Don’t Steal the Surgeon’s Clogs: Surgery Past and Present

I never had any illusions that I wanted to be a surgeon. Blood, gore and heroics didn’t appeal to me, but medical students are required to study surgery as well as medicine. Once qualified as a doctor I had to do six months in a surgical job, and my GP training included six months in obstetrics and gynaecology which also involves surgery.

My first ever clinical placement as a medical student was on a general surgical firm. I was sent to assist in the operating theatre and changed into theatre greens, which looked like unflattering pyjamas, and swapped my shoes for clogs from a pile in the corner. Little did I realise the peril involved.

One day the consultant surgeon came into the theatre, angrily announcing that someone had stolen their clogs. They inspected everyone’s feet and, once satisfied they had found the culprit, demanded the offender return the clogs. The poor humiliated student had to slip them off on the spot. Several of my medical friends tell me they still have nightmares about this scenario.

To assist with surgery, I had to wash and gown up in the scrub room. I donned a paper hat and mask, then started washing at the massive stainless steel sinks with taps with long handles to be operated by my elbows. I had to scrub my nails with a nail brush, then smother my hands and forearms in pink hibiscrub and wash for several minutes. Next I opened a sterile pack and put on my gown (someone else tied it up behind) and my gloves. I had to wait with my hands together in front of me and not touch anything. Ignore that itch or else I would have to do it all again!

In Thomas Hammond and John Keats’s time there was no antisepsis. They would have washed their hands after the operation, not before. Surgeons wore frock coats to protect their clothes, but these were soaked in blood and pus, hung up in the theatre and not laundered very often. The infection rates were very high, and many patients died of sepsis.

I remember the operating theatre was always freezing cold. Sometimes it was silent, sometimes there was music, sometimes hospital gossip or chat. Oh, the interminable tedium of holding a retractor for hours for a hysterectomy or gallbladder operation. I often felt lightheaded, not because I was squeamish, but because I’d been on my feet for hours. Sometimes I’d also be starving.

The patient was asleep and didn’t feel a thing; the anaesthetist made sure of that. In Hammond and Keats’s time (late eighteenth and early nineteenth centuries) there were no anaesthetics, so speed was one of the most important attributes for a surgeon. Astley Cooper was renowned for being quick, but the pain the patient experienced must have been excruciating. Sometimes the patient was dosed with opium or alcohol to help dull it, but they would still have been conscious. General anaesthesia came into use in the 1840s.

For me, watching surgery was a shock, completely different from anything I’d witnessed before. The scalpel cutting into flesh, blood oozing along its path. The smell of burnt flesh from the diathermy machine. The sight of organs, guts, livers and kidneys. It felt unreal. At the end of the operation there was the thrill of sewing up skin, which I was allowed to help with. It was a sort of running stitch. I liked sewing and had made my own clothes as a teenager. This didn’t actually feel that different.

Surgeons have long had a reputation for being brusque, brilliant technicians but no good at talking to conscious patients. This is difficult because they need to explain diagnoses, operations, choices and risks. In the short film “Romantic Surgeons” Dr Michael Brown argues that the stereotype of surgeons in pre-anaesthetic times as hard-hearted butchers is a myth and many, including Astley Cooper, were empathic and did feel but controlled their emotions to help patients. (www.surgeryandemotion.com) I’m aware modern surgeons are also empathic.

I have great respect for surgeons who cut into a living body, see the organs and systems of a living human, and remove organs or repair tissues. Some conditions can only be treated by surgery however good medicines have become. I couldn’t be a surgeon because of the fear I would make a mistake and the patient might bleed to death if one vessel was left untied, or a nick in the wrong place might cause paralysis. Surgeons need to be supremely confident. Keats told his friend Charles Brown that in his last operation he had successfully opened a man’s temporal artery, but afterwards thought it a miracle. To me it sounds as though he was terrified by the thought of what might have happened if he’d made a mistake.

My sympathies are with John Keats but thank goodness for the Astley Coopers.