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Two new books take on the latter task. One homes in on the most majestic of the resident fauna, the surgeons striding godlike through the hospital corridors, breezing past the rest of us dithering little pill-pushers hunched over our computers. Plenty of surgeons may be small women these days, but somehow they all seem 15 feet tall.
Dr. Paul A. Ruggieri summarizes their ethos bluntly: If you are his patient, “I do not exist to talk about your heartburn, neck pain, weight gain, fatigue or swollen legs. That is not my job and, frankly, I’m not interested.” The surgeon, he says, exists only to operate (or, sometimes more challenging, to decide whether to operate). The rest of the work belongs to the small, hunched, dithering crowd.
Generally, the surgeons we meet in memoir form are somewhat atypical of the species, like the poet-philosopher Richard Selzer, or the thoughtful policy guy Atul Gawande. Dr. Ruggieri, by his own description, is a regular Joe Scalpel: An average student, he graduated debt-ridden in the middle of his medical school class, weathered a grueling old-style residency program, and now works as in private practice at a community hospital.
As a general surgeon, Dr. Ruggieri spends his time not probing for the location of the soul but deep in intestinal muck: “I need to take out several feet of your colon, sir. Does next week sound good?”
Of course, just because you are a demigod in the O.R. doesn’t mean you’re exempt from the perplexities of modern medicine, and it turns out surgeons get their share and more. For all the immediate gratification of the calling — they can raise the dead with a few slashes of the knife and a purse-string suture — they too are condemned to a little dithering.
Calculating the risks and benefits of surgery in a sick old patient is only part of it. Like everyone else, surgeons are tormented by ambiguous test reports, whose cautious wording often forces them into an unnecessary operation. Malpractice law casts a giant shadow over their decision making, with statistics showing that virtually all surgeons will be named in a suit at some point during a career.
Dr. Ruggieri ruminates at length on bad surgical outcomes — some the fault of bad surgeons, some of bad equipment, some of bad luck. Human flesh is never completely reliable, and a successful operation will not necessarily improve the patient’s health. Inexperience, impatience and fatigue may all undermine a basically competent surgeon; Dr. Ruggieri makes the interesting point that even though training programs now curtail residents’ work hours, a fully trained surgeon may nevertheless have been up all night with an emergency before a full day of elective surgery, including yours.
And while smooth sailing in the operating room is an exhilarating, ego-boosting rush, things can go wrong in an instant, leaving the surgeon “grasping blindly into a rising pool of blood.”
Some of the statistics describing the “best” hospitals for a given type of surgery are available to the public, but performance measures for individual doctors are generally not. Ask for your surgeon’s complication rate before your procedure, Dr. Ruggieri suggests — you will have to assume the answer is truthful. And if you want to know what really happened while you were asleep, track down the operative report (although even that document may not reflect all the potholes on the trip).
It must be said with some emphasis that creating realistic dialogue is not Dr. Ruggieri’s forte, but the reader will forgive him the stilted paragraphs he encloses in quotation marks for the immediacy and honesty of the rest of his narrative. He offers up the requisite anecdotes featuring hapless people impaled by various pointy objects (including the horn of an annoyed rhinoceros), but he is at his best describing his own worst moments, muttering under his breath to a recalcitrant section of intestine, his right eye twitching in anxiety, wondering why he didn’t go for that M.B.A. instead.
A preoperative patient might prefer to leave Dr. Ruggieri’s book at home until it is all safely over. Elizabeth Bailey’s book, by contrast, is specifically meant to be included in the hospital suitcase, a marketing gimmick that is not a bad idea at all.
Checklists for doctors to complete have been shown to reduce errors in the hospital; Ms. Bailey offers a collection of checklists for a patient to complete toward the same end. There are lists for “before you go” and “during your stay,” various ways to organize the cupful of unfamiliar medications left by your bedside, and sections for planning your escape and coping with your insurance. While it would take an unusually energetic sick person to fill it all out, the book will be a godsend for concerned friends and relatives trying to rein in the chaos.
And for a little background reading, no one should miss Ms. Bailey’s introductory essay: A producer of music videos, she was thrust into the role of patient advocate when her elderly father was systematically manhandled by one of New York’s great teaching hospitals. Bravo to her for turning that all too common misery to a constructive end.
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