‘We are like dwarfs sitting on the shoulders of giants’

…. John of Salisbury in Metalogicon

Great teachers of surgery who made immense contributions in preparing teachers for the present and for the future have enlightened us all from time to time. Each of these ‘teachers of teachers’ had their own ways of imparting this training and each one including the great Susuruta was unique in his approach. Most, however, would agree that the training of a surgeon should be to be able to perform with the mind not just the eye.

There goes a story in scriptures about ‘working with the mind and not just the eye’ of a woodcutter who would go to the forest every day, chop the wood and sell pieces after making idols of gods and goddesses. Once, a king while on a hunt was resting under the shady banyan tree and the woodcutter, oblivious of his presence, was chopping away ‘to glory’ the pieces from the branch of a just felled tree. The whole act was so rhythmic, precise, effortless and refined that there was harmony, music and spirituality in the air. The king was mesmerized in to a trance and with each suttle movement of the woodcutter’s body and his axe, the king was experiencing divinity. The king was woken out of this trance by the arrival of his Prime Minister and soldiers on the spot. The king called for the woodcutter, who was now conscious of the king’s presence and of his folly of having ignored His Highness completely. He fell at the king’s feet seeking forgiveness while the king, still under that spell, asked the woodcutter to rise and reveal the secret of his masterly skill that made even a crude job appear like a meditative activity and a divine art.

The woodcutter very humbly narrated the story of the making of a woodcutter. ‘Your majesty, I used to accompany my father, my mentor, into the forest as a child. He got me an axe when I was only seven and when I started, I would see a forest full of trees in front of me and had to change my axe every third day as I would hit the knots, harder areas of wood and would mostly miss the interstices. With the passage of time, I started seeing only a tree and then a branch and my axe would last only for a month. Further on, I could barely see anything, as my axe would automatically find those crevices to perfection. Now ‘I don’t see I just do’ and this axe has been with me for the last 17 years’. This is what I would refer to as seeing with the mind and not just the eye. The making of a surgeon should be on these lines and most surgery should ideally be learned at the elbow of a mentor.

Surgery is a unique medical profession that is still married to the concept of mentoring. [‘Mentoring’ originated from the famous legend, Iliad and the Odyssey. King ‘Odysseus’ had left his son under the care of his friend ‘Mentor’ while he left for war].

The eyes of the mind play an important role in the development of cognitive skills that are an integral part of the practice of surgery. The surgical axe should fall on the right crevices that are the embryological planes of fusion. Heald has famously called them ‘holy planes’. Surgical navigation through these planes not only makes surgery precise but also a clean act in term of going through relatively avascular planes. The eyes of the mind develop with internalization of not only the skills but also the knowledge of human anatomy and physiology. Surgery is not a simple act of the hands but a holistic endeavour that puts the hands in synergy with the spirit, heart and mind of the surgeon. Surgery is married to the word ‘precision’. It is a spiritual pursuit that calls upon us to develop our eyes of the mind to see like Arjuna i.e. to see only the eye of the bird amidst the cacophony of motion amongst multitude of visual stimuli.

‘Time stops when you’re in the O.R. You step up to the table, you evaluate the patient, you pick up a scalpel, and then you go into a bubble. It’s just you and your surgery and nothing else matters; not time, not pain, not exhaustion, nothing…. And suddenly, you realize it’s a whole new world’. Grey’s Anatomy (Season 11)