Dismembering the Image of God: Surgeons, Heroes, Wimps and Miracles

Abstract

Joan Cassell is Senior Research Associate at the Research Institute for the Study of Man, New York City. This paper is about the temperament of surgeons, about men and in the U.S. they are primarily men who aspire to be heroes, to vanquish death and defeat disease, and who scorn as 'wimps' those with lesser aspirations. For the past two years, I have been doing fieldwork among surgeons.1 I have focused where they focus on the operating room but I have also followed them on hospital rounds and into their lounges and consulting rooms, and joined them at tables in the -hospital cafeterias. My data come primarily from two mediumsized suburban community hospitals? I circulated freely within each hospital,3 observing people (chiefs of Surgery, senior surgeons, Chief Registrars, operating room nurses, and intensive care unit nurses) and settings (operating rooms, operating room lounges, charge desks, surgical wards, intensive care units, surgical clinics, emergency rooms, cafeterias, women's dressing rooms); in addition, I followed fourteen surgeons throughout an entire day, and administered an open-ended questionnaire on attitudes and practices to thirty-one surgeons.4 My research has been conducted during a period of critical, and to surgeons, disturbing, changes in American medicine. Doctor and hospital fees are coming under stricter regulation by the government and third party insurers; lawsuits against doctors are increasing, the costs of malpractice insurance costs rising, and competition for patients intensifying.5 Although older, established surgeons, make an extremely comfortable one might say luxurious living, I have observed younger men struggling, caught between a scarcity of patients and the high costs of malpractice insurance. Many surgeons of all ages expressed disillusion, telling me they would not want their sons to become surgeons today. It is difficult to predict the outcome of these changes and how and whether they will affect the bearing, behaviour, and even gender, of those who practice surgery. Today, however, surgeons in the U.S. exhibit a specific and recognizable set of traits that accord well with a specialty that focuses primarily on event, rather than process (Cassell, n.d.). Working with character or temperament is not in vogue these days. In liberal discourse, one is likely to be accused of 'stereotyping'. Moreover, the terms call to mind studies where the adult personality of an entire culture waslUerived from purportedly Freudian analyses of practices such as swaddling, weaning, and toilet training. Nevertheless, the facts are that colleagues and popular culture ascribe certain temperamental characteristics to surgeons which they themselves recognize and admire.6 I'm not sure whether to speak of temperament, 'social character' (Fromm 1948) or 'ethos' (Bateson 1937). But the traits are clear and resemble, in many respects, those of the test pilots trained as the first cadre of astronauts (Wolfe 1979), to whom several surgeons I interviewed in 1980 (Cassell 1981) compared themselves. The more I studied surgeons, the more similarities became apparent between the death-defying, almost exclusively masculine world of surgeons and that of test pilots and astronauts: not only occupational similarities in the lengthy training, high level of technical skill, pyramidal system of advancement, and scarcity of women in anything but supporting roles but temperamental similarities, as well. The legendary Chuck Yeager, who walked away from demolished planes to become the first man to fly faster than the speed of sound, could well be the surgeon's heroic ideal. Like Yeager, the successful surgeon takes risks, defies death, comes close to the edge, and carries it off. 'We all sit together', explained the Chief of Surgery on my first day of research, as we walked into the cafeteria and he walked for the patch of green that marked the surgical table, where several young men sat, wearing green surgical scrub suits covered by white lab coats, the 'diacritical signs' (Nadel 1957: 30) that identify them as surgeons. Three registrars sat at another table; this was due to the presence of a female outsider, said the Chief, who indicated that it would take six months for the registrars to accept a woman, and even longer for the senior surgeons. A similar camaraderie and exclusion or, at the very least, distrust of women was found among surgeons at other hospitals.7 'There's a kind of comradeship', said one man, describing the relationship between surgeons, 'almost the comradeship of someone you've faced death with even though it's not your own death'.

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