The surgical hierarchy

The surgical hierarchy

What is the hierarchy’s reputation in medicine?” asked a bald friend of mine, when I referred him to a general surgeon to remove an annoying sebaceous cyst on his flaky scalp. “Brain surgeons don’t deal with minor problems like this. “I’ve removed it a couple of times before and it keeps coming back, so I want you to do it,” I said with joyful arrogance, dismissing the swelling on his head. said.

“Neurosurgeons are at the top of the medical totem pole,” I asked to answer his question. “We do the most sophisticated and precise work. Furthermore, our job has the maximum potential for loss and, therefore, the stakes are high—because the brain and spinal cord control everything,” I explained. My cardiac surgery colleague turned his head into my office to see if I was free to discuss a matter.” Cardiac surgeons draw closer to each other, but their job is essentially plumbing, knowing that That’s how to bypass the faulty pipe!” I said, to make her laugh. “But we do plumbing when the faucet is running or the toilet is being flushed,” he justified his position in second place. Said, “Everyone else is the slacker on the other end of the spectrum!” My poor friend seemed quite upset by our joke now. “The general surgeon, urologist, and gynecologist are literally the farthest from the top,” we said. Explained.

A therapist listening to our open-door conversation leveled the playing field. “Did you know that in some countries, such as the United Kingdom, surgeons are not even called doctors? They lose the title of ‘doctor’ when they go out to perform surgery; they are then simply called ‘Mr. In the olden days, they were considered unskilled like a barber’s surgeon. It is we who are the thinkers and planners, telling the surgeon what to do,” he concluded and quickly walked out, up for debate. No space left.

A few days later, I got rid of the cyst we started talking about. When my friend complained of unbearable pain, I gently scold her and said, “Do you know what some of the people who come to us are doing?”

It made me think about what someone recently presented to me: “Is there a hierarchy of suffering? Does a person who is handicapped by injuries and pain deserve more sympathy than one whose life has been crippled by the grief of a failed or lost love?”

Until recently, I used to compare patients’ illnesses to the dreaded ‘C’ for so-called minor problems: “At least you don’t have cancer.” But now I believe this is the wrong way to empathize with someone. Who are we to decide that someone’s depression, an unseen illness, is less serious than something we can see, like a tumor spending its time inside someone? How can you justify the loss of a parent being less intense than the loss of a child, even though the suffering of the latter is almost universally greater? Why is heartbreak always seen as something that someone will end up with when the time comes?

Just because some people feel fine while doing whatever they are doing, doesn’t mean they feel less at it. They have either found a way to turn their difficulty into something transformative or have made peace with what it is, accepting it. I think there are two ways to live: one, as if everything were a matter of life and death; Second, like nothing.

Each person’s suffering is their own and does not exist in relation to someone else, even though it is human nature to compare suffering: theirs with ours, theirs with someone else’s. Being in the profession, I have seen with my own eyes that most of the people live with much more suffering than the most sensitive and closest beholder. “I’ve had this pain for the past two years, but I informed my family only a week ago, when it became unbearable” or “I haven’t been able to see clearly for six months, but I just saw my husband.” A few days ago, when I started hitting objects, that’s something I usually hear, and unfortunately, it’s often a sign of a patient coming to us during the course of an illness.

Some time back, I was undergoing a brain tumor operation through the nose with my ENT colleague, who cut off all the nasal debris with hubris. “Be a little gentle with the nose,” she nudged me, as I was showing little respect for it. “Nothing really important here!” I said going ahead. He replied, “Next time your nose is blocked, you’ll realize its worth.” This sentence stuck to me like food stuck in the molars: even after removing it, it looks like it’s still there; Just like how an unblocked nose still feels blocked.

Even COVID has its own chain of command. Two years ago, the virus was treated with a terrifying distance that was more than just social, because we were apprehensive of those who had it; Now, we suspect those who don’t. Some time ago fever was a phobia; Now, this is freedom—to take a week off. “It’s just a cold!” is no longer the ubiquitous expression whose higher order allows us to use it.

There is a hierarchy of human needs proposed by Maslow, ranging from the basic physiological ones of food, water and shelter to security, love and belonging, respect and finally self-actualization – the most one might desire to become. Humor also has a hierarchy, with dumb jokes and puns forming the base of the pyramid, practical jokes and irony somewhere in the middle, and self-deprecation and contradiction at the top of it. Art has its own hierarchy (although it can easily find its place in the hierarchy of humor – especially modern art), as does architecture and science. There is a hierarchy to the workings of the universe, so why not in medicine.

A recent study published by the British Medical Journal found (not to my surprise) that neurosurgeons are no smarter than the general population. Maybe it’s time to discard the phrase, “This isn’t really brain surgery!” And give another specialty a chance to sit on that pedestal. any takers?

PS: Dermatologist, you are not allowed to apply.

The author is practicing neurosurgeon at Wockhardt Hospitals and is an Honorary Assistant Professor of Neurosurgery at Grant Medical College and Sir JJ Group of Hospitals.



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