A surgeon's most important tools are habits of mind

2014-02-04T00:00:00Z A surgeon's most important tools are habits of mindBy Tom Beal Arizona Daily Star Arizona Daily Star

Brain surgeons need to cultivate two behavioral characteristics — perseverance and equanimity of spirit, said Dr. G. Michael Lemole Jr.

Lemole, who will speak Monday about the evolution of neurosurgery as part of the University of Arizona’s “The Evolving Brain” lecture series, said his presentation will not be a “Ph.D. science talk” about the brain.

He’ll be talking about the nuts-and-bolts of invading it with medical instruments and how that skill has evolved.

It is an ancient practice, Lemole said — 3,000 to 4,000 years old.

Archaeologists have uncovered evidence of surgical drilling, probably to remove tumors or relieve pressure in pre-Columbian Peru, in ancient Greece and by medical practitioners who traveled with Roman legions.

It is not that different from what is done today in his trauma center, he said, except that today’s operations use better techniques and tools and are guided by imagery that allows neurosurgeons to more precisely guide their interventions. “Now we have MRIs and CAT scans to show us where to go.”

Lemole, professor of neurosurgery and chief of staff at University of Arizona Medical Center, is a recognized expert in skull-base surgery and is best known in Tucson as the neurosurgeon who treated the brain injuries of former Rep. Gabrielle Giffords, D-Ariz, after the Jan. 8, 2011, shootings.

He won’t be talking about that in his Monday lecture for a couple reasons.

First, he said he takes no credit for Giffords’ survival and recovery. “I can’t claim credit for her outcome. She came to us in good condition.”

Second, trauma surgery is not the arena in which his medical science advances, Lemole said. “Not a lot has changed in trauma surgery. It’s still brute-force surgery.”

Surgeons learn more from planned interventions, Lemole said. The perseverance and equanimity surgeons need to cultivate are important to those tasks, he said.

Surgeons know their actions can cause the death of patients, he said, and they need to deal with that, to persevere in their attempts, to learn from failure and to cultivate an equanimitous response.

He used the example of brain aneurysms, bulges that develop in blood vessels and could burst.

Surgeons must decide when it is appropriate to operate, knowing that in 1 to 2 percent of cases, those bulges can burst during surgery. “Out of 100, I will hurt or kill one or two.”

You need to compare that, he said, with the option of doing nothing, knowing that 20 percent to 30 percent of those patients will eventually die from a burst aneurysm.

“You have to take solace in the fact that you are doing far greater good for your patients than if you had done nothing.”

The same is true for all surgeons, all doctors and all people for that matter, he said.

Persevere. Succeed or fail. Learn from the failures.

Contact reporter Tom Beal at tbeal@azstarnet.com or 573-4158.

Copyright 2014 Arizona Daily Star. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

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