Reflections on a Recently Concluded Journey

Toledo, Ohio: After 33 years of practicing surgery I have finally put down my scalpel, took down the shingle and called it a day. I would have liked this to be a smooth and gradual transition from a full-time practice to a slow leisurely pace leading to eventual retirement. However, the current malpractice scene does not allow a smooth and dignified transition. In an all or none equation you are either in it or none at all. Let me explain.

For the past number of years the cost of running a practice has been climbing faster and steeper than any other index. And the biggest cost for practicing doctors has been the malpractice insurance premium. In fact the state of Ohio is one of the dozen or so states in the United States where malpractice issue has reached a crisis stage. Dishing out $53,000 a year for malpractice coverage (expected to go up another 20 to 30% in the coming year) in the face of an ever-diminishing reimbursement from health insurance companies has widened the gap between expenditure and income. In my case this gap in the past few years has been widening to a degree where there was often a lot of month left at the end of the money. To continue to practice surgery had, to put it bluntly, become a very expensive hobby.

Whether the malpractice insurance crisis is due to greedy legal system gone amok or an equally greedy insurance industry fleecing the medical profession is for society to ponder and for the legislators to debate. In the mean time while the wheels of public policy grind ever so slowly an ever-increasing numbers of doctors are being forced to quit and leave the profession prematurely. Compared to some of my younger colleagues I have been rather fortunate. I have had a good ride and at this juncture I would rather celebrate the transition than lament my somewhat early departure from the scene. I think it is time to take stock, say thanks, and move on.

I landed in Toledo in 1963 for training in surgery. The journey from the cobblestone narrow alleys of the walled city of Peshawar in northwest Pakistan to the wide and airy corridors of some of the prestigious institutions of this country was difficult, at times scary but always exciting.

Behind the intimidating institutional façade there were men and women, my mentors, who went the extra mile to mould and nurture a bewildered young man who was struggling to find his bearing in a strange land. In Toledo there were the likes of Stew Siddall, Jack Brunner, Morris Selman, Roland Gandy, Earnst Sternfeld and Gerald Stark and many others. Even in an impersonal a place like Detroit’s Receiving Hospital (Wayne State University) there were kind people who went beyond their customary responsibility to teach and took personal interest in my professional future. Zwi Steiger, Bob Wilson, Alex Walt and Dutch Day were touched and shaped my life. They taught me how to deal with people who happen to have surgical problems. They taught me that patients were not walking lung cancers or aneurysms. And while they taught me how to operate safely they also taught me when not to operate.

Surgery is an ancient craft that has changed in scope and complexity over many millennia. The rise of surgery from the foggy beginning in prehistoric times to the present day craft right out of the sci fi books have had a common thread: to cure and to palliate and along the way to alleviate the pain. It was the genius of my mentors who like relay runners passed the noble legacy of surgery on to the younger generation of surgeons. What I learned sitting at the feet of those teachers remains a precious legacy and I have in some small way tried to pass it on also. In my book of shariat a teacher is up there with the likes of saints and prophets.

No surgery, even a minor one, is possible without the help of a team that comprises the anesthesiologist, operating room nurses and surgical technicians. They are the essential ingredients of surgery but for the most part they go unrecognized and unsung. They are the ones who help surgeons stay the course, stay cool and stay focused. There is an undefined bond of friendship, camaraderie and interdependency among them. Together they celebrate the successful completion of a difficult operation and together they mourn and shed a tear when an unsuspected disaster strikes during an operation. The bond is truly magical and I am grateful to have been part of it. I am also grateful to them for allowing me to keep company with the likes of Sehgal, Jagmohan, Noor Jehan and Nusrat Fateh Ali Khan during surgeries.

And lastly I am grateful to thousands of my friends, called patients in common vernacular, who gave me the privilege to operate on them.

Amjad Hussain can be reached at <aghaji@buckeye-express.com>