The surgeon

Case history

The physician

Case history

Tom, aged eight months, was brought to the pediatrician with a cough. Tom had had the cough since he was born. Tom’s family lived on the thirteenth floor of an apartment building. The building had been built in the 1960s and was now damp, dirty and run-down. Tom’s father had left his mother three months ago. She was miserable, smoked twenty cigarettes a day and did not take Tom out much. The pediatrician saw that Tom was thin and small for his age. Tom was not seriously ill but he had a chest infection.

The pediatrician gave Tom antibiotics for his chest infection. Two weeks later he was ill again with the same problem. Poor housing, damp air and cigarette smoke had all helped to cause Tom’s illness. Tom would not get better unless some of these “root causes” were removed.

Doctors have always divided themselves into surgeons and physicians. The surgeon’s tool is the scalpel; the physician’s tool has traditionally been the drug. The surgeons were originally barber-surgeons who cut people’s hair and performed other cutting procedures (such as draining abscesses) at the same time. The physicians thought that they were cleverer and more cultured than the surgeons. In fact, people did not think of surgeons as doctors at all! In ancient times, physicians did not touch the human body directly. They decided what was wrong with the patient by asking questions and looking at body fluids such as urine, phlegm and vomit. In ancient times, physicians used herbs to treat patients. More recently, as the sciences of chemistry and pharmacology developed, they began to use artificial chemicals or drugs.

In 1992, Alan Jenkins, aged fifty-fife, collapsed with a heart attack. His general practitioner came quickly, and gave him an aspirin tablet while he waited for the ambulance to arrive. At the hospital, the doctors gave Mr. Jenkins an infusion of streptokinase into his vein, as well as the traditional drug morphine for pain. Within a week Mr. Jenkins was back home and walking about. After six weeks he was back at work. He now takes an aspirin every day to protect him against further damage due to blood clots.

By the early twentieth century surgeons were able to cure many patients by removing diseased parts of the body. They had earned the trust and respect of the general public. The surgeon had changed from a dangerous butcher to a wise and skillful professional. He had the unique authority to cut into the living human body. Many people thought of surgeons as perfect and god-like. Surgeons enjoyed their reputations and some of them even began to believe in their own perfection.

In the late 1970s, surgeons began to see that major operations caused major stress to the sick patient. Patients, more aware of their rights over their bodies and influenced by alternative medicine, demanded gentler forms of treatment.

The era of minimally invasive therapy began in the early 1980s. Surgeons tried to operate through smaller incisions which healed more quickly.

In the past, people said that the surgeon had “the eye of an eagle, the strength of a giant, and the hand of a lady.” The modern surgeon must also, perhaps, be skilled in the art of self-restraint. Until a few years ago, people judged the surgeon’s skill by how deep he could cut and how much he could remove. Today, we judge the surgeon not by what he removes but by what he leaves intact. Minimally invasive therapy has, thankfully, replaced the heroic surgery of the past.

Дата добавления: 2014-10-15