Ohad Oren: Routine operation, impeccable performance

Ohad Oren“Bring sac close to peritoneum, drain its purulent liquid content, and have the shrunken pouch squeezed through this tiny hole.” Such was the senior surgeon’s instruction at the conclusion of a gallbladder removal operation. After the laparoscopic resection of an infected gallbladder, which went as smoothly as anyone would have wished, the ultimate manipulation was still in the planning phase. A gentle hum was heard on auscultation; the strategy to employ for the sterile evacuation of the inflated, ping-pong sized, gallbladder through the periumbilical laparoscopic aperture was still being considered. Several minutes later, the drain-first-then-pump approach proved to be the chosen surgical regimen, with the infection challenge overcome seemingly successfully.

So all went according to plan. And with the sludge-harboring organ shining across the operating table, the nurse seemed eager to complete her checklist and summon the next patient to be operated on. But the surgeon wished to emphasize a certain point to those present. He might have been about to convey a a practical reflection of his previous experience as a surgeon. With a stern expression, he delineated the anatomy at the foot of the liver, along with the important relating structures. “What you have essentially performed here,” he lectured the young intern,” could be paralleled to the historic conquering of east Jerusalem, 1967.” He immediately captivated us with his thoughts. “Rather than reach for the posterior aspect of the proximal cystic duct, you choose to start your dissection at a more distal location, a locus highly susceptible to inadvertent operative damage.” He reminded the surgical team how the Israeli Defense Forces had complicated their position during a famous battle back then, passing through successive Jordanian palisades, instead of compartmentalizing the whole “infected” zone, aiming for eastern Jerusalem. By moving through a forest so abundant in vessels, the intern was endangering several essential arterial branches, and for no good reason. The intern seemed perplexed, asked for the clarification to be repeated, and the analogy was stressed one more time. It was indeed a peculiar way to conclude a cholecystectomy.

You may argue that the Middle East’s unique geopolitical reality diffuses even into the medical – and surgical – domain. How do such metaphors as the operating physician’s find their way into rooms where Arab and Israeli surgeons build on each other’s knowledge and where operating teams composed of individuals of all nationalities tirelessly work for hours, repairing pathologies, brainstorming pertinent implications, and sharing their innovative ideas?

However, the moral of the surgeon’s story wasn’t to glorify a landmark battle; it wasn’t to remind those around him of the influence of a blood-soaked battle at the height of the Six Day War; not even the mere logistic principle at the core of that military sortie. It was about every surgeon having to improvise, glance outside the catalogued, stepwise ordered, textbook, and tailor an adequate ameliorating tactic to the unfamiliar situation that is evolving. And it also aimed to tackle the inevitable nature of a humanistic medical care, embedded in just four words: No casualties left behind. Much similar to the uncompromising modus operandi of any battalion commander, the operating team must share the spirit, the motivation, and the willpower to traverse the unconventional, aspire for the unimaginable, and creatively reach for perfection. And that remains insurmountable in the absence of a determined, ingenious, and wisely integrating, mind.

Ohad Oren is a fifth year medical student at the Bruce Rappaport Faculty of Medicine, Technion – Israel Institute of Technology, Haifa, Israel