You Never Forget the First Time You Cut Someone Open

Cutting open a human body goes against every natural instinct to preserve life. We are pre-conditioned to recognize the color red as a signal for danger and crimson blood a warning of deep injury. Also, only 0.0001 percent of the world's population has successfully pursued a vocation in surgery, charged with commanding surgical teams in operating rooms where they spill blood daily. Trained to perform as expertly as an elite performance athlete—plus, assuming responsibility for their patient's survival and quality of life—a surgeon's existential powers are akin to a god's.

Unwavering concentration, cat-like reflexes, and a steadfast nerve are prerequisites for qualifying as a surgeon, not to mention the ability to complete procedures that sometimes take up to 18 hours. Every day, these physicians battle against what has often been genetically preordained—removing tumors and dangerous tissues, reconstructing bones, flesh and organs, or just attempting to alleviate pain. We spoke to five UK-based surgeons from a range of specialities about their experiences and what it feels like to watch life thrive or fade on their operating tables. Anne Dancey, Plastic Surgeon, Spire Healthcare

What was your first experience of cutting into a patient like?
It was an appendectomy and I sat at the nurses' station the whole night just to check if the patient didn't have any problems. It was such a relief that he recovered and went home. The risk of mistakes occurs with complacency. Each operation presents new challenges and every patient is different. If you don't learn something new each time and try to improve what you do every day, then you stagnate as a surgeon. How did working for the military department impact your personal growth as a surgeon?
I was constantly in awe of the young soldiers who would arrive from the battlefield with devastating injuries and yet they would be so positive and put so much effort into their recovery. However, there were sustained periods when I saw many injured individuals and the surgical tempo was high. Sometimes I wondered whether this would become the new normal—thankfully it did not. We would then hear about how military patients go on later to do parachuting or skiing despite some losing multiple limbs. It's incredible that despite these life-changing events, they had the courage to do many activities that I would never be brave enough to do.

What has been the most gruelling operation of your career?
My specialist interest is microvascular reconstruction, which only a limited number of plastic surgeons do due its complexity. The surgery involves taking skin and soft tissue from one area of the body and moving it to a completely different area. It relies on re-attaching blood vessels with very fine sutures. Each suture is finer than a hair and we must use microscopes to see them. The operation can take hours to do and if they don't work you must keep retrying or the tissue will die and the operation is a failure. The operation normally takes up to eight to ten hours to do and we don't take a break. If it is not going to plan, then it can be longer; I think 18 hours has been the longest one to date.

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Jimmy Ng, ENT Surgeon, Charing Cross Hospital Imperial College Healthcare NHS Trust

When did you first realize you wanted to be a surgeon?
At the age of five, I broke my left leg after an accident while dancing to Michael Jackson's "Billie Jean." I was in the hospital having the leg treated at the time when I saw the orthopedic surgeon in his white lab coat—It reminded me of superman in his cape, only it wasn't red. I thought he was very cool. In secondary school, I was convinced that I wanted to be a surgeon when I read the book Every Second Counts which was about the first ever human-to-human heart transplant by Christiaan Barnard. What has been the most humbling moment you have experienced when caring for a patient?
A 93-year-old woman, who wished to die, came in with abdominal pain and was being treated for diverticulitis. She was frail but her body held on, although she had pain and the disease did render her bed bound while she was in the hospital. She survived with conservative treatment and was discharged. It was humbling because this woman survived two world wars. When I was drawing blood from her, she told me that depression isn't what drove her desire to end her life. "I have lived a great life…I am happy with my life thus far but I don't want to carry on because I am ready to leave it all behind and go on to the next stage. My daughters and grandchildren want me to see a shrink but I am not [depressed]," she told me. "You're doing a good job and you have a good life ahead of you, young man, and I am sorry that I have to inconvenience you and be such a demand on your time." What impresses you the most about the human body?
The grit, resilience, and the will to tread the untrodden path and that even when the human body is dead, it still has a story to tell. Deborah Nicols, Consultant Colorectal Surgeon, Worcestershire Acute Hospitals NHS Trust

How much more challenging is it to establish yourself as a female surgeon?
When l was training I never worked for a female [surgeon]. There were one or two, mainly breast surgeons. But there weren't general surgeons because it's always been a slightly testosterone fueled, male-dominated area of medicine, so it never attracted women. There are a lot of jobs you can do for more money, less hours, less stress. I could see more of my kids, go to the gym more—but I can't imagine myself doing anything else. Most surgeons will [complain] but most of them will tell you they do it because they love it. Tell me about one of your first surgeries.
When I was 21 and working in Kenya, I was driving up to this peripheral clinic which was in the middle of nowhere—a three-hour drive from the hospital. We could always only bring one person back with us. If someone was really sick we could put them in the back of the Land Rover and drive back. There was an old man who had been brought by his family and had walked several hours to get to this village to meet us. He had an infected open fracture to his leg and needed surgery immediately, or he would have died. The nurse then informed me that there was a woman [at the clinic] with heart failure there too. They asked me which one l wanted to take. I couldn't make that decision. I was a medical student, but I was the most senior person. I said, "This woman is here…she may be dead by the time she gets there, so we take him. He's sick and he's here." We put him in the Land Rover, then halfway down the track, the other sick woman appeared. It was a small car—no room for more than just the nurse, driver, me, and one patient. I wanted to get out but I had no idea where we were. The nurse had a relative who happened to live a three hour walk from where we were. So she got out and we took both patients. Then we sent the driver the next morning to get her. After treatment both patients did okay. There was no right answer there, it was about doing the best you could. Shivam Bhanderi, Surgical Resident, Health Education West Midlands

What has been the most humbling moment you have experienced when caring for a patient?
During my first job as a [resident] I was asked to see a patient who'd just recently had keyhole surgery. She was much more unwell than she should have been after an operation and so I was quite worried about her. It turned out that she was still bleeding internally after her surgery and she needed to be taken back for another operation. I fully prepared her to go back to surgery and sought support from other senior doctors even though my shift had ended. As a reward, I suppose, the consultant allowed me to assist with her emergency operation. She was the first patient who thanked me "for saving her life."

Do you remember the first experience of cutting into a patient, what went through your head?
If having to place a suture perfectly under the watchful eye of an experienced senior wasn't stressful enough, imagine my astonishment when during an operation, I'm handed the scalpel to make the initial incision. It certainly is surreal. It's a surprisingly pivotal moment as it's at that point that it occurs to me that we're really about to perform this operation—you're committing yourself to it. It's also got to be done right first time—there's no going back from an incorrect first incision. I was extremely cautious as I didn't want to go too deep too soon. Nothing really can prepare you for it, and over time I've become more confident and calm about handling the scalpel.

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