Thursday, May 7, 2009

The surgeon as neophyte torturer

Dr. Pauline Chen, in a piece for the NY Times last week, writes about the daunting moments right before a surgeon-in-training first takes scalpel to flesh. I remember my first incision as an intern as well. I barely broke the skin, so tentative were my motions. But after a while, the blade sinks deeper, the blood runs, and you don't even notice it anymore. It's like you aren't doing it to a real live human, so detached your act of physical violence seems--in this draped-off, sterile setting-- from the smiling, affable patient you just spoke to in the pre-op area. Dr. Chen attributes this to an "habituation" process that occurs over time. (I disagree with her on principle, and will have to adress why in a different post).

But then she takes a logical leap, presumably for the purpose of making some sort of poetic analogy, to compare the habituation that occurs during surgical training with the fact that the Bush Adminstration seemlessly implemented a state sponsored, systematic torture program that was carried out by willing participants. I'm not exactly sure what she's trying to get at here. That surgeons are similar to torturers in that they "get acclimated" to the commision of violence and can thus tolerate it? That torturers diverge from surgeons only in a manner of means and ends? Really, the only message to me is the patently obvious one that unpleasant acts become easier over time to the person who commits them. In this sense, a surgeon is a lot like the serial killer who perfects his craft the more the knife is brought to flesh. I guess that's true but it's an inconsequential truth; it represents willful neglect of the fundamental characteristics that differentiate the surgeon from the torturer. It's like saying Mt Everest and the hill in my backyard are similar because they're both examples of terrestrial elevations.

Torture involves the complete subjugation of a captive, helpless human being by any means for the purpose of eliciting answers that the torturer wants to hear. A surgeon cuts an anesthetized patient (after getting informed consent) for the purpose of alleviating the patient's conscious suffering. The fact that torturers "get used" to unspeakable cruelty is illustrative of Hannah Arendt's "banality of evil", where a seemingly average, normal citizen (think of Adolf Eichmann and all the number-cruncher accountant types who carried out the fine details of Hitler's Final Solution) could stoop to the level of pure evil. That a surgeon is able to quickly slice into a patient's belly without any qualms is just emblematic of the fact that he/she isn't bothered by the sight of blood, knowing that the patient cannot feel anything, knowing that the purpose of the procedure is to make the patient feel better.

Dr Chen has written some good pieces since taking up the NY Times gig. But on this one, she misses the mark widely....

15 comments:

nemsova said...

I disagree,buckeye. I thought that the comparison between the two types of habituation was apt. she's not comparing surgeons to torturers, but using the trope of habituation; and showing how it can be either positive(surgery)or negative (torture). it's a subtle, effective argument.

Frank Drackman said...

So you've NEVER operated on someone without a signed consent??
What about that emergency thoracotomy??
Its like the girl who'll sleep with you for a million dollars, you've admitted what you are, only question is the price...

Frank

Buckeye Surgeon said...

Nemsova- I don't see it as an argument at all. She just points out an extraneous similarity between a profoundly heinous act and a one that is good for our health. It's like walking by a raging house fire, seeing people screaming from the top floor windows and thinking to yourself, "oh that fire, it harkens memories of the ones Grandpa used to build in the living room when I was a girl" and then just walking on by in your self-reflective way.

I think you have to be very careful with topics such as torture/rape/murder/undeniable evil when used in the context of a short essay. Flimsy comparisons and forced analogies like the torture/surgery paradigm only serve to distract from the nature of the evil committed....

Frank Drackman said...

But Buckeye,
If Waterboarding a single victim resulted in saving 20 million lives, not to mention avoiding the environmental catastrophe of a thermonuclear detonation, that WOULD be Good, No??
You're not being Logical.
Can you tell I'm excited about the new Star Trek movie??

Drackman out

platensimycin said...

Sensationalism at best.

Would one equate chef to butcher?

ParatrooperJJ said...

What torture?

rlbates said...

I agree with you, Buckeye.

nemsova said...

buckeye and friends, it's not a comparison between torture and surgery. it' a comment about habituation. about how seemingly "nice/regular" guys, like the chain of people involved from top bottom, including the memmo authors, and everyone who helped execute the orders, became habituated to somthing awful, horrendous, terrible. the author uses the comparison of everyone who assisted the nazis in ww2. and yes, just a simple thing like making an incision can elicit such a thought. remember proust????? nemsova

Buckeye Surgeon said...

Nemsova-
I'm glad you enjoyed the article. But to me, there are thousands of better ways than torture to illuminate the gradual habituation process that occurs during surgical training. It's a weak link at best. Like I said before, might as well compare a surgeon to the serial killer who progressively becomes less squeamish, more efficient with each kill. It's almost as if Dr Chen is exploiting the recent torture revelations in order to lend interest to a topic that is actually interesting enough on its own (how a surgeon learns to detach himself from the violence/pain he must inflict in order to make someone feel well). It's an unnecessary move, I think.

nemsova said...

we disagree

Frank Drackman said...

Might have to give you this one, Buckeye...was thinkin back to the first IV I started, 14g on a young guy with a Sickle Cell crisis..."Torture" describes it pretty well....

Frank

nemsova said...

frank--i know that you're just trying to entertain with your comments...but habituation was the theme not surgical incisions as torture~~n

nemsova said...

frank--i know that you're just trying to entertain with your comments...but habituation was the theme not surgical incisions as torture~~n

Anonymous said...

Regardless who is at helm, the argument is dual-sided.

Dr. Chen, as Nemsova stated, merely tried to point out that habituation (a widely recognized phenomenon) has the potential for good (surgery) and evil (torture).

Dr. Parks and most commentators here deem such a comparison grossly inappropriate. Surgeons, after all, wedge scalpel (it's not even called a knife) to ease suffering and preserve life. To them, it's as if drawing parallel between horse and greyhound on ground that both run on four legs.

Both arguments are valid, in my opinion, even though the two parties seem to speak on different frequencies. Our opinions (and by extension, world perception) are the reflection of our life experience, and there are time when we can agree to disagree.

As for Frank's wise*ss remarks, he's somewhere between Mars and the Moon.

Buckeye Surgeon said...

Anon-
Nicely put.