The Art of Setting Up Success

What makes a great surgeon? Do they have long fingers? Or steady hands? Or the heart of a lion?

I think it is the preparation they do right before they make the incision.

In VMH, I would be assisting various surgeons, especially Dr MR Seetharam in orthopedic surgeries. MRS is very methodical in preparation for a surgery. Every surgery is different. One might require an expensive equipment, or a team of skilled surgeons. The patient might have severe comorbidities that make post-surgical management difficult. The economics might not work out. Functional recovery maybe more important. There are many factors that go into choosing the right kind of surgery for the right kind of patient. MRS will be thinking of all these as soon as becoming aware of someone who has an issue. But that's not the preparation I'm talking about.

Inside the operation theater, with the patient and others eagerly waiting, there's a final and crucial step of preparation that MRS does. The X-rays are put on the viewer where it can be seen from the operating table. Another look is given at the X-ray to review the approach and the location of the fracture fragments. The fractured part is positioned with great attention to allow the views and manipulations that would be required later during the surgery. Extra tables are brought in if so required. The position of each assistant is decided. All the props are set up exactly where they have to be. The C-arm (A C-shaped X-ray machine that can be rotated around the patient during the surgery to see the bones and the implants near real-time) is brought in and out of the field to ensure there are no hurdles. A shoot is made in each position that the part would be during the surgery to be sure there is no obstruction in the C-arm's view. All the implants and instruments are reviewed to make sure they're right. The assistants are warmed up on the procedure and the tools that'll be used. The success of a surgery is decided before the incision is put.

That last sentence might sound like this speech by Harsha Bhogle. Or the saying "The more you sweat in practice, the less you bleed in battle". But I am not talking about the years of dedication one puts in before one becomes a fine surgeon.

I am specifically talking about the setup. Take this example of a setup for arterial blood draw.

Depends I think. If you're crammed between the wall and the ICU bed on an obese hypovolemic patient whose diaper you cannot remove completely and you're drawing the femoral artery with a plastic syringe not meant for it, should be sufficiently difficult.

— Akshay S Dinesh (@asdofindia) December 31, 2020

That is a setup for failure. If one compromises on the setup, they would often have to compromise on the result as well.

* * *

What I realized as I was writing this is that I tend to compromise a lot. I don't know whether I do it as a way to challenge myself so that I feel good about myself if I luckily succeed. Or because I've not learned how to negotiate better. Or maybe I don't know what I need. Or maybe I don't think. Or maybe I think being accommodating is a virtue.

Perhaps accommodation isn't a virtue. Perhaps if you don't ask for the right working conditions, you're going to end up being ineffective and lowering the standard all over.

But you're never going to have all that you need. "You're going to have to compromise" is the folk wisdom. It's difficult to imagine having everything I need. That's a contradiction.

Perhaps then my core premise is wrong. It is probably not about the setup. Or maybe it's a bit of everything. Maybe I'm partly right.

Maybe you can compromise on the setup if you can compensate with your skill (or luck). Or maybe that's too much strain on you.

I don't know. Maybe I'll have clarity later.

PS: I was wondering whether to make the latter section "PS". But maybe that's the script. It's a blog, after all.