Stephen J. Birchard DVM, MS, Diplomate ACVS

Sunday, November 3, 2013

Are Some Doctors Born To Be Surgeons, Or Can It Be Learned?

I was a 2nd year veterinary student and it was my turn to be the primary surgeon in our surgical lab course. The procedure to be performed was a splenectomy and it was on a live dog. (Many years ago shelter or purpose-bred dogs were used for a variety of surgical procedures in teaching labs like this. Today surgical laboratories in many veterinary schools do spay and neuters on shelter dogs that are then adopted.)

I was nervous about this lab for days in advance. I was a surgery “virgin”; it was my first time as the primary. I was afraid that I would make a mistake that would hurt the dog and ruin my confidence. I knew these labs were a “rite of passage” for vet students in their journey to becoming a doctor, and I didn’t want to fail. My quest to be a vet began when I was 10 years old; I didn’t want it to end prematurely because I couldn’t successfully do surgery.

The surgery began fine but quickly deteriorated. I made the initial incision and opened the abdominal cavity, but I was afraid to pull the spleen out. I thought if I was too rough it would rupture and the dog would bleed to death. (Splenic rupture can lead to life threatening hemorrhage so there was some logic to my hysteria.) After about an hour, which felt more like an entire day, I finally got the spleen exteriorized. It was enormous. The anesthetic drugs had caused severe splenomegaly, and to me it looked like a gigantic purple throbbing alien that was ready to explode and create an epic disaster.

I had to identify the splenic blood vessels and get them ligated so I could remove the scary organ before it ruined my life. For those who have never done a splenectomy, there are about 16,000 little blood vessels that have to be tied off. I thought I had to dissect and ligate every tiny vessel individually so that’s what I started doing. The minutes and hours ticked away. After a while the student doing anesthesia (who probably still hates me to this day) rudely announced that the dog was going into shock; pale mucous membranes and rapid heart rate. Not what I wanted to hear and now my worst nightmare was beginning to take shape. He wanted to know what the hell was I doing and why was there blood all over the floor. I looked down and there was an accumulation of blood that was definitely the size of Lake Erie.

Unknown to me when I manually pulled the spleen out of the abdomen I had created a small fracture of the organ at its end (or tail) and it had been bleeding down the surgical drape and onto the floor for quite some time. Trying to maintain my composure, I called my faculty lab supervisor over for advice. Embarrassment and shame were making inroads into my consciousness. Ditch digging was starting to look like a very attractive career choice. Dr. Roger Brown, one of the older, wiser, and calmer surgeons at the vet school, was running the lab.  In a soft and reassuring voice he told me to get the damn vessels ligated and take the spleen out so the dog will not bleed to death.

Somehow I willed my shaky, tentative hands to perform. I got the vessels tied off and removed the spleen. I closed the incision and the dog made an uneventful recovery from anesthesia. I stayed with him most of the night and prayed to the god of surgery that he would make it. Miraculously, the dog survived.  Ditch digging would have to wait till another day.

After this brush with surgical disaster I was convinced that surgery was not going to be my game. Obviously that changed over time. After 35 years of teaching surgery to students, interns, and residents, I am convinced that some people have a natural ability and demeanor to be surgeons.  But that doesn’t mean that the other 99% of the world has no hope of ever being a competent surgeon. The American College of Surgeons Division of Education Website states: “Surgeons are trained, not born.”( If you have the desire and are willing to study, learn from others, practice your skills, have a positive attitude and resilient personality, and love to do positive and definitive treatments for your patients, you can be a good surgeon.

But, here’s my other advice: if you don’t like surgery and don’t want to do it . . . its OK! Let someone else do it, and don’t feel bad about it! An oncologist once told me that he only does minor surgeries; he refuses to do anything that requires taking the scalpel blade out of its foil package. Do the things you love to do, and feel good about yourself. The veterinary profession is a community. We help each other and we compliment each other’s interests and skills. The end result is high quality patient care delivered to our 4-legged family members. I am very glad to be a part of it.