Putting down the scalpel, putting up the scope – Antonio Oposa

Dr. Antonio Oposa gave me this piece of writing in 2010.  I like to share it with everybody especially the “older” surgeons.  Food for thought.

Sept 17, 2010  10:25 a.m. 

Yesterday, I met a colleague in the MDH library who was starting to write about: “When to put down the scalpel”. 

I even immediately told him – facetiously – that it’s time to put DOWN the scalpel, and then, put UP the (endo)scope! 

I was intrigued and interested in the topic, I feel like putting down my 2 (centavos) pesos or dollars worth. 

Here goes: 

With “put down the scalpel,” I meant, to drop the surgery work; with “put up the scope,” I meant, to hold the stethoscope up high, to acknowledge that now you need Help! from another and younger surgeon. Even the best cannot stay the best forever. 

For us who spent so very many years of intense sacrifice & dedicated effort and commitment – to learn to use the scalpel [becoming a surgeon]  in our calling, it must be a sad moment, even to think of doing it, basically  to give up! And – NOT do O.R. work anymore. 

That is understandable. Even the great American writer Ernest Hemingway had his moments of terror thinking of stopping what he did best, writing. He said, “Retirement is the ugliest word in the language.” But look at what happened – he forced his own retirement by pointing a gun at himself and squeezing the trigger. We need to stop when the signs are there telling us that if we continue, more harm than good will follow. 

The moment will surely come, just as sure as the afternoon comes, after a certain time, follows dusk! And then you need a different kind of light. We need to illuminate our minds about surgeons who do not see the light. 

Surgeons or not, we all must be ready to accept with “tearful joy” the inevitable. A painter can no longer paint with the art that is expected of him/her; a singer can no longer reach the high notes where he/she used to; a writer can no longer compose a story at the level of his/her talent; a doctor can no longer cut into flesh – ’clean’, and maybe have some tremor of any of the fingers. They all must stop. 

In the meantime, we have to consider many facets and factors that come to one’s mind and one’s heart as he or she considers voluntary retirement – or is forced into retirement. 

The following are random thoughts: 

In the USA, surgeons retire from active manual work in O.R. at age 65. The logic is simple – one mistake, and all is ”washed – wiped out” with a man-made hurricane – aka “malpractice suit”. 

Some think that, along with their very highly technical skill acquired by high-level education & long years of excellent experience, they still have that manual dexterity to continue surgery even up to age 80 & beyond! I know some Filipino friends – surgeons – doing this here. 

Some old surgeons perhaps do it because of financial necessity. In this case, it can easily turn out that necessity is the mother of disaster. 

We need to regulate. I do not know of any hospital or surgical organization that has any clear cut  guidelines,  rules,  or policies about a stage in the  life of surgeons whether they may or may not continue doing O.R. work. That is sad because it means that we are not concerned about mistakes and misdemeanors, etc. 

I personally know that only in certain, very few instances, that surgeons were directed to stop operating. 

Thank God, I myself voluntarily stopped doing it several years ago. I like to believe that we surgeons should know when to cease and desist, and when to delegate our O.R. service to our younger and very able colleagues. After all, they are well trained and highly competent. Although And  because of our YARNING to be in the O.R. we can – every now and then,look over the shoulders of our assistants and associates, and even give some suggestions and or “tips”. It is all for the good of our patients, and us surgeons!. 

I have some more “tiniklings” {that is, thinking while nimbly dancing with the feet} in mind. 

No matter how or what a surgeon feels or thinks, at a certain age, we know that the scalpel is sharper than ever, but the physical reflexes of the one holding it are NOT as quick and “refinado”!  as those some years before. 

I believe it is NOW time to address this matter, and to come up with some clear-cut directions. 

NOW, I am not as young as I would like to be, but my opinions and advices are still sought. I give them gladly – pro bono at that! This is most truly satisfyingly happy moments indeed – being still needed, and continue to be ‘functional useful and productive”!



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