Signature

 

What explanation can there be for a surgeon to write his initials on a patient’s liver? It sounds bizarre and disrespectful. This almost surreal, alleged event is sub judice, and I know nothing of the people involved or any details beyond what was in the papers, but perhaps it exposes some interesting psychology.

In the medical specialties that require practical skill, especially surgery, you work hard to become expert. Over the years the movements of the hands and fingers become practised and slick. Operations that appear impossible to the lay-person or junior trainee become routine, yet each patient is different. Each procedure presents its own challenges, hiccups, sudden recalibrations and extempore solutions. At the end of a particularly difficult case, when the patient appears stable and safe, you might sigh with relief, but also experience a surge of pride on a job well done. Congratulations are hard to come by in medicine. The job well done should be the norm, after all. But looking down at the organ, structure, or vessel that now pulses healthily as a result of your dexterity, you might be forgiven for thinking – ‘I did that!’

To mark a job well done with your initials is appropriate in other walks of life – in art and sculpture, in literature, in architecture. The artist owns the piece. A part of them, their skill, their creativity, their experience, lives within its lines.

Can medical procedures be regarded as art? Yes, I would say. The long facial reconstruction, the painstakingly re-joined finger, the delicately implanted heart valve… in the fine skill and seamless results it is easy to identify the hallmarks of the inspired artisan, the committed artist. Perhaps it is understandable that a surgeon who comes to see the results of their skill as art feels the urge to sign it.

However, it is a living body that we are talking about here. What lies under the skin is sovereign to the patient. They will carry it around with them for the rest of their lives. They were born with it. It is wholly theirs. (In the case of a transplanted liver of course, it belonged to another. The act of altruism and donation makes it worthy of even greater respect.) Perhaps that is the line that may have been crossed here – the distinction between what a surgeon can claim to ‘own’, and what is and will forever be sacred to patient.

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