Surgery and Rape
Sid Schwab is a semi-retired surgeon, a medical blogger and an amazing writer. He recently wrote a powerful piece called Taking Trust, about his experience of the intimacy (his word) of surgery.
Why then did I find myself profoundly disturbed as I came upon this part:
I will reach in gently and caress the liver, the stomach and spleen. Slide over the top, into the recesses, curl the fingers enough to sense the texture, the fullness. The bowels move away and under, and over the top as I direct my hand. I can describe your kidneys now, I've circled the top of your rectum, held your uterus, measured your ovaries between my fingers. Part of you is gone at the moment, but I'm here, I know you now. You trusted and let me in, you opened your belly to me, and I entered with force. I'll stay until it's right. It's what I must do. You think you'll never touch me so intimately as I've touched you. But you have. You have.
The word-image he had drawn so skillfully -- a female (as this patient happened to be) immobilized, unable to respond, carefully positioned, and then invaded -- reminded me of another powerful blog entry I had read. Although this other post described a very different situation, I was stunned by the similarity of my visceral response to each:
He ran his hands all over me, inside and out … gently at first, and then rougher and rougher. After what seemed like an eternity of having his hands prying, pinching, pressing … he positioned me the way he wanted me … and did what I knew he was going to do. I remember thinking that it was never going to end. Rough doesn’t even begin to describe it. I hurt for a long time afterward in places I didn’t even know I had.
For anyone who may not recognize this, it is part a description of a rape. I almost got the feeling that I was reading about the same incident, but from the other side (since no one knows what the rapist was thinking.)
Surgery is not rape. I do not mean to imply in any way, shape or form that it is. I am well aware that these are two paragraphs taken out of context, and juxtaposed. (Please read the two posts again in their entirety. The links are here and here.) But what am I supposed to do when two skilled wordsmiths describe such different things and evoke the same disturbing picture in my head?
There is no getting around the subliminal ways in which surgery resembles rape. There is bodily violation by one person of another; and there is pain. Obviously all resemblences end there. Every effort is made to minimize the violation (laparoscopy) and the pain. The intentions are polar opposites: service, not subjugation. But I submit it is that visceral resemblance which engenders the trepidation, the unease, the fear with which surgery is approached by the patient. And I confess it bothered me to sense the surgeon's enjoyment of it.
I have exchanged emails with Dr. Sid, and I understand that he was trying to convey surgery's mystique, the reverence with which he undertakes it, and the respect he has for the patients who allow him to do this to them. I don't believe he feels any differently from generations of surgeons, but I do think he has a gift for words and more courage than most as he tries to share his feelings with us.
Perhaps more explicit acknowledgement of these superficial similarities -- even if just in our own hearts -- will allow us to better assure our patients that our caring and concern sometimes requires actions with roots of brutality.