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Expected Miracles

Expected Miracles: Surgeons at Work

Joan Cassell
Copyright Date: 1991
Published by: Temple University Press
Pages: 259
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  • Book Info
    Expected Miracles
    Book Description:

    Expected Miraclesexplores the world of surgeons from their own perspective-how they perceive themselves, their work, colleagues, and communities. Recognizing that surgery is an art, a craft, a science, and a business, Joan Cassell offers, through poignant, painful, and thrilling descriptions, a vivid portrayal of the culture of surgery.

    Cassell has entered a realm where laypersons are usually horizontal, naked, and anesthetized. Using the central metaphor of the surgical "miracle," she illuminates the drama of the operating room, where surgeons and patients alike expect heroic performance. She takes us backstage to overhear conversations about patients, families, and colleagues, observe operations, eavesdrop on gossip about surgeons' performances, and examine the values, behavior, and misbehavior of surgeons at work.

    Said one Chief of Surgery, "You couldn't have a good surgeon who didn't believe in the concept of the Hero." Following this lead, Cassell explores the heroic temperament of those who perform surgical "miracles" and finds that the demands and pressures of surgical practice require traits that in other fields, or in personal interactions, are often regarded as undesirable. She observes, "surgeons must tread a fine line between courage and recklessness, confidence and hubris, a positive attitude and a magical one." This delicate balance and frequent imbalance is portrayed through several character sketches. She contrasts the caring attention and technical mastery of The Exemplary Surgeon with the theatrical posturing of The Prima Donna and the slick showiness and questionable morals of The Sleazy Surgeon.

    She also identifies the attributes that surgeons admire in each other. They believe that only peers can really evaluate each other, and, while doctors might not speak negatively about colleagues in public, the community of surgeons exerts considerable pressure on its members to perform competently.

    Unlike "doctor-bashing" chronicles,Expected Miraclesseeks to understand the charismatic authority of surgeons, its instability, and its price-to surgeons and to patients.

    eISBN: 978-1-4399-0528-9
    Subjects: Sociology, Anthropology

Table of Contents

  1. Front Matter
    (pp. i-vi)
  2. Table of Contents
    (pp. vii-x)
    (pp. xi-xii)
  4. PREFACE: Some Words for Social Scientists
    (pp. xiii-xxvi)
    (pp. xxvii-xxx)
  6. INTRODUCTION: The Surgical “Miracle”
    (pp. 1-8)

    IN A BOOKabout surgeons, it is appropriate to begin with an operation. I shall be prodigal and begin with two.

    “Another miracle!” said Raoul, the chief resident, leaving the operating room, where he and an attending surgeon had just performed an emergency operation on Mr. Heinz Neumann, age sixty-nine, who had arrived at the emergency room some hours earlier, in pain, with an enormously distended abdomen. He had an obstructed colon, which might rupture and spread feces and infection throughout the abdomen. The operation had been messy. The colon had bled copiously, and a vast quantity of loose, noxious-smelling...

    (pp. 9-32)

    TO SPEAKof surgery as “miraculous” is both metaphorical and wishful. Successful surgery does, in truth, display some of the characteristics of miracles. But, unlike miracles, surgery is based upon knowledge, training, and technology; it is fathomable and explicable; and its principles and techniques can be imparted to others.

    Surgery is an art, a craft, and a science, which explains why surgeons rarely mention miracles, except “jokingly.”¹ Surgeons know they cannot brandish a scalpel, utter an incantation, and become a conduit for supernatural forces. The surgeon mustmakethe miracle happen.

    It is the more rational, perceptible aspects of surgery...

    (pp. 33-59)

    SURGEONS DISPLAYa specific and recognizable temperament, or ethos, “a standardized system of emotional attitudes”¹ that differs from that of members of other medical specialties. The surgical ethos resembles that of the test pilots trained as the first cadre of astronauts,² to whom several surgeons I interviewed in 1980 compared themselves.³ The legendary Chuck Yeager, who walked away from demolished planes to become the first man to fly faster than the speed of sound, might well be the surgeon’s heroic ideal. Like Yeager, the successful surgeon takes risks, defies death, comes close to the edge, and carries it off. Yeager’s...

    (pp. 60-80)

    IN THISchapter, I examine the relationships among senior surgeons who work at the same hospital(s), see each other several times a week, hear about each other’s successes, failures, scenes, and situations more often than that; surgeons who, among each other, may fight, play ferocious practical jokes, relay gossip and scandal, steal patients, yet join together when threatened by outsiders, be they hospital administrators, litigious patients, critical laypersons, or members of other specialties. Within this small group, admiration, ridicule, and the attribution of roles becomes a kind of communal “morality play” that operates to regulate the behavior of members. There...

    (pp. 81-103)

    SURGERY ISnot only an art, a craft, and a science; it is also a business. Its cost is reckoned in hundreds or thousands of dollars—whether or not the patient can afford the fee,¹ whether or not the surgeon has achieved a cure. The business aspects of surgery disturb many patients, who presume that those with special powers should concern themselves with more important matters than grubby financial details.

    We are ambivalent about money in the United States. Believing that spectacular performances—by athletes, actors, surgeons—deserve spectacular rewards, we are, nevertheless, offended by the affluence of those so...

    (pp. 104-127)

    DR. BRYNAis a compassionate surgeon,” said the chief resident. After ten months of observing surgeons at work, I was still struck by their martial, heroic approach to patients and illness. “Isn’t that a contradiction in terms?” I inquired. “No,” replied the resident, “he’s unusual. If there’s an old man who lives alone who needs stitches removed, Bryna would just as soon go to his home to remove the stitches; he’ll visit patients at home. If a patient dies, there he is right in front at the funeral, feeling bad. He's a good surgeon,” he added, “although he gets excited....

  12. 6 LET'S GO FOR IT!
    (pp. 128-152)

    SOMEONE HADblocked out the “fe” on the “female lockers,” where women (doctors, nurses, and female anthropologists) change to sterile green scrub suits to enter the operating-room suite. That morning, I went back and forth three times between two doors, both bearing the legend, “MALE LOCKERS,” before the joke became evident. At Mountain View Hospital. as in all hospitals I observed, you enter the lockers from the public hallway. Unlike many hospitals, however, the Mountain View lockers exit directly into the OR lounge. After changing into “greens,” you must walk through the lounge to reach the actual rooms where operations...

    (pp. 153-181)

    THIS CHAPTERexamines misbehavior. The surgeon’s ability to perform “miracles,” the power he wields over those in need, and the temperament of the miracle worker each has its shadow side: the capacity willfully to do harm rather than good. The chapter explores deadly surgical “sins,” which I have arranged in four categories: vices of excess; generative sins; defects, or character flaws; and deficiencies. The classification can help identify appropriate responses to various kinds of misbehavior.

    Unlike those critics who, perceiving the world as a simple opposition between good and evil, believe that a causal chain links surgical error to misbehavior,...

    (pp. 182-209)

    BET YOU CAN’Tdo it in ten minutes!” said Dr. Villar to his partner, Dr. Desai, in the tone of one boy daring another. The patient, an eighteen-year-old booked for an emergency appendectomy, was asleep and draped on the table. Desai smiled, nodded assent, and started to open the patient, as Villar set the large OR clock to measure off the minutes. As Desai and Chuck, the intern, operated, Villar kept calling the time out: “two and a half minutes” … “four minutes” … “six and a half minutes—you’d better hurry!” The intern, who had little experience with appendixes,...

    (pp. 210-218)

    THIS BOOKhas a crucial omission. In it, I explore the world of surgeons from their perspective, indicating how they perceive their work, colleagues, and communities. But I pay little attention to patients, except as bearers of disease to be meliorated or cured by surgeons’ procedures, or as adversaries, bent upon avenging their thwarted desire for miracles.

    I am aware that patients are at the center of the medical enterprise. I am also aware that for surgeons, however compassionate, every patient is one of many, while for patients, however ill, every operation is unique.

    Let us reverse our focus and...

  16. CODA: The Research Process
    (pp. 219-226)

    THE IDEAof studying surgeons originated when the editor of a professional journal asked me to write an article reviewing Charles Bosk’s book on the training of young surgeons¹ and suggested that, for the article, I interview two or three senior surgeons who had read the book. Their responses were so interesting that I ended by interviewing ten.² In his book, Bosk described how professional self-controls are instilled in surgical house officers by the senior surgeons who train them. I wondered how such controls functioned later in a surgeon’s career, when he is no longer closely supervised by superiors who...

  17. NOTES
    (pp. 227-260)
    (pp. 261-264)
    (pp. 265-274)
  20. INDEX
    (pp. 275-281)