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DECISIONS ARE MORE IMPORTANT THAN INCISIONS
BY CONOR MAGEE MD FRCS, CONSULTANT SURGEON
After five years of training there comes the day when the medical
student receives their degrees and finally becomes a doctor. Shortly
after the degree ceremony all these newly minted doctors take the
“Declaration of Helsinki”- a modern take on the famous Hippocratic
Oath whose central dictum was “Primum non nocere”, first do no
harm.
For those doctors who decide to become surgeons, primum non
nocere has especial meaning. On day one of your surgical education
you are given a knife that can be wielded for good, or terrible harm.
It is said that the true of art of surgery is in deciding when not to
operate.
Surgery is safe - but it is not risk free and even in the finest hands
operations can go awry. I am always minded of the tale of Anthony
Eden and the Suez crisis and it bears repeating here.
Sir Anthony Eden (later Lord Avon) was the youngest Foreign
Secretary and then succeeded Churchill as Prime Minister at a time
when Britain’s global power was receding. Eden was a survivor of the
trenches of World War 1 and a man of great integrity who resigned
from government in protest at Chamberlain’s policy of appeasement
towards Hitler.
In 1953 he developed jaundice and severe pain and was diagnosed with
gallstones. His personal physician Sir Horace Eden recommended
cholecystectomy (removal of the gall bladder). It is said that he was
given the choice of the finest hepatobiliary (specialist gallbladder
and liver) surgeons but instead opted for the chap who removed his
appendix almost 40 years earlier. Unfortunately, the operation was
not a success - Anthony Eden had a bile duct injury. The bile duct
is the pipe that drains the liver and injuring it is the most feared
complication. A second operation to drain bile that was leaking into
his abdomen needed to performed - but still this did not rectify the
problem.
82 wirrallife.com
Eventually Eden had to undergo a series of operations in the Lahey
Clinic in USA to reconstruct his damaged bile duct. The operations
were performed by Richard Cattel, the world’s leading liver surgeon.
Eden was well until 1956 and required further assessment. The
medical notes from the Lahey clinic are startling in their content-
they describe repeated episodes of fever and jaundice that needed
treatment with powerful painkillers and sedatives.
The timing of these fevers could hardly be worse - in 1956 Colonel
Nasser nationionalised the Suez canal. The Suez canal was jointly
owned by Britain and was responsible for the passage of half of
Britain’s oil supplies. At this point Britain only had 6 weeks of oil
reserves left. Eden responded by sending troops to Suez and bombing
other targets in Egypt. This move was condemned by the United
Nations and eventually Eisenhower and the United States withdrew
support. Eden was left isolated in his cabinet and the British troops
were withdrawn with Eden resigning shortly afterwards. The Suez
crisis is thought to be the curtain call of Britain as a world power.
We know that during the crisis Eden was under enormous strain - but
he was also unwell. The fallout from his gallbladder operation and
subsequent procedures left him with episodes of sepsis, requiring
powerful medications to treat.
There is no doubt in my mind his decisions were affected by the
illnesses he suffered - all through surgical mishap. It is sobering to
realise that even in retirement Eden sti ll required further surgery to
address his bile duct with operations performed in the 1960s and
1970s. He died of prostate cancer in 1977.
At Eden’s original operation a decision to cut the wrong tube was
made- all things that followed came from that error. And that is why
decisions are truly more important than incisions.
Mr Magee operates at Spire Murrayfield Hospital and can be
contacted there. He can be followed on Twitter @mageefrcs.