When is a surgeon’s sell by date, and what is the shelf life of a
young to make mental notes about what to do [and not do] when they are
older, and older surgeons should do so as a reality or insight check.
I made mental notes about teaching about 25 years ago. I overheard a
group of students referring to our famous, emeritus, retired, renown
teacher who had stayed on: “There was this funny little old guy with
round glasses who burbled about hernias.” It had something of Maria
Callas returning to the Royal Festival Hall after a long absence, and
half the audience walking out on hearing the cracked voice, or the
reappearance of an ancient rocker with an exuberant wig, and guitar. I
also remember noting when I was a trainee that the very old surgeons
secretly felt, and sometimes said, that radical mastectomy was the
only proper operation. In the same spirit some may feel that
laparotomy is the only real operation and not laparoscopy. Another
marker of age, and perhaps a nudge to retirement is when the older
speaker gravely announces that there is nothing to beat a good history
and physical examination, and all this endoscopy, spiral CT and MRI
stuff is nonsense. Thats another nudge to retirement. Go, my friend.
Operating is brutal and unforgiving. I saw this and migrated from
vascular to oncology in my thirties, realising that I would not do, or
want to do, a ruptured or dissecting aneurysm at 2am when I was older.
Those that did, including some American vascular VIP’s I knew,
disappeared down the neck of whiskey bottles. Manipulative skills
deteriorate with time. Less often do you pull off your gloves and say
that that was a perfect thyroidectomy or adrenalectomy. The surgery
becomes coarser. A famous academic went into private practice on
retiring at 65, did a Whipple, which took 12 hours, and made him lie
down on the OR floor drenched in sweat, and was his operating
swansong. Surgery is like professional sport, with a limited [but of
course longer] life, and a short time in the sun. In your late forties
you become aware of the young pack at your heels, slick and quick in
the OR. They are arrogant and unforgiving and condescending. Just like
you were.
Should you just go on operating until you kill someone, or kill
yourself? If you believe that surgery is all there is in the world you
are living in blinkered pathos. You have missed out, and will miss out
on the pleasures and satisfactions our limited life has to offer. By
the time you are in your sixties, you should have made and invested
enough money from unnecessary cholecystectomies to retire. Osler said:
“Study until twenty five, investigate until forty, profession until
sixty, at which age I would have him retired on a double allowance.”
We cant have that luxury. Pilots used to have compulsory retirement
at 60, and this was extended five years ago to 65. The pilot’s death
in the plane from Brussels to the USA in the last 24 hours may make
them want to rethink that.
If you are very lucky – and perhaps wise – you can have a period of
transition into retirement. Perhaps administration and no surgery,
perhaps less and a lesser type of surgery, perhaps no night call. The
most important thing is to think about it, and to plan it. Most can’t
do either.