"Men wanted for hazardous journey, small wages, bitter cold, long months of complete darkness, constant danger, safe return doubtful, honour and recognition in case of success."
This advertisement, famously attributed to Ernest Shackleton for his 1914 Antarctic expedition, strikingly resonates with the life of a surgeon, particularly in the field of complex trauma and oncology. As the story goes, 5,000 individuals applied for the position. One wonders what type of men these were.
Surgeons, akin to the explorers of old, embark on perilous journeys, navigating the uncharted terrains of the human body, often forging ahead while not entirely sure that their innovative solutions will work.
Dr Jane Smith, a renowned surgeon, articulates this balance well: "Each incision is a balance between bold innovation and the sanctity of life." This perspective underscores the dual responsibility of surgeons: to push the boundaries of medical science while safeguarding patient welfare.
The hazardous nature of surgical work mirrors the extreme conditions described in the historic call to exploration. A testament to this is the case of a 12-year-old boy with a compound tibia fracture and significant soft tissue and bone loss whom I recently treated.
His family, having travelled a considerable distance, sought my expertise after other doctors advised amputation. Their request was heartfelt and clear: "Save our son's leg."
The challenges were immense. We first ascertained that there was still blood flow to the leg, then undertook several surgeries to stabilise the bone, including devising a method to stabilise an unstable ankle joint, where he had lost a significant section of his fibula.
Additionally, we had to find ways to achieve coverage of a large section of exposed bone. Throughout this process, there was an element of venturing into the unknown, pushing forward with solutions that, while well-planned, carried inherent uncertainties. In this instance, we were successful.
Innovation in surgery often reflects the spirit of exploration. The case of another patient I treated recently, a five-year-old girl with cancer in her distal femur, is another poignant example. Her parents, coming from another country, entrusted me with the daunting task of saving their daughter's leg.
In collaboration with international colleagues, we developed a unique surgical plan. Yet, despite our innovative approach, the prohibitive financial costs made the procedure unattainable, and we couldn't proceed. This case not only highlighted the innovative spirit in medicine but also the painful limitations sometimes encountered.
The emotional burden borne by surgeons is immense, akin to the uncertainties faced by explorers. In complex cases, we grapple with uncertainty and self-doubt, maintaining a facade of confidence for the sake of our patients. This emotional fortitude is a cornerstone of our profession, requiring a delicate balance of empathy and clinical detachment.
Surgical success brings immense emotional rewards. The joy of saving or significantly improving a life is profound, yet these highs are balanced by the lows of challenging or unsuccessful cases. Surgeons rely on robust support systems, including colleagues, mentors and family, to navigate this emotional landscape.
Each surgery carries the weight of a life-altering decision, reminiscent of the critical choices explorers faced in hostile environments. Our decisions have far-reaching implications, impacting not only our patients but also their families and our careers.
Society often celebrates successful surgeries, similar to how successful explorations are revered. However, the attempts that do not yield success are frequently overlooked. This dichotomy can be challenging, as surgeons often shoulder the blame for failures.
It is crucial to acknowledge critiques of the surgical profession. Accusations of hubris and overreliance on technology over patient care are not uncommon. While innovation is essential, the core of surgical practice remains patient-centred care, where empathy and understanding are as important as technical skill.
Surgical exploration has evolved dramatically over the years. From rudimentary procedures to advanced robotic surgeries, the field has seen remarkable innovation. A notable example is the development of minimally invasive techniques, which have revolutionised patient recovery and outcomes.
As a prominent surgeon once said, "Our aim is to tread the fine line between daring innovation and patient safety, a challenging yet rewarding endeavour." This quote encapsulates the motivation and challenges faced by surgeons in their quest to advance medical science.
The ethical and financial aspects of surgery pose significant challenges. In the case of the young girl, financial barriers prevented us from undertaking the innovative surgery. Following the realisation of these constraints, the family disappeared in silence, leaving a lingering sense of unresolved responsibility. This reflects the broader ethical dilemmas we face, akin to the logistical and moral decisions that confront explorers.
Surgeons, in many ways, are the modern-day explorers of medicine. Our expeditions, though in the realms of human biology, embody traits of courage, innovation and resilience, akin to Shackleton's journey to the Antarctic.
Though fraught with peril, the pursuit to extend and improve human life remains a noble endeavour, channelling the indomitable spirit of Shackleton and the timeless ethos of exploration.
Consultant orthopaedic surgeon
