Commentary: Bones



I’ve always thought that “Bones” of the “Star Trek” series is the sort of surgeon I want to be. He is a treasure trove of wisdom that anyone worth their Federation credits who aspires to be a surgeon should study. Here are some of his truths we should follow in these primitive times, long before surgery becomes the ideal profession it is in the 23rd century (obviously it takes us a little time to solve universal health access).

“Permission to speak freely?” he asks the captain. “Are you out of your mind?” Even in the future, the ship’s surgeon is the one who sees clearly the hazards ahead with oblivious leadership at the helm. It is our job to point out the obvious and the dangerous and see the picture as clearly as possible – because if we don’t, bad things will happen. It seems that the good surgeon is the person who points out that ejecting the warp core of medicine might be the wrong move.

Dr. Tyler Hughes
Dr. Tyler Hughes

“I’d give a lot to see a hospital. I suppose they still cut and sew people like garments.” Since I cut and sew people like garments every day, one would think I would take offense at Dr. McCoy’s observation of 20th century medicine. But what would a surgeon do without the instruments of our originating profession, the barbers? No scissors and thread? It is now the 21st century, but we still use these basic tools and will probably do so for the foreseeable future.

Most good surgeons I know feel that we operate when it is the best option for our patients, and when that is not the case, we are pleased when a disease is best addressed by other means. Does anyone miss surgically putting sterile ping-pong balls into chests for TB? How about managing a leaking duodenum after an operation for a bleeding duodenal ulcer? That was a lot of fun, wasn’t it? I miss the excitement of operating on a perforated ulcer, an operation in which I could quickly take someone from agony and near death back to health. But I am glad that proton pump inhibitors and H. pylori were discovered. When I was a resident, esophageal cancer and rectal cancer were a death sentence. They are still ugly diseases; however, we now see people with no evidence of disease after chemoradiation. Will the world be a lesser place if esophagectomy and abdominal-perineal resection virtually disappear?

“Dammit Jim, I’m a surgeon not a …” This has to be the motto of every surgeon. We are a highly trained, highly strung set of individuals. In general, we were born to become surgeons, and I have no doubt that by the time Dr. McCoy is galloping about the cosmos, it will be common knowledge that the Cutter gene is found in people who become surgeons. Because this is true, society and surgeons make the mistake of thinking that being really good at surgery in some way equates to being an expert on business, health policy, home repair, or politics. The first thing a surgeon should do when asked to step outside the OR and begin messing with something he or she knows about only tangentially is to repeat Dr. McCoy’s mantra: I’m a surgeon, not an engineer. I’m a surgeon, not a CEO. I’m a surgeon, not a president. The surgeon, of course, can be all these things, but not until he or she has actually learned something in these areas. It would also be nice if nonsurgeons would refrain from posing as experts on surgery.

“He’s dead, Jim.” Dr. McCoy was great at being a realist and so should we surgeons. McCoy rarely made wildly ineffective attempts to save a life that was already gone. Surgeons have to be able to tell families and colleagues the truth about patients who are far beyond saving with today’s technology. It is often our role to do so, but sometimes we forget.

“I had to join Star Fleet – my wife took everything in the universe in the divorce. All I’ve got left is my bones.” This is the origin of Dr. McCoy’s nickname. I am grateful that this is one McCoy trait I’ve not emulated. Being married to one of the great creatures in the universe has made me a much better surgeon.

Sometimes when I look at how much has changed since I became a surgeon, I feel a little like Dr. McCoy. Even a country boy like me gets to work a miracle every now and then. I guess we may live long and prosper after all.

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