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A Day In The Operating Room: A Forked Path

In medicine, there is a saying that the training is onerous but the rewards are many. More often than not, these rewards come coated in a myriad of shapes, including lucrative incentives, personal gratification, warm contentment and sated joy. For some physicians, a last wound-closure of the day, a smile on their patients’ faces, or warm, heartfelt regards from the people they care for carry immense significance. Yet, for many others, lucrative incentives seal their fate, becoming a bane to the integrity of the medical profession as a whole.

Medicine ought to be a profession, first and foremost, of compassion, empathy and sincerity. Focus too much on medicine’s lucrative decoys, and you reap the worst possible crop: a warped perspective. For many physicians in Pakistan — especially those that work in the private sector — this certainly seems to be the case. Delving into the four months I spent shadowing a cardiothoracic surgeon will delineate a picture of Pakistan’s medical care sector that is astoundingly perturbing.

On my first day of shadowing, I entered the operating room where a cardiac bypass procedure was underway. With the surgical tools all lined up neatly on the surgeon’s desk, I keenly observed the surgeon deftly make his first incision, focusing and planning his next move, much like a chess player at work. As I watched the process take place seamlessly, a frenetic banging on the OR door rendered me startled. Midway through the procedure, the chief surgeon at the hospital interrupted and said, “This patient has not paid all his dues. In addition, there is no guarantee that he will be able to afford the cost later because his cosigner has now declined to afford the costs of his treatment.” Shocked, still, I noted the befuddled expression on the surgeon’s face. In response, the surgeon exclaimed, “Let me finish the procedure; we can talk about this issue later on.” Yet, despite the surgeon’s response, which carried a hint of disappointment, the chief kept arguing, subtracting from time that is crucial in the operating room. However, despite the chief’s order to stop the surgery midway through due to the lack of payment, the surgeon carried on, undeterred.

There are two types of physicians. There are physicians that succumb to the lucrative incentives that come entrenched in medicine, and there are physicians that retain an empathetic conscience. The chief surgeon indubitably belonged to the first category, and so, midway through the procedure, walked out of the OR, ordered the staff, I assume, to turn off the life-support machine for the OR we were in, and then continued with his daily roster — proud, no less, of his ostensible boldness.

Within that OR, a hubbub besieged us. With scalpels clattering, hands a blur and the surgeon’s cacophonous shrieks now omnipresent, I fell into a reverie of brooding, introspection and perusal, feeling a sense of doom which was novel to me.

Why on earth would someone actively do, or even come close to doing, something as cold-blooded as what the chief surgeon did? What could be his rationale? Is money more important than a poor man’s life? Or, was this man’s blood, who was now about to evaporate from earth, cheaper than mine, or the chief surgeon’s? But the more potential reasons I came up with to see any sane justification in the chief’s doing, the more I despised the chief’s repugnant, vile course of action.

In the end, like a late-autumn tree, bare and dejected, on the verge of collapse, I left the OR with the realization that I had seen a man die in front of me — not because of his disease, but because of his financial status.

For me, the word “medicine” now conjures images of selfishness, apathy and indifference — traits that every individual should expunge from his or her persona, let alone a physician. But at the same time, the word “medicine” also brings a ray of hope, and a realization of the amends that must be made. Maybe, if not now, later; if not me, maybe someone else. But such brutality must terminate eventually, for it cannot possibly sustain a people of any nation, race or sect.

For me, medicine is a double-edged sword; while it hurls such obscure images of cold-bloodedness towards my face, it also motivates me to grow, to observe and to learn so that I may be able to positively contribute — even if to an infinitesimal extent — toward overcoming this wrongdoing someway, somehow, someday.

Talal Almas Talal Almas (1 Posts)

Talal is a third year medical student at the Royal College of Surgeons in Ireland class of 2022. He hold the world-record for scoring the most number of A*s at the British General Certificate of Secondary Examinations being the only Pakistani to be crowned at the British House of Lords for his meritorious achievements. In his free time, he loves playing tennis, table tennis, consuming copious amounts of exquisite coffee, and reading about and discussing politics. After graduating from medical school, Talal plans on pursuing a residency in cardiothoracic surgery.