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J Thorac Cardiovasc Surg 2008;136:1607-1608
© 2008 The American Association for Thoracic Surgery
Letter to the Editor |
Toronto General Hospital, Department of Surgery and Joint Centre for Bioethics, University of Toronto, Toronto, Ontario, Canada
To the Editor:
Jeffrey Shuhaiber's "Tribute to our Fallen Comrades"1
in the June 2008 issue of the Journal recounts the tragic story of the crash of the University of Michigan Survival Flight air ambulance into the waters of Lake Michigan 1 year ago. The twinjet Cessna Citation was returning in the early morning hours with the organs they had retrieved for a double lung transplant. Four university transplant team members and two pilots died. The story of the fallen comrades of Ann Arbor turned the world's attention to their heroic role in the warrior culture of surgery. In his eloquent tribute, Shuhaiber underlines the burden of risk, including the ultimate risk of death, that surgical teams accept in performance of their duty to retrieve organs for transplantation.
The burdens and risks of surgery are generally considered to be entirely on the patient's side. Lay and professional observers, lawyers, and ethicists commonly envision the surgeon's role as technical, almost analogous to that of a hairdresser who provides the cut specified by the customer. Surgical teaching about informed consent focuses discussion narrowly on explanation to the patient about the benefits and burdens of treatment.
There are also inevitable burdens and risks for the surgeon, which are rarely discussed. The inherent strain of performing operations on patients who are seriously ill takes a toll that is generally underemphasized or dissembled. Surgeons worry, usually constructively. They have regrets and bad dreams about choices and interventions that they have made. The responsibility for decisions as well as incisions is uniquely intensified by the immediacy of the surgeon-patient relationship. Surgeons give their informed consent to take on these burdens and risks. When they share their concerns, "Here's what I'll be worried about," and give realistic assurance, "Here's what we'll do to manage it," they are managing their own as well as their patients' expectations and fears. They make a decision to trust their patient to do all that is required for both of them to come through the ordeal of surgery successfully.
Besides these burdens, surgeons risk loss of reputation, even loss of privileges to operate, when they make errors in judgment or technique. The silent grief that passes over the room at the time of an intraoperative death is uniquely focused on the operating surgeon. Heroic surgeons like Norman Bethune have contracted lethal or career-ending illnesses in the course of operating on infected patients.
Martinus Spoor was a staff cardiothoracic surgeon, a hockey player, and violinist. He was the father of three, as was resident cardiothoracic surgeon David Ashburn. Transplant donation specialist Richard Chenault II was a high school coach and father of two. Specialist Rick Lapensee was an emergency medical technician and firefighter. Pilot Bill Serra received the US Air Medal for his support as a civilian pilot during Operation Desert Storm. Pilot Dennis Hoyes leaves five children behind. Mechanical problems were thought to be the cause of the crash according to the National Transportation Safety Board. The recipient patient, whose chest was already open when the plane went down, was moved to the top of the priority list and successfully received a transplant 2 days later at the hands of a grief-stricken but resolute surgical team.
Readers who would like to learn more or contribute to the education funds for the children of these lost heroes can do so through the following Web site: http://www.med.umich.edu/survival_flight/update/
References
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