HIV, hepatitis B and C, Bovie smoke—neurosurgeons routinely put their health and lives on the line during surgery. And yet, it never has been safer to be a neurosurgeon. Work conditions in a modern operating room and for doctors in general are so much better than in any previous era that the risk of a surgeon incurring a serious illness or injury at work is practically nil. But it was not ever thus. Not all that long ago, during my training, it was routine to draw blood and insert peripheral IV lines without so much as wearing gloves. The risk to doctors (and to patients!) of that practice seems obvious now.
Infectious disease as we now understand it was the most difficult and feared medical problem for humanity until about 60 years ago. It was and still is the main hazard in patient care faced by physicians and surgeons. Doctors (and nurses) have always put themselves in harm’s way in the line of duty. In the late 19th century the hemorrhagic viral illness known as yellow fever, a recurrent threat in the United States, decimated the workers building the Panama Canal. The mechanism of disease transmission was proved in large part by human volunteers—physicians and nurses—who submitted themselves to mosquito bites. Public health measures that followed led to the suppression of yellow fever.
Surgeons in war today, such as our colleagues in the Middle East, are potentially in harm’s way as were their predecessors, including Sir Victor Horsley. At age 58 he volunteered to join the British Army during the First World War and was sent to Mesopotamia in what is now known as Iraq. In his second year abroad Horsley died after a short illness that probably was a Salmonella infection (and most likely not heat stroke as is sometimes reported). Harvey Cushing too suffered in that war during his service in France. Following a bout with influenza, epidemic among the armies, he was stricken with debilitating numbness in his hands and feet. Diagnosed with multiple toxic neuritis, his symptoms would continue to dog him for the rest of his life.
Surgery, like life, never can be completely risk-free for patient or surgeon. Whatever chances we take in the operating room, it is the patient who almost always has more to worry about.
How much risk should doctors assume? This has been a matter of ethical debate for thousands of years. Talmudic law states that one who risks his life for little benefit is a “pious fool,” yet it was also understood that physicians, more than most, had to endanger themselves to care for the sick. This was especially so during plagues, the true cause of which was unknown until the mid-19th century but the perils of which were well understood. Most doctors today will probably heed the words of this hadith: “If you hear about plague in a land, do not go there; but if you are in that land, do not run away.”
Michael Schulder, MD, is vice chair of the Department of Neurosurgery and director of the Harvey Cushing Brain Tumor Institute at the North Shore Long Island Jewish Health System, Manhasset, N.Y. Send topic ideas for Timeline to Dr. Schulder at [email protected]. The author reported no conflicts for disclosure.