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'If you don't feel anything when a patient dies, it's time to stop'

With your life in their hands, it’s little wonder some patients see surgeons as living gods.
But no amount of skill with a scalpel can change the fact surgeons are real people too, with emotions and frailties that usually remain hidden behind those sterile surgical masks.
Urology surgeon Gautam Das discusses his book
Urology surgeon Gautam Das discusses his book
However, after more than 40 years as a doctor, consultant urology surgeon Gautam Das has lifted the lid on the thoughts and feelings behind the professional surgical demeanour, in his new book Tender Is The Scalpel’s Edge.
“I chose the title because you don’t associate a scalpel’s edge with anything remotely like tenderness,” he says.
Gautam Das
“As a consultant surgeon in the NHS, you have a huge responsibility – you’re like an army commander, and the most important thing is that you command confidence. But behind that there’s a human being with all the things that come with that, and some of it is self-doubt.
“That’s what I wanted to get across – it’s not a text book of surgery, it’s not about me, it’s about the emotions, the love, the tenderness.”

Harsh reality

Das, who completed his medical training in Calcutta before coming to work in the UK, admits in the early years of training, he questioned whether he could cope with the harsh realities of his profession.
“Seeing disease in a text book is one thing, but when you come to the ward and see a little boy crying and missing his mother and yet we’re learning about his childhood cancer, it’s hard.
“I nearly gave up medicine because I thought I couldn’t be doing with that side of it.”
Fortunately for his many grateful patients, Das stuck with medicine, and the tales he recounts in his book demonstrate that as well as becoming an esteemed surgeon, he managed to combine selfless humanity with medical skill.
For example, instead of simply watching a 12-year-old boy get diagnosed with agonising thigh bone cancer, a young Das managed to secure him a mattress on the floor of a crammed Indian hospital, to prevent him having to trek 80 miles home by road, rail and rickshaw.
And rather than subjecting an 87-year-old war veteran, who was at increased risk of infection and bleeding, to an uncomfortable rectal biopsy to rule out prostate cancer, he decided ‘watchful waiting’ with regular blood tests was a better option ( “It would be such a shame if this Trojan who had survived such odds were to be felled by cowardly sepsis or bleeding”).

Death on the table

Despite the impressive letters after his name Das, 67, is clearly a sensitive man who is at pains to stress that doctors should never become hardened to the suffering and death sometimes associated with their work.
“If you don’t feel anything when a patient dies, it’s time you stopped and did something else,” he insists.
Before his retirement last summer, Das’ career saw him practise as a surgeon for 26 years, during which time he only lost one patient on the operating table – and it’s imprinted on his mind as one of the worst things he ever experienced in the job he otherwise loved.
It was a 64-year-old man undergoing a radical nephrectomy – the removal of a cancerous kidney. In the book, Das wryly observes that after losing a patient, surgeons are expected to convey a craggy Charles Bronson-type image, rather than appearing as a “floppy-haired weakling”.
“We are not encouraged to fold up. Yet, if one is entirely honest, some recollections, and their effect, are impossible to entirely erase. Some things are inescapable, even for surgeons,” he writes.

Job satisfaction

Part of a surgeon’s skill, he says, is remaining calm, no matter what unexpected turns an operation takes.
“Before an operation – and in my book there’s no such thing as a small operation, every one is big to me – as soon as I gowned up and put on the rubber gloves and heard them snap on, a calm used to descend,” he explains.
That calm professionalism has enabled Das to perform operations as complex as kidney transplants and radical cystectomies (removal of a cancerous bladder together with the prostate/uterus, regional lymph nodes and the urethra), and he writes: “Absolute focus and concentration is required as one is working with sharp instruments at very close proximity to large blood vessels which are unforgiving if disrespected.”
One of the things he loved most about his job was the satisfaction of knowing he’d performed an operation “meticulously”.
“At the end of the day, surgery is art. Of course you need your knowledge base, but if you do the operation well, you feel great. Saving a life may sound cliched, but when it’s there and it’s real, it’s a wonderful feeling.”

Amazing NHS

Despite the current furore about lack of funding and efficiency in the NHS, Das insists the UK’s health service is fantastic.
“Our NHS is amazing – people in the rest of the world don’t realise what a great thing the NHS is. It’s incumbent on all of us who have the great honour and responsibility of practising in the UK to bear that in mind.
“People talk about an adversarial relationship between clinicians and managers, but I don’t think that’s fair because the poor managers are doing a very difficult task. I would hate to be the chief executive of some of these front-line hospitals, with all the pressures of juggling the finances with the service you have to provide.”
He explains that if a doctor’s in clinic and has to see many patients within a certain time-frame, but one has to be told he has cancer, you just can’t say, ‘You’ve got cancer, here’s a leaflet, go away and read about it and we’ll talk about it in two weeks’. ” You just can’t,” says Gas.
“You have to take time, and your clinic goes on and there are people outside waiting. That sort of thing can grind you down.”
Tender Is The Scalpel’s Edge by Gautam Das is available now.

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