On Monday, retired surgeon Ira Levine of San Diego discussed his four decades in the operating room. Today, he talks about the care and healing of patients.
Levine says before the knife cuts, there is always time to back off, and sometimes surgeons should.
“Once, early in my career, I asked a senior surgeon to assist me (in operating) on a patient who had a complicated procedure to be done. On the morning of surgery, I went to see the patient, a woman in her 80s. I said, ‘Are you ready for surgery?’ She said, ‘Doctor, to tell you the truth, I don’t feel good about this operation.’ And I said, ‘If you don’t feel comfortable about it, we won’t do it and I’ll cancel it.’”
Regardless of the reason?
“Regardless of the reason. I called the surgeon that was going to help me, and he was irritated. He had set aside the time, and he said, ‘You got to talk her into it.’ I said, ‘She doesn’t feel good about it, and I’m not going to do it.’ She died before the next morning.
“One of the things I learned is, listen to the patient.”
Do you remember your very first operation?
“No, but I’m sure I was scared. The scalpel is razor sharp. You’d be surprised how sharp it really is. It’s very difficult to know what amount of pressure to put on your hand to cut through skin.
“I was doing a mastectomy about a dozen years ago, and an intern was helping me. I gave him a scalpel to make a small incision to put in a drain. He sliced almost as lightly as you would with a fingernail, just made a little redness. I told him he had to push just a little harder to get through the skin. But then he pushed too hard and cut through the muscles in the chest and into the lung. So instead of asking for a drain, I said, ‘Can I have a chest tube?’
“One of the things we say in surgery is experience comes from bad judgment, and good judgment comes from experience.”
Levine’s attitude toward surgery is, “What’s the hurry? There’s always enough time to do it right. Some surgeons think they are really terrific if they can do it quick, and boast, ‘I did it skin-to-skin in 30 minutes.’ And then they have complications.”
How about surgeries that are done for the surgeon’s income?
“I’d like to think that doesn’t happen, but I don’t want to be naïve because clearly there are doctors that have done that, and some have gotten away with it, and many haven’t.
“My cardinal rule was to care for patients as I would want to be cared for, and to treat them like a preposition — do something for the patient, not to the patient.”
What specific operation would cause you to wake up in the morning and say, “Oh, I have to do that today?!”
How tough is it to operate on severely obese people?
“Very difficult, very tough, because their abdominal wall is very thick from fat, and it increases the chances of infection.”
Levine does not shy away from what he sees as the overuse or even misuse of endoscopic and robotic surgery.
Endoscopic surgery is done by inserting fiber optics through small holes and manipulating instruments at the patient’s side. Robotic surgery is operating by using instruments remotely with a monitor and sitting some distance from the patient.
Levine says both methods are useful, but what’s happening today is that more and more surgeons are using them for operations that don’t need to be done that way, ignoring that conventional surgery would give the same results and possibly be better for the patient.
“Robotic surgery sounds sexier to the patient, but it’s expensive and not always desirable or even sensible.”
As an example, he says surgeons are learning to take out the thyroid gland endoscopically. “I did a great many of those operations, and I don’t see a need for it. I think you can be much safer looking with loupes (glasses worn to magnify tissues).
“Just recently, I talked to a colleague who said a number of general surgeons are also using robotics to take out gallbladders. And I asked, ‘Why are they doing that? It’s just an unnecessary increase in cost.’”
“I talked with an OB/GYN who had just finished a simple hysterectomy, not a complicated operation. The doctor told me it was done robotically, and I asked why. The reply was, ‘Because it’s fun.’ And I said, ‘Fun? It’s overkill.’”
What are your impressions of our general health?
“Organic food, I think, will be shown to be little or no healthier than non-organic food. I also believe many products and over-the-counter medicines that promise to allow you to live longer, sleep better, etcetera, will be proven valueless.
“There are five things that Americans can do that will reduce health risks dramatically: eat in moderation, drink in moderation, exercise, don’t smoke and wear seatbelts. And you don’t need a doctor to tell you any of those things.”
Today, Levine can sit in his home above San Diego, where he and wife, Ellen, raised three children, and reflect on those decades in medicine. In hindsight, he doesn’t see disease, he sees healing. He doesn’t see pain, he sees relief. And his golf game is coming around.
Fred Dickey’s home page is freddickey.net
His email is firstname.lastname@example.org