Musings of a Surgeon

29 Dec 2021

 By Dr. Sandra Krishnan

“Words are, of course, the most powerful drug used by mankind.” ― Rudyard Kipling

 ‘Do you want to do surgery?’

 ‘Yes, very badly.’

‘Anticipation is one of the most important qualities a surgeon must have and you anticipate instinctively, I am sure you will make a great surgeon.’

This was a conversation that took place 20 years ago, etched into my brain and effortlessly, I am transported back to the scene. Three of us in a procedure room, an extremely senior and intimidating plastic surgeon, a patient, and the lowly intern, myself. The plastic surgeon was about to remove her dressing, it was standard; plastic surgeons perform intricate wound reconstructions. Sometimes they are grafts, a piece of skin harvested from one part of the body and sometimes flaps, tissue thicker than skin; regardless of what method is used. The recipient site is looked after gently to inspect the graft or flap and not peel away tissue.

So here I was, at my short plastic surgery term watching as he pulled the equipment trolley towards him and proceeded layer by layer, becoming deliberate as he headed towards the skin. I realized that he had a dressing set ready to clean the wound and redress it. I moved towards the trolley, took some tape and cut it equally, and stuck it to the side rail, so that the tape would be ready to secure the dressing.

He turned around, looked at what I was doing, went back to his wound and without missing a beat, we had that brief conversation. To be honest I can’t remember a smile, I can’t remember much more, but obviously I didn’t need to remember it all, I understood that I was on the right track, and pledged to myself to keep going.

I did eventually learn a lot in theater, despite my being ‘just an intern;’ he would teach me the fine art of plastic surgery tissue handling, which was different. There was a ‘holy’ respect for tissues, and he literally held my hands to teach me how to secure a square knot. Towards the end of that term, there was a day when the registrars were not around, and I was holding the pager. A patient came in with a traumatic injury to the tip of the little finger. I took the patient to the theater and debrided, trimmed, and reconstructed the wound. There was an inquiry the next day on why I was alone (it happened somehow) holding the pager and how I managed to do the procedure. I am so proud to say that the patient did well.

 Robert Greene in “Mastery,” describes mastering a skill as, “Making your way to the inside.” According to him, when we begin something new, we are on the outside looking in. It is not until we put in the work, learn the details, and experience the good and the bad, that we begin making our way into the “inside.”

It was a six week posting, for a feel of what plastic surgery is like and to teach us basics. I never saw this plastic surgeon again. But every time I use a particular needle holder and utilize a pair of toothed Adson forceps to meticulously bring skin together, I think of him and pay a silent, internal tribute.

Sandra Krishnan is a Consultant Surgical Oncologist; Breast, Melanoma and General Surgeon. She is an Educator, Writer, Speaker. She has recently created Note to Myself, What I wish I knew in my 20s, an online program for women; empowering women while raising funds for charity.


Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.