No matter how much learning we do, there's still going to be information we don't know. Essayist Dr. Bruce Campbell can relate, as he goes about teaching the surgeons of the future:
My most vivid memory of medical training is the pressure we felt to learn everything that was set before us.
When I was just beginning my residency, a volunteer faculty member offered to let me assist removing a tumor from his patient’s parotid gland – one of the major spit glands in the cheek. I was anxious to work with this teacher because he had trained forty years before at one of the most prestigious residency programs in the country.
As we scrubbed, the faculty member carefully explained the steps of the operation to me. The work is tricky because the nerve that controls the facial muscles runs right through the gland. The initial step in performing the surgery is to safely identify and protect this nerve.
He crafted the incision and created a narrow one-inch tunnel in front of the ear that ran from the skin down to where he expected to find the nerve. I looked in. It was hard to see anything at all. Blood and fluid repeatedly obscured the view.
“Here,” he said. “Watch carefully how I do this. This is the most critical step.”
And so I watched. He pushed and prodded, opening a space between the tissues with a small spreading device. Things did not go well. He noted that there was more bleeding than usual. The patient was large and the tunnel needed to be longer than expected. He repositioned the spreading device over and over – first aiming more superiorly and then more inferiorly. I could sense that he was not happy.
Finally, after several minutes of anxious searching, retracting, stretching, and straining, there it was: the facial nerve. He poked it gently with a nerve stimulator and the patient’s cheek jumped.
“There you have it!” he announced. “That’s how you find the nerve!”
I dutifully noted what he had just shown me. That night, I wrote down the steps of the procedure for later reference. The approach I had witnessed seemed perfectly logical. I worried, however, that the initial steps had been so difficult and the risk to the nerve so high that I might never be able to duplicate what I had been shown.
A few months later, I scrubbed with a different surgeon on the same operation. He, too, told me that the critical first step involves finding and protecting the nerve.
I looked for the spreading device I had seen used to create the narrow, dark tunnel during the first procedure, but there was none. Before I had a chance to ask the surgeon whether he would need the spreader, he created a the same incision but then took a long, wide, and well-lit approach to the nerve, carrying the dissection down to the nerve with a broad front rather than the narrow tunnel I had seen the first time. Before long, he had safely found the nerve and the procedure was off and running. Suddenly, I could see myself being able to someday master this operation.
I asked him: “Why did the other surgeon use such a limited approach to the nerve?”
“Perhaps,” the surgeon replied, “that was the way he was taught and he never learned another way.”
Someone wise once commented that: half of what we teach medical students is wrong; we just don’t know which half. Innovation and technology are constantly pounding on the physician’s door; there is always some new medication, approach, or technology. Many of these “latest and greatest” things will soon disappear.
I am certain that there are many – perhaps half –of the things I teach to today’s students and residents that will be sources of laughter and wonderment in a couple of generations. I wish I knew which half. My only hope is that they will be gentle with me.
Lake Effect essayist Doctor Bruce Campbell is a head and neck cancer surgeon at Froedtert Hospital and the Medical College of Wisconsin. He also writes about his experiences in his blog, “Reflections in a Head Mirror.”