Why I Am Turning Off The Surgical Engine
The career of the legendary stunt motorcyclist Evel Knievel seems like an ideal metaphor when I contemplate my career as a foot and ankle surgeon. Knievel’s forte was jumping over cars, buses, bulldozers or wild animals on his Harley. There was danger and Knievel suffered when things went wrong. At the end of his career, he had more hardware in his body than a Home Depot outlet. I always wondered if he had selected a retirement date or was he going to let the physics of death-defying motorcycle jumps choose for him. As a foot and ankle surgeon, I have always realized that the patient is taking the real risk. The surgeon might end up with a whole lot of legal paperwork if things go wrong but the real risk takers are our patients who entrust their surgical care to us. I performed my first (paid) surgical procedure at the age of 28. I was as nervous as a long-tailed cat in a room full of rocking chairs. My hand shook as I created a zigzag incision across the first metatarsophalangeal joint of a young woman’s foot. The aging orthopod who was assigned to monitor my case stood and grinned as I sweated through a simple bunionectomy. The nurses and OR tech observed with detached boredom. The patient was wide awake with a local block since the hospital had not decided if a podiatrist should be allowed to use IV sedation. The case took 90 minutes. The patient thought it was great that she did not have to recover from dreaded general anesthesia. The old orthopod had a prostate problem and left halfway through the operation to use the men’s room. He never returned. I was exhausted but high on adrenaline from the thrill of accomplishment after performing my first real hospital surgery. My practice grew steadily over the years and the surgical aspect grew to the point where one day each week is a “block” day at the hospital where five to eight cases are scheduled. That is the day of the week I least enjoy. Surgery is pretty boring if you do it right. You determine the criteria for the procedure and match the patient’s need with a particular operation. Assuming you are trained and skilled, the steps of any procedure are rather routine. The real skill is selecting or deselecting the patients. I decided when I was a young podiatrist to pick a date when I would stop performing elective surgery. I did not want to work past the time when my skills began to give way to age. I also observed that older surgeons tend to be overly cautious, which can deny patients sophisticated procedures that may be more beneficial. I do not want to work past the point where somebody or some committee suggests that I curtail my surgical activity. I have chosen to discontinue the surgical aspect of my practice on Dec. 31, 2006, the day I turn 60. I will miss surgery and I am told that my skills and surgical care will be missed. That seems the best way to part with something that I have loved and that has given me a feeling of accomplishment. I have chosen not to avoid the Evel Knievel route. Knievel kept upping the ante toward the end of his career by jumping over more buses and trucks lined up in stadiums. He almost bought the farm when he tried to jump across the Snake River Canyon in Idaho on a rocket propelled “skycycle.” His parachute deployed shortly after he cleared the launching ramp. He was yanked off the machine and floated toward certain death in the roaring water below. Fate spared him. A year later, he miscalculated the physics of jumping over 13 double-decker buses in a London stadium. He remained in traction with multiple fractures for many months. My foot and ankle surgery is not likely to put me in traction or kill me but it would be devastating to me to cause harm to a patient because of deteriorating skills. I have a partner who is well trained and recently passed the American Board of Podiatric Surgery examination for certification. I also have two other highly skilled foot and ankle surgeons in my community. These doctors are willing and capable of taking care of my patients who need surgery. I will enjoy spending Thursdays visiting with patients who are awake. I will still take care of surgical patients but my colleagues can perform the operations. Podiatric surgery has become more complex during the past 30 years. I feel that attempting sophisticated rearfoot and ankle procedures for me would be just as dumb as jumping 30 bulldozers on a Harley.