Grey’s Anatomy This Ain’t

What Your Doctor Won’t Tell You About Surgery

A surgeon dishes on the biggest secrets your doctors won’t tell you about the OR—like why obese patients are hardest to operate on.

20thCentFox/Everett

Click-bait articles are arguably the worst invention of the past decade (dubstep being a close second). We’ve all seen the über-catchy headlines time and time again that almost compel you to click them because they sound so amazingly amazing: 10 SECRETS YOUR AIRLINE PILOT WON’T TELL YOU. 15 THINGS YOU EAT EVERY DAY THAT YOU SHOULD NEVER TOUCH AGAIN BECAUSE THEY WILL TURN YOU INTO A ZOMBIE. You know it’s going to be complete claptrap, but your curiosity is piqued. So you click . . . and you instantly regret it. You’re whisked away to some horrible slow website that only shows you one of those 12 things per page, each of which is plastered with advertisements for everything from weight loss pills to organic dog food to singles dating sites.

This is not one of those articles. Mostly.

The field of surgery seems to be shrouded in mystery. You go to sleep on the operating table, someone does something to some body part while you’re under, and then you wake up, hopefully fixed. But what exactly happens in the interim? Even if you’re awake during the surgery (i.e. under epidural anaesthesia during a Caesarian section), the surgeon puts up a large sterile drape, which prevents you from seeing what’s going on below. As it goes up you can almost hear the Wizard of Oz bellowing, “PAY NO ATTENTION TO THAT MAN BEHIND THE CURTAIN!”

So what does happen back there? What are surgeons thinking? What makes us tick? Well, I’m about to tell you. Here are some secrets about surgeons and surgery that most of us would never admit. Hopefully there is no Top Secret International Surgeon Society that will come after me for divulging this information.

Anyway, I’ll start with what I think will come as the biggest surprise...

Surgeons do not consider themselves gods

The most common misconception about us is that we think of ourselves the way that Hollywood portrays us—as arrogant jackasses with a scalpel and a god complex. I’ve known many surgeons who put on that face when they are seeing patients, but very few who actually are that guy outside the OR. Make no mistake, there are plenty of arrogant surgeons out there, but behind the scenes most of us are just as humble and modest as we could be. When we’re performing surgery, our patients are at their absolute most vulnerable, and we are in charge of their lives. To me the Arrogant Surgeon is a facade that must be maintained, because not only are we the captain of the ship, we have to look and act the part.

We respect the hell out of primary care doctors

This one may not be as huge a surprise as the last, but I tease my internal medicine, family medicine, and pediatric colleagues mercilessly. I jokingly tell them that I think my job is better than theirs, because unlike them I can see a patient with a discrete fixable problem and then fix it, often in a matter of minutes. I just don’t have the attention span for primary care. But the reality is that as much as I tease them, I have the utmost respect for them, because as hard a specialty as surgery is, primary care is much, much harder. Seeing blood may be easy for me, but I can’t stomach the idea of seeing someone month after month for the same malady, giving them a pill to make something higher or lower, faster or slower, wetter or dryer. I can’t imagine seeing dozens of screaming children complaining of earaches and stuffy noses day after day. The truth is that I am glad people with patience like them exist, because I could never do what they do.

And I’m sure they feel the same about me.

The human body is like a box of chocolates

Sadly, the body is not put together like it looks in anatomy books. Arteries are not red, veins are not blue, nerves are not yellow, and organs aren’t always where they belong. My father (also a general surgeon) related a story to me where he performed an operation on a patient with situs inversus— all of the patient’s internal organs were mirror images of where they were supposed to be. Fortunately he knew this before the operation, and for a week he practiced doing the operation backwards, yet it still turned out to be much more difficult than he could have imagined.

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Even worse is operating on someone who has had surgery before—something I call “surgical archaeology”. These redo operations can be some of the most difficult procedures we do. If you see me to have a hernia operation redone, just know that I’m cursing internally. Not at you per se, but at the scar tissue and distorted anatomy that I know I’ll be faced with.

We sometimes get nervous

Not only is the body not color-coded, but there are innumerable anatomic variances and anomalies that we see, and the vast majority are completely unpredictable. Blood vessels, for example, often don’t course exactly where they are supposed to, and they can branch in the most unlikely places. If we encounter (read: cut) an extra blood vessel or an anomalous organ during a routine surgery, it can completely throw us off. Yes, there are times in every surgeon’s career when we’ve confronted something unusual and thought to ourselves, “What the HELL do I do now?” Fortunately part of our surgical training includes accounting for exactly such aberrations. We are rigorously trained to deal with just about any type of disaster imaginable, so we take a deep breath, correct for it, and move on. We just don’t like to have to. We like routine surgery.

We are deathly terrified of leaving something inside you or removing the wrong organ

Stories of surgical mistakes (“So there was once this surgeon who took out the wrong kidney...”) used to be the stuff of surgical lore, passed down from surgeon to student, but with the advent of the Internet these terrifying (and often true) tales now readily spread to the farthest reaches, and it seems everyone knows someone who heard of some guy who has had a pair of scissors left inside him (yes, that actually happens). We have strict protocols now before, during, and after every operation to prevent these mistakes, yet despite our best efforts they still do happen. Rarely. We make fun of these protocols and pretend they are meaningless and silly, but deep down we know they are important and potentially life-saving. Giving someone a not-so-pretty scar may be defensible, but leaving a huge surgical retractor in someone’s abdomen is not.

Obese people are much more difficult to operate on and take care of

There are few surgeons who would actually be willing to admit this and I don’t say it to be a heartless cretin, I’m only being honest. Obesity is increasingly becoming a worldwide problem, and it comes with a laundry list of associated health problems, including hypertension, diabetes, stroke, heart disease, high cholesterol, and obstructive sleep apnea, among many others. But in addition to that, being obese makes your operation much more difficult technically and puts you at a much higher risk of wound (and other) problems. Only the most honest surgeons will tell you this, but all of us are thinking it.

The operating room is not a serene environment

When you’re wheeled in, there may be tranquil music playing, and everyone there will probably use soft voices to calm and soothe you as you drift off to sleep. As soon as you’re out, however, the music changes to whatever the surgeon feels like listening to. I’ve heard everything from heavy metal to country to jazz to Japanese bluegrass (yes, really). The jokes come out too, and the more indelicate the better. Don’t misunderstand me—the operation always comes first, and no one takes that lightly. Ever. But that doesn’t mean the conversation is limited to just “Scalpel . . . Scalpel. Scissors . . . Scissors.” We do have some fun while you’re asleep, but not at your expense. Unless you have a misspelled tattoo.

Just kidding.

We all see you naked, but we don’t care

When I had my appendectomy in college, I was absolutely mortified when I discovered the next day that the surgeon, residents, nurses, assistants, techs, aides, and probably several dozen other people all saw me au naturel. It hadn’t even occurred to me beforehand that this was even a possibility. Several years later during the first operation that I witnessed as a medical student, I immediately realized that no one in there cares. We’ve all seen it a million times, and trust me, despite what you may believe, yours is no different than anyone else’s. I’ve had many patients who have been apprehensive about disrobing before surgery, but there is nothing remotely titillating in the operating room. Nothing.

The bandage matters

It may seem like an inconsequential afterthought, but to me the bandage I put on at the end of an operation is one of its most important aspects. You’ll never see what went on inside you as I was working, but when you wake up the first thing you’ll see is the bandage. I may have done a pristine gall bladder surgery, but if the bandage is crooked or wrinkled or bloody, then I immediately look like a hack. So I will take the extra 15 seconds to make the bandage look PERFECT.

We make diagnostic mistakes, and we hate it

Everyone knows that medicine is an art as well as a science, surgery even more so. High-resolution CT scans, sonograms, MRIs, and other diagnostic tests are better than ever and incredibly helpful these days, and when we combine them with our own physical examination, we can get pretty damned close to perfect at making the correct diagnosis ... pretty close, but not quite. Unfortunately we do rarely make diagnostic mistakes and perform unnecessary surgery. Though it hasn’t happened lately, several times I’ve been lead astray by a false-positive CT scan, and I’ve subsequently taken out several perfectly normal appendixes. And I feel like an idiot every time. I hate being wrong, so every time it happens I go back and try to figure out why I was wrong so it doesn’t happen again. Still, we know it will happen again, and this frustrates us to no end.

So what really goes on behind that sterile curtain? It’s really quite simple: we never lose sight of our purpose, and we always remember that for a short time, you are completely at our mercy as we quite literally have your lives in our hands. All we do is our absolute best to take you apart, put you back together, and make it look and feel like what we just did to you was no big deal.