My first appendectomy: on both sides of the table. A surgeon’s personality
Moja pierwsza appendektomia – po obu stronach stołu. Osobowość chirurga
Szpital Solec Sp. z o.o. hospital, Warszawa
To start with, here are a few details about the author: in May 1960, I completed my medical studies at the Warsaw Medical Academy (today: Medical University of Warsaw). In 1966, I became Doctor of Medical Sciences (PhD). In the same year, I completed the first stage of general surgery specialist training and in 1970 the second stage. In 1981, I received the title of doktor habilitowany (a title conferred to academics with a PhD based on their independent research) and in 1988 I received the title of Professor. Already after I retired, in 2012, I passed my surgical oncology specialisation exam. Some of my students were my examiners. Since previously I had never taken an exam in the form of a multiple choice test, everybody was worried if I would manage to pass such a test. But I did succeed. And my oral exam was not a problem for me at all. From 1981 to 2008, I held the position of medical and administrative head of department. I still work as a contract surgeon at the hospital in the Warsaw area of Solec. I also perform the function of the Commissioner for Patients’ Rights. In that hospital, in 1960, I started to learn surgery at the Department of Surgery of the Physicians’ Further Training Centre (today: Centre of Postgraduate Medical Education) headed by Professor Józef Kubiak. In order to prove the Earth’s sphericity, I returned to the place where I started my surgical journey.
In 1960, the Director of the City Hospital No. 8 in Warsaw at ul. Solec 93 was Dr Pierożyński. The Head of the First Department of Surgery of the Physicians’ Further Training Centre was a distinguished surgeon, Professor J. Kubiak. One day, I was part of a surgical duty team that covered the left Vistula bank area of Warsaw. The team was headed by a superb surgeon, Dr Władysław Liszka. I was the youngest member of a three-person duty team. A patient Jerzy Blachowicz aged approximately 30 years was admitted. I still remember him. He did not have a right hand and forearm, which he had lost during the Warsaw Uprising. Dr Liszka diagnosed acute appendicitis and appointed me as the operating surgeon. I was to be assisted by Dr W. Liszka. I felt a huge joy and disbelief. I was to be the operating surgeon at last. I had been an assisting surgeon for appendectomy so many times. I knew every detail of the operation, but... every patient is different. Every appendix is different and the course of appendicitis varies from patient to patient. There are so many anatomical variants and a few forms of acute appendicitis. But, I thought, why do I worry that much, this is not my appendix after all and I will be assisted by an excellent surgeon who will be formally responsible for me. Nevertheless, I did feel stress, anxiety and uncertainty. I am a humble person, this is how I was brought up to be by my Parents. I immediately remembered the famous view expressed by Joseph Lister, a distinguished British surgeon (1827-1912), that ”putting an inept hand into the human body, a miracle of divine mechanics, is an enormous responsibility indeed“.
I was right! After the abdomen was opened, the problem turned out to be acute, gangrenous inflammation of a retrocaecally located appendix. The operation lasted approximately two hours (when performed by me!) I silently admired Dr Liszka’s patience. Despite my difficulties, he did not take away the role of operating surgeon from me. Today, looking back from my perspective as an experienced surgeon, I can imagine what Dr Liszka felt during that operation, standing on the other side of the table. I realised that after many years, often assisting young Colleagues at different operations. I also tried not to take away the role of the operating surgeon too soon from someone, unless the patient’s condition required so. Learning and patience are important, but should not come at the cost of the patient’s health or life.
After the operation, I saw the patient a few times a day. He was not well after the operation. He developed a high, hectic fever. Biochemical markers of systemic inflammation increased. The patient was clinically diagnosed with purulent pylephlebitis and suspected with liver abscesses. The strongest antibiotic therapy and multiple drug treatment were applied. The patient’s condition was deteriorating. The symptoms of sepsis and septic shock increased. Finally, a decision was made to perform relaparotomy. During the operation, a large abscess was found in the right lobe of the liver. The abscess contents were evacuated and drained. Samples were taken for culture and antibiotic sensitivity testing. During surgery, the portal vein was found to be dilated and purulent pylephlebitis was confirmed. The patient’s condition after the operation was extremely serious. In those times, there were no intensive care units. I sat with the patient day and night. I wanted him to survive so much. He was just 32 years old. He had been crippled during the war and now this terrible appendicitis happened. I do not know why, but the patient’s condition started to slowly improve. He survived. We became friends. He visited me for many years to come. I decided to never forget about Jerzy Blachowicz.
That patient did not only mean my first appendectomy. Thanks to him, I learnt to treat every patient as if they were my first one. From that time, for every critical case, I have had a habit of exchanging telephone numbers with the patient in order to be in constant touch. This gives the patient a certain sense of security and I can call the patient to ask how they are feeling. Now, after 60 years, I still treat my patients this way. Today, I also went to visit a woman in hospital who had a complication after laparoscopic cholecystectomy. Unfortunately, there is no surgical medicine without complications. A surgeon does not have any complications only if they do not operate!
I have not got and I promise I never will get into a rut, since every patient is not just another case, but is a Person with their own individual personality and disease. There is no statistical patient.
What are the desired personality traits of a surgeon:
– features of a Good Person (friendly, warm-hearted, sensitive),
– sense of responsibility for one’s actions,
– willingness to always give the patient hope (there is no life without hope),
– ability to tell the patient the truth in a way that does not kill them,
– excellent surgical technique,
– calm and composure,
– good concentration,
– belief in oneself,
– being a good leader of the surgical team,
– clinical wisdom (knowledge verified in practice),
– ability to work as a team,
– attention to detail,
– resistance to getting into a rut.
A surgeon often agonises over their failures, sometimes at the expense of their own life. We should experience every single patient as if they were our first patient.
A person becomes a surgeon through decades of training and learning and thanks to such personality traits as intelligence, creativity, carefulness, courage, a caring attitude towards the patient, diligence, conscientiousness, reliability, humility and the ability to ask for help at the right time. A candidate for a surgeon must be mentally and physically sound.
What contributes to the magic of surgery? What makes a surgeon extraordinary?
– Efficacy and quick results of surgical treatment.
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