The Surgical Soul

Thoreau once said that talent writes with coffee, but genius writes with wine. Tonight, I write with gin.

What seems like a lifetime ago someone very special gave me a book entitled “Mortal Lessons.” It is written by a surgeon, Richard Selzer, and it’s less about surgery and more about his observations on life while being a surgeon. One of his more memorable essays is called “The exact location of the soul.” It raises probing questions about what makes us who we are.

Flash forward a few years and I’m now an aspiring trauma surgeon. One of the popular texts written by a giant in the field – Kenneth Mattox – has a chapter titled “The wounded surgical soul.” Mattox describes the “seat of the soul” as a “spherical area, not much larger than a silver dollar, centered on the head of the pancreas.” He calls injuries to this spherical areas soul wounds because “they are more lethal than any other type of abdominal trauma.”

The mortality of these wounds stems from the critical anatomy that is in this area. The portal vein, the superior mesenteric vessels, the pancreaticoduodenal arcade, the inferior vena cava, and the origin of the right kidney all converge here. Furthermore, accessing this area for the surgeon can be impossibly difficult under the chaotic circumstances likely present.

Last night a young man came into our trauma center having sustained a single gunshot to his surgical soul. We operated for hours, and nearly depleted the blood bank, but it wasn’t enough to save him. The multi-focal exsanguination was too much and he died with our hands inside him trying to stop the bleeding.

It’s interesting to think of a soul as something less abstract than we normally do, but rather to think of it as a space with defined borders. A space that, when violated, has predictable – and catastrophic – consequences.

Of course, the thing about our souls is that – unlike our bodies – they are eternal. Everything we do is not about building up our lives but more about building up our souls. Every action we do to one another, and everyway in which we react, and everything we preach in the process all serves to impact our souls.

It is nice to think that I can sometimes help individuals whose surgical souls are wounded. But it’s nicer still to believe that my own soul is being mended by someone far greater than I.

My glass is empty - more gin?