A Short Story: The Ninety and the Ten, or, Why I am still a surgeon

I have been here for long enough to get used to the silence. I miss seeing someone work to music, though sometimes I forget that was ever normal. I always enjoyed working to Handel’s Messiah – high culture enough to please my unbelieving colleagues, and sufficiently spiritual to calm my nerves as I set about my task – though I first learned my trade under someone who used to play Metallica in theatre: he always said metal was an ‘epic’ form of art that went well with surgery. But what I still cannot get used to is knowing that no surgeon prays anymore – or feels dependent on anything bigger or higher than itself – when operating.

 

In my early days, when surgery was still one human operating on another, I had a few devoutly religious colleagues, though not many. Surgery is an inherently tense undertaking regardless of one’s religion (or lack thereof): the ‘routine’ always carries risks, and the surgeon is always aware of his capacity to err, to say nothing of the drastic potential consequences of such error. In theatre, I saw many silent prayers to an unknown God etched on the faces of my irreligious colleagues, which were usually followed up (post-surgery) by a sense of thanksgiving that had to be released, albeit not channelled in any particular direction. I used to work with a Muslim surgeon, a Shia of Iranian descent, who would breathe out a quiet al-hamdu li-llah when his work was done and a junior had taken over with the remainder of the operation. The Christian surgeons I knew were generally pretty bashful about offering any public praise to God post-surgery, though I did once work with a Nigerian who would say, ‘Thank you Jesus!’ in precisely that setting.

 

I once described the existential weight of working in an operating theatre to a theologian. “It’s like Schleiermacher,” he said. “Working there gives you a sense of your absolute dependence on God.” I would say that was true of myself, and in a modified sense I suppose it was true of everyone involved. In theatre, we are all aware of our¬†unconditional reliance on factors bigger than our own training or skill. And so, while I was never surprised or upset by the knowledge that my atheist colleagues didn’t pray at the start of an operation, something would have been wrong had any of my colleagues set to work on a broken human body – an embodied, living creature – and felt no existential burden in so doing. Our work taught us to be human. As a surgeon, that always made me feel like I played a role in society that went beyond the surgery itself. I was someone entrusted by my fellow human beings to treat their bodies as works of art, someone granted access to those bodies in order to repair them in the most minimally invasive way possible. I saw my vocation, in some small but significant way, as one that reminded humans to be humane, to care for their neighbours’ failing bodies. At its core, my profession was a caring profession.

 

I still work in theatre, but it has now been fifteen years since my hands last guided the scalpel that opened someone’s skin. The new surgeons, unflinching, unfearing, perfectly precise machines, do all that for us. There’s really no need for me to be here. Or at least, that’s what I tell myself – and what many others tell me. And yet here I stand, unable (or more likely, unwilling) to go anywhere else. When the post-NHS Health Industry decided to discontinue human-led surgery (a move that instantly made RoboMedCorp one of the most profitable medical companies in England today – I understand that the current Health Secretary’s spouse is a major shareholder), we were all offered pay-offs. I refused. My skills were too specialised to be ‘redeployed’ elsewhere, I was not interested in retraining to work anywhere else, and I was certainly far too young to retire. Surgery was my life, and I was not prepared to give that up. And so, I found myself in this absurd situation: I am a human surgeon who is ever present in theatre, who is paid to be there, but who is an observer as the machines do their work.

 

When I first refused to leave my profession, I thought that some patients would not want a robotic surgeon. I know I would see no reason to trust a machine over one of my own colleagues. There must have been room for that consumer choice in a privatised healthcare system. How naive! The private medical insurance lobby, married to the almighty power of RoboMedCorp at Westminster, meant human-led surgery quickly became virtually impossible: thanks to a dubious academic paper (wilfully misinterpreted by the Health Secretary and seized upon by some government-friendly tabloids), we, the human surgeons, were deemed ‘too risky’ in comparison to the machines. Overnight we became a danger to public health. So, even if you wanted a living, breathing surgeon to replace your hip joint or remove your cataracts, your wish would never be granted. No English insurance policy anywhere would cover it, and no English hospital would sanction it.

 

Of my colleagues who declined the pay off, most decided to move abroad. The end of nationalised medicine in the West meant that one’s options were limited. Some colleagues found work in Eastern Europe. My Shia fried moved to Azerbaijan. A lot of the enthusiastic Christians became medical missionaries in various parts of sub-Saharan Africa. In the end, most surgeons I knew took the pay off: financially, RoboMedCorp and our government came together to reimburse them handsomely. A few of my old colleagues have now been operated on by the machines. One of them is even a spokeswoman for RoboMedCorp – a former surgeon paid to tell the country that the robots do it better than we ever could. Fifteen years on, I am aware of a couple of others in the same position as myself. Hence the article on us in the Observer last week: ‘why do they insist on standing through operation after operation, watching the machines, and doing nothing?’ We know that some scorn us for ‘collecting high salaries for no work’. Most simply regard us as oddballs and eccentrics. We are like the old woman who refuses to leave her house when the developers come to build a motorway in its place. Our protests did nothing to stop the motorway coming. But we are still in the house – albeit in a house that now stands wedged between great lines of tarmac on either side, for ever to be gawked at by passers-by who cannot fathom our choice.

 

In part, I refuse to leave because I want to delay my extinction as much as possible. England now is very different to the England of my youth. When I trained, medicine had an easily recognisable place in the class system. When I was a student, some of my year group (myself included) were working class, a fair number were very much upper middle class, but I don’t think any were true aristocracy or the children of the super-rich. Most were somewhere in the middle of the middle class. When I first qualified as a doctor, the NHS in England was on its knees: privatisation was inevitable. By the time I was a consultant surgeon, England had elected its fifth successive neo-liberal government. Now, when I talk to my own children about life in their grandparents’ era, they struggle to imagine their world. To them, whether you are the child of a bricklayer or an accountant makes for little difference. “We’re all just in The Ninety, Dad,” they remind me. “We’re never going to be part of The Ten.”

 

The Ninety and The Ten. It doesn’t surprise me that something like human-led surgery became unsustainable when The Ninety and The Ten replaced the class system. It is not in The Ten’s interests to retain a group like (human) surgeons, when we could be replaced by robots. The robots are owned by The Ten, and accordingly, every robot-led operation further entrenches their power and wealth. The existence of human-led surgery, itself a part of the class system The Ten has replaced, is a hindrance to this. Human-led surgery says, ‘a person is a person because of other persons.’ RoboMedCorp and Westminster monetarise the human body, and put the bodies of The Ninety in servitude to The Ten.

 

I do not mourn the death of every aspect of the old class system. That is not why I am writing this response article, dear readers of the Observer. I admire much in my children’s post-class perspective: they have inherited none of the elitist pomp engrained in my own upbringing. It is a good thing that the children of surgeons and cleaners see themselves as social equals. But, as part of The Ninety, these are all also equal in social insecurity. This is something I cannot envy. I wish they could follow me in my vocation and know the dignity of being entrusted by someone’s very flesh and blood – as one human making another human better. But that chance does not exist in their world.

 

And so I go on, attending operations faithfully as an awkward reminder of an era the Health Industry and government would rather forget. But that’s not my real motivation. All I want is for ‘my’ patients to know that another human was there when their fragile bodies were at their most vulnerable, that someone was there as a reminder that their bodies are no mere machines and (while I would never have said this openly fifteen years ago, though now I think I have little to lose), for them to know that someone shared their fear and prayed for them.

 

Mr John P. Taylor, FRCS(Eng)

Consultant Colorectal Surgeon

The Royal London Hospital

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