A Better Operation

John Doe had a hernia 15 years ago--and he still talks about his operation. It was certainly something to remember. There was that terrible three weeks in the hospital: the retching, agonizing hangover when he came out of the ether, the two weeks flat on his back (not eating, not sleeping) and his belly a constant, burning torment. Months after he was back at work, he felt something like a big hole where the scalpel had slit his muscles; and for years he looked with awed distaste at the lumpy, four-inch scar on his abdomen.

When Mrs. Doe had to have the same operation last week, Mr. Doe was understandably upset. He was sure that she was in for all the horror he had endured. But he was wrong.

First of all, Mrs. Doe was not rushed to the hospital the night before her operation. Because she was tired, nervous and rundown, her doctor put her in the hospital three days early. She had time to rest up; the hospital staff had time to make blood tests, check her heart, get acquainted with her mental and physical state, know her as both person and patient. Mrs. Doe came out of the anesthetic with no nausea; after a day's rest she was sitting up. After two days she began to walk; in a week she was home. Her scar was a thing of surgical beauty.

The surgical advances of the past 15 years have come about so gradually that most surgeons are not completely aware of them.

What year and month were the changes made? Medical histories are footnote deep with the names of men who made the spectacular goat leaps to better man's health: Lister for his development of antiseptic surgery, Horace Wells and William Morton for their discovery of anesthesia, Walter Reed for taming yellow fever. More modern surgeons and technicians added bits & pieces to medical knowledge that were less dramatic. Examples:

New anesthetics have replaced sick-making ether, or made it possible to use much less. Hangover-proof cyclopropane was first demonstrated only 15 years ago; curare, a South American arrow poison introduced four years ago, relaxes muscles, reduces the amount needed of any general anesthetic. Sodium pentothal (the "truth drug"), no more terrifying than a sleeping pill, is enough for some operations ; it may also be used to calm a frightened, fighting patient for the once-dreaded trip to the operating room.

Surgeons, because of better anesthetics, no longer have to fight tissues that are only partially relaxed; operating-table in juries are less severe, scars smaller. Surgeons have also become better-trained, gentler, more skillful seamsters ; penicillin arms them better against infection.

Anesthetist (now more often called anesthesiologist) and surgeon now do better teamwork; surgical nurses get better, more specialized training.

Early ambulation ("an ugly phrase for a beautiful idea") means that patients are out of bed as soon as possible, perhaps one or two days after the operation. Result: less pneumonia, better healing of muscles, fewer "sick-man complexes"; patients can relieve bowels and bladder normally, eat better, sleep better, feel better.

Gadgets have helped: new machines for anesthetics; easily tilted operating tables; glareless, heatless, shadowless operating-room lights; new sutures, like those made of the rare metal tantalum, to replace cat gut* for certain operations.

Care after operations has improved through blood-typing and blood-banking; new concentrates of amino acids and proteins nourish the patient who cannot eat a normal diet.

A surgical patient can never hope to lie in a bed of roses, but it is becoming less & less a bed of pain. Without making head lines, or much of a splash, a steady drip of knowledge goes on eroding much of the hospital's horror.

* From sleep, not cat, intestines; the name came from early dancing masters' fiddles called kits, their strings kitgut; prissy etymologists "corrected" it to catgut.

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