From the Editor

From the Editors: One pebble at a time


This is a story about Sarah Prince, FRCS, and thousands of others here and abroad who are surgeons. Only a few of you may have heard of Miss Prince, consultant surgeon from Fort William, Scotland; but she represents to me one of thousands of stories that make surgery such a rich subject that spans more than pure science. Sarah achieved immortality in what she accomplished in 43 short years.

Sarah was trained in the United Kingdom system, attaining specialty training in hepatobiliary disease. While she loved that sort of work she decided, with her internist husband Patrick Byrne, to work in a rural town in northern Scotland. In nine years she built up the hospital there and its training paradigm. She went on to work toward creating a better rural surgical system in Scotland, eventually becoming an expert who spoke all over the world about rural surgery and allocating resources to build surgical capacity in rural areas. She understood the volume debate and the need for rural surgeons to have a connection that was substantive with a larger center in a collaborative way benefiting both locales.

Dr. Tyler G. Hughes
Dr. Tyler G. Hughes

I bring her up because she represents something we all can do. A few surgeons become academic giants known far and wide, but all surgeons have the ability to be local giants, unknown but immortal and essential in their own way. Sarah’s accomplishments confirm that.

Unlike surgery in the United States, the U.K. system is more regimented in many ways and even more political than what the average U.S. surgeon experiences. It is a single-payer system that was there long before Sarah became a surgeon and will be there long after. The fact that the system into which she was born was not of her making did not deter Sarah from taking on that very system to make her corner of the world a better place. I was always surprised when speaking with her that the problems she faced in Scotland were much the same as what I’ve seen in rural surgery in the United States and in other countries. She didn’t bend the whole system but she made a significant dent in how things were done. Isn’t that the challenge for us all?

Sarah Prince Stephen Seymour/Courtesy Patrick Byrne
Sarah Prince

Recently on the ACS Communities and elsewhere, the debate on single-payer, multitier, and market-driven health care is being argued. In light of the current political environment, the path forward seems bewilderingly tangled. Most surgeons just want to operate. The OR may be the last bastion of control we surgeons have in our professional lives. There may be a barrage of obstacles getting to the OR and hordes of explanations and details postoperatively, but in the OR we still get to do what we think is best at the moment using all those skills we so painfully acquired during a career of learning and practice. To despair is easy until one takes a look at what so many surgeons achieve in their lives.

Like Sarah, most of us try to make the profession a little better. In small town Iowa, that may be getting sonography privileges for FAST exams that improves the lot of trauma patients in that town. In an exburbia hospital, the surgeon may bring new expertise not previously available. It goes on and on with each of us contributing one pebble at a time to a mountain of effort. Any one pebble seems so insignificant in itself and sometimes just placing it on the mountain takes enormous effort, but each is worth the toil to put it there.

Which brings us back to Miss Prince (it is a faux pas to call a consultant surgeon in the U.K. by the honorific doctor). Sarah faced just as many challenges and perhaps more than surgeons elsewhere. Yet she brought her best every day to her hospital until cruel fate delivered her a fatal blow at a young age. Even then facing her imminent death, Sarah made sure that her patients and trainees would be well cared for after her passing. Her indomitable approach to surgical life shows that no matter what the opposition, a surgeon can with grit and wit make life better in his or her town, region, and maybe even the world.

As we face 2017 with all its potential for defeat or victory for our patients, let us remember surgeons like Sarah Prince who made a difference and commit ourselves to the same goal. We can do it one pebble at a time until we’ve created a mountain of accomplishment.

Dr. Hughes is clinical professor in the department of surgery and director of medical education at the Kansas University School of Medicine, Salina Campus, and Co-Editor of ACS Surgery News.

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