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THERE ARE NO BRAVE SURGEONS,
ONLY BRAVE PATIENTS…
BY PROFESSOR CONOR MAGEE MD FRCS, CONSULTANT SURGEON
The Hippocratic Oath contains the Latin phrase “Primum Non
Nocere”- First, Do No Harm. As Doctors we have the ability to
do immense harm to patients, thankfully our training, skills and
humanity make this very rare.
However, every surgeon knows that what they do will involve some
form of harm or risk to their patient. On day one of Surgery School you
are given a knife and it is clear that although it is wielded for the greatest
good, cuts must be made, tissue incised, pain inflicted and harm always
a possibility.
One of the constants of hospital life is the semi-serious friction between
surgeons (the craft specialists, descendants of barber surgeons and
bladder stone cutters) and physicians (the educated, intellectual
shock-troops of medicine). Both make patients better but in different
ways - none are superior (OK, that’s not true, surgery wins every time
because… well just because!).
One barb thrown at us is the fact there are no brave surgeons, only
brave patients. And I do have some sympathy for this - after all it is very
unlikely that the surgeon will be harmed or die as a result of operating.
There is no doubt that operative mortality and morbidity (the risks of
dying of having complications) was enormous during the early years of
surgery. But, what was the alternative?
In the 19th Century, when modern surgery began, patients were dying
from cancers, perforated ulcers and strangulated hernias in the most
terrible of ways. Surgery was introduced to make these diseases better.
Patients were brave to undergo surgery - but there was also surgical
bravery, the belief that you can make a difference.
They say that we remember the surgeon but not the patient - well, that
is not always true. In 1881 the great Viennese surgeon Theodor Billroth
was called to see a 43 year old lady called Therese Heller. Therese was
dying from a cancer of the stomach - the cancer had almost completely
blocked her stomach meaning every drink or mouthful of food was
vomited up. She was weak and wasted. Billroth could feel the mass
through her thin abdomen. He knew that there was little hope as
nobody had successfully removed a stomach cancer before. Therese had
maybe days left to live.
Fortunately for Therese, Billroth was also a genius and had spent months
researching whether it was possible to do this very operation - hours of
work in his lab and operating on dogs gave him the confidence to try.
On January 29th, he exercised all his skill and performed the world’s
first successful gastrectomy - he removed the part of the stomach with
the cancer. The cancer was so advanced it barely admitted a feather
shaft. He joined the remaining healthy stomach to the bowel and after
90 minutes of operating Therese was returned to the ward. She made
a rapid recovery and was able to eat and drink normally. This is the
operation that ignited the world of surgery and is the bedrock of the
surgical wonders performed routinely in every country of the world.
This operation is still called a Billroth gastrectomy to this day.
Professor Magee operates at Spire Murrayfield Hospital and can be
contacted there. He can be followed on Twitter @mageefrcs.
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