Finding The Middle Ground Between Flexibility And A Cookbook Approach
I am cooking this afternoon. It is a beautiful, balmy western Washington summer day and a light rain shower has spared me from harvesting the lawn on the John Deere.
This evening’s dinner will be shared with a pediatrician who has been my taste critic for the past 30 years. Dinner will be an Italian rice dish, risotto with radicchio. I tried it in a little Rome bistro a few months ago and concluded it was the best meal of a three-week trip around Italy and France.
I never trust one recipe so there are two cookbooks and a Bon Appetit open in the kitchen. Tonight’s dinner will be a blend of three authorities. Dogged devotion to one cookbook is as foolish as dogged devotion to one surgical text. No two cooking authorities ever agree on one recipe and I have found that no two authors of surgical texts ever agree on the criteria or performance of surgical treatment for a foot condition.
When I was a podiatric surgeon, I reviewed McGlamry’s Comprehensive Textbook of Foot and Ankle Surgery, Gilbert’s Textbook of Bunion Surgery and even something by a foot and ankle orthopedist in order to select and execute a procedure for my patient.
The hazard of devotion to one cookbook is that you stop thinking about what you are cooking. The dish may accentuate a taste nobody cares for or lack a touch that makes it special. One of my cookbooks did not include garlic for the risotto. Another did not include saffron. Those are two key ingredients for an Italian rice dish that makes your guests smile, close their eyes and say, “Wow!”
The hazard of devotion to one surgical text is that all patients are different and have different expectations for a result. Adhering to the strict criteria of one text makes the surgeon incapable of tailoring the procedure to the patient’s needs.
Dogged devotion to the angle between the first and second metatarsals is an example to ponder. Some texts say that if the angle is more than 13 degrees, one must perform an osteotomy. However, many patients cannot use crutches during the post-op period because of a previous mastectomy.
This is where I deviate from the textbook and select a soft tissue correction such as a McBride procedure. It will not look perfect on post-op X-ray but it meets the patient’s needs and avoids an impossible post-op mobility issue.
We just finished dinner. It was awful. I must confess that I deviated from the recipes in all three references because I wanted to be creative.
The standard method of cooking risotto is to add chicken, beef, vegetable or fish stock slowly as the rice releases its starches. I decided to reconstitute Chanterelle mushrooms with pinot grigio, a dry white Italian wine and warm water. I would use the reduction of this creation instead of chicken stock. What could go wrong?
Everything! First, I served the pediatrician, who tasted it and grabbed the salt and pepper. His wife tasted it, grimaced and said nothing. My wife tasted it and commented that I had done worse in the past. I tasted it and it reminded me of rusty metal covered with soap.
One should avoid pure creativity when it comes to cooking and surgery. It is okay to blend concepts and develop a unique strategy but creativity in cooking can taste nasty and creativity in surgery can become malpractice.
My wife’s antipasto dish was melon balls covered with thin slices of proscuitto ham. That and her gelato de Mele (baked apple with vanilla ice cream) salvaged the dinner. The pediatrician offered to take the left over risotto home to work on it.
Cooking has been my outlet for creative disasters. I always adhered to proven concepts during my 33-year surgery career. There have been no surgical disasters that I am aware of with my patients. My surgical results have not always been post-op X-ray perfect but the pediatrician has never had to offer to take them home for repairs.
I have a large collection of cookbooks and cooking magazines. I also have a large collection of surgical texts and journals in my medical library. I urge young podiatric surgeons to familiarize themselves with all of the literature that pertains to our calling. We are a relatively young medical specialty but have a rich history of advancements we have developed for our patients.