some who may not completely agree with me. I graciously agree, to disagree!
Right from starting off with the way surgeons handle the patient in terms of the care, the medications, the dosing, the charting of the medications and all the way to OT, it’s a rigid box and tightly drawn.
I remember distinctively, in an episode/episodes where Miranda Bailey of Grey’s Anatomy (yeah, okay! Don’t judge me, watching GA isn’t a crime!) had this OCD going on with her where she spent far too much time focussing on how her instruments were placed and she was shown going mad when they weren’t in such a manner, and it started affecting her personal life.
Drama aside, surgeons usually don’t place their instruments in any manner when operating, and its usually the assistant or nurse who hands us the instruments as we ask. But, we usually have OCD about the way those instruments are handed to us, especially if we are seeing down a 30 X magnification and our eyes are so oriented to 30X that we need those assistants to be extensions of our own arms. Those very same assistants are ipso facto the most important beings in that OR who we trust with everything we have got. We like to know that the very assistant is capable of being our eyes, ears and limbs in any surgical crisis. If there is turbulent, active, voracious bleeding, or any sudden unexpected complications, those assistants need to anticipate what we need before we can even form sentences from our brain, and speak it aloud. The OR room is often like climbing a mountain, you never know where you would slip or get your next support to climb, and it’s a plan made as you manoeuvre, even if you know the terrain like the back of your head, and in retrospect you always feel you could have done better.
If the OR is a battlefield, those assistants are our men and brothers. They have to be so entuned, so ingrained and engraved in our actions, that they know what we need, what we will ask, and how we will respond. They are like our better halves. (Insert – you all do know the story of how Halsted created rubber gloves? For the love of his life, who occupied his heart in the OR?)
We are very picky with whom we operate. And truth be told, it makes sense. Given that, new blood often tests our patience, for the fact that it hinders with our thoughts and actions and interrupts our flow of the surgical technique. We surgeons are crafty beings, and we like our methods, our rituals and mannerisms, and anyone interrupting or interfering with that is often at the end of our wrath and impatience. I think as an extension of that trust, comes a main component of comfort – we get comfortable with a form of assistance, with a form of comradery, that we receive in the OR from those assistants. We wish for that person on every professional journey we ride. We look forward for that solace in each day. And we carry that with us, all the time. There is a sense of a satiated void that occupies our professional heart. And a sense of belonging and happiness. It would be a waste to describe further in words, and only a surgeon would be able to understand the true essence behind my words.
I described above that the OR could be a battlefield, but in all honesty, for most of the time, it’s also the only social platform for us to embrace. We joke, we banter, we talk about random topics, we listen to music, we place bets, we do as much as any one sitting at a café nearby, and its all in the mood of the day, of the moment and it comes and goes, like the breeze flowing outside and within seconds our demeanour can change from a happy one to a profusely sad or disastrous one, as we brace for impact. Our pace, and bearing the OR can determine our attitude the rest of the day/week.
In the course of our training, there is so much we see, we learn, we pick up and we form visions of what we would like to be, each part and flavour nit-picked and woven together by the teachers, mentors we acquaint with. And with that, forms our habits, rituals, superstitions, assumptions, inferences, and influences. From the very beginning in our professional route, we recognise the things we don’t want to learn or copy, but it takes mountains and eons of work, skill, ethics and observation to emulate the things we want.
Therein, I think comes the tendency for the obsession. Watching your mentor dissect away a tumor meticulously and generously, his daft hands patient and steady, can be exhilarating. At the crux of that, lies a need in every budding surgeon, a need to be able to do what his mentor can do, and that need paves way for obsession. We become obsessed with the size of the gauze, the needle type, the suture material, the strength of the cautery, the technique, the approach and it’s all related to comfort and preference, yielded under years of observation, of junior and senior residency, obedience, experience and mentorship.
For me, the OR is my comfort blanket. Its my place of happy memories (my photographic memory is sharper in the cold walls of the OR), tears, stories of cribbing, of talking out doubts, of huddled, rushed snacks at a canopied cafeteria, of intense pressure, of focused mind, of never-ending yawns, and exhaustion, of sleepy vision, of experimentation, of solitude, of eavesdropping charm, a sheltered environment of enacting my obsession in comfort.