Iron surgeon?

The other day, Sid Schwab, surgeon blogger extraordinaire, brought up a question that, I’m guessing, most nonsurgeons wonder about from time to time when contemplating how it is that we surgeons do what we do.

What about bathroom breaks?

Given that most of the surgery that I do is breast surgery, my operations rarely take more than two or three hours. The only time a typical operation that I do takes longer than that is the uncommon times when I am doing a double mastectomy, and even then it’s rarely more than a four hour affair. All I have to do is to make sure to hit the bathroom right before scrubbing, and I’m fine.


However, back in the day (namely, when I was a resident), as all residents do, I tried to get involved with the more difficult cases in order to hone my skills. Naturally (and unfortunately) the more difficult cases were often the cases that taxed not just my skills, but my bladder. Indeed, when I was on the transplant service, it was not uncommon for me to scrub on a liver transplant, a case that could easily take 8-12 hours. What I learned back then is that the attending surgeons did on occasion take bathroom breaks. There was no shame. Anyone who can hold it for 12 hours, at least as far as I’m concerned, is a bit of a mutant anyway.

More problematic was the time when–well, to put it delicately–problems with the lower GI tract arose during the middle of a case. It’s a horrible thing to have happen when you’re in the middle of an operation. Really. You have no idea. It happened to me only once, but it provided a serious dilemma. What do I do? I’m captain of the ship of the O.R., so to speak. The entire team depends on me. The patient depends on me.

And that’s the key to making the correct decision.

If I’m to do my best for the patient, I can’t be trying to hold it in, so to speak. I can have no distractions that might cause me to screw up in any way during the task at hand. Patients’ lives depend upon it.

So I did what I had to do. I scrubbed out, headed to the bathroom, did my business as quickly as I could, and then scrubbed back in. What else could I do? I came back free of the distraction that holding it in was causing, and the case went much better after that.

As hard as it is to believe, surgeons are human, too. We sometimes suffer exactly the same sorts of problems that anyone else suffers. When these problems happen during the middle of an operation, our duty to the patient demands that, unless circumstances make it impossible for us to leave, we answer whatever call our bodies are making and then get back to the business of the operation as soon as possible. Sid is right: As much as surgery is about thinking about what to do to fix a problem, because it’s such a technically oriented specialty, there are time when it is indeed all about the body.

Unfortunately, even the body of s surgeon is not made of iron.