I don’t know what to do with my life. I love surgery and I love people. It is frequently implied to me, without much subtlety, that those values are steeply at odds. “Surgery? I’m surprised! You’re so patient, you take time to explain things, and you don’t seem to get frustrated.” The resident had just met me for the first time, watching me explain the importance of anti-hypertenisve medications to one of my patients at a primary care clinic in a small and underserved town near Boston. I sighed at her comments, and couldn’t help but laugh. Did surgeons have such a bad reputation?
I already knew the answer. When I briefly flirted with pre-medicine as an undergraduate, I loved working in the emergency department. I was drawn to the excitement and adrenaline, but liked equally the time talking with patients, making them feel comfortable in challenging, frightening times. By the time I finally committed to medicine, after working in public health and living abroad, I quickly became hooked on anatomy. I was always the first of my team to lab, having carefully read the planned dissection for the day. I had noticed on the first day of lab that our cadaver had on the brightest, most perfect red toe polish. I often wondered silently about her life as I searched for her nerves and vessels. Anatomy was beautiful, but I enjoyed working with people. I never considered surgery. In a weird twist of fate, our anatomy professor had auctioned off her old copy of Schwartz’s Principle of Surgery, I ended up buying it because I was so drawn to the cover, the weight, or so I tell myself. My professor found out that I’d bought her prized volume, asking with glee “Are you going to be a surgeon?!” I remember mumbling something only slightly more gentle than “absolutely not” and awkwardly backing away from the encounter. Surgery just didn’t make sense.
The stereotypes that we carry about surgeons are densely layered and deeply cultural. We imagine the surgeon as arrogant, technically masterful, controlling, and perhaps even quick to anger. But, he, and it is generally a “he” that stars in our fictions, is this way because it is best for the patient. By taking control and “fixing the problem,” he has obviated the need for bedside manner. For compassion. When we imagine a good surgeon, we do not often imagine a “good” doctor.
When I was diagnosed with breast cancer a few years ago, my first visit was with a surgeon. She was patient. She took the time to explain the treatment options. She did not seem frustrated. I felt comforted and optimistic. And, several weeks later, when she called to give me the news that I’d been dreading, that the PET scan showed an area of uptake in my lung, I could hear the pain in her voice. I was in shock, alone in my apartment, splayed out on the bedroom floor and reeling from the emotional equivalent of vertigo. “We will make it through this” she said with a strength that resonated with a place inside me that I had not yet begun access.
When things got better, in a very relative sense, and the nodule in my lung turned out to be a primary tumor and not a metastasis, I visited a thoracic surgeon. Though imposingly tall and perhaps a little hulking, he was boisterous and smiled easily. He held my hand tightly as I went off to sleep. I remember his voice in the recovery room saying that things had gone well. He was at my beside every morning throughout my hospital stay. His visits were quick, but always meaningful as he perched on the side of my bed and updated me on the plans for that day.
Despite my experiences with these good surgeons, these good doctors, I had still felt the burden of stereotype pulling me away from surgery. As a person concerned with empathy, with the humanities, as a woman, I had been surreptitiously and insidiously taught that surgery would not be the right fit. Now, at the beginning of my fourth year, despite these pervasive generalizations, I know that surgery is a wonderful option for any medical student.
Certainly, the personalities of surgeons likely differ, on average, from the personalities of specialties considered more person-centered. But, empathy, or the ability to imagine the experience of the other, is not out of reach for any physician or surgeon. The dance is delicate. To understand the situation of the other, to take it to heart, but to not be immobilized by it, even to push it to the corner of our minds if it impedes our service to best interests of the patient. But, to connect with a person, and then to participate in his or her operation has never really felt counterintuitive to me, and I would imagine that this is the case for most surgeons.
In fact, the most memorable surgery of my third year was a gastric bypass performed for a patient that I had known through my primary care clinic for the entire year. I squeezed her hand in the preoperative area, telling her that we would take the best care of her. In the operating room, I didn’t wince when incisions were made or closed. I was wrapt with the beauty of the surgery, thinking to myself often that this would finally help her joint pain and hypertension. Help her move again. This was the surgery that she and I had been waiting for all year.
I hope that my caring, my love of people, and my patience will be valuable, regardless of whether or not I choose to spend part of my time in the operating room. I hope that we, as a profession that includes both physician and surgeon, can ensure that the empathetic student is not deterred from surgery. And, moreover, that the empathetic surgeons, of whom there are many, can be recognized as teaching us all what it means to be good doctors.
Shekinah Elmore is a fourth year at Harvard Medical School. Her creative work has been published in Third Space, the College Hill Independent, and JAMA. She was awarded first prize in the 10th Annual Michael E. DeBakey Medical Student Poetry Contest for her poem “gnosis,” and an honorable mention in the 2013 Arnold P. Gold Humanism in Medicine Essay Contest for an earlier version of “The Good Surgeon.” She is thankful to the many good surgeons who have been her carers and teachers, and looks forward to working with many more in her career in oncology. Correspondence at email@example.com.