Ruggieri M.D. - Confessions of a Surgeon: A Deeper Cut

Paul Ruggieris other books:

Confessions of a Surgeon:

The Good, the Bad, and the Complicated.

Life Behind the O.R. Doors

The Cost of Cutting:

The Truth Behind a Multibillion-Dollar Industry

Colon and Rectal Cancer:

From Diagnosis to Treatment

A Simple Guide to Thyroid Disorders:

From Diagnosis to Treatment

The Surgery Handbook:

A Guide to Understanding Your Operation

The views and opinions expressed in this book are solely those of the author and do not reflect the views or opinions of Gatekeeper Press. Gatekeeper Press is not to be held responsible for and expressly disclaims responsibility for the content herein.

Confessions of a Surgeon: A Deeper Cut

Published by Gatekeeper Press

7853 Gunn Hwy., Suite 209

Tampa, FL 33626

www.GatekeeperPress.com

Copyright 2023 by Paul Ruggieri, MD

All rights reserved. Neither this book, nor any parts within it may be sold or reproduced in any form or by any electronic or mechanical means, including information storage and retrieval systems, without permission in writing from the author. The only exception is by a reviewer, who may quote short excerpts in a review.

Library of Congress Control Number: 2022951860

ISBN (paperback): 9781662936098

eISBN: 9781662936104

Disclaimer

The events depicted in this book are real experiences of real individuals. To protect their privacy, the author has changed their identities by altering any identifying details and, in some cases, creating composite characters. Any resemblance between a character in this book and a real person is therefore entirely accidental.

To every patient who trusted my judgment by granting me the privilege of guiding them through their unique surgical journey.

CONTENTS

I realize it has been over a decade since I pushed open the operating doors, with the writing of Confessions of a Surgeon. Despite its raw and personal message, the memoir was a unique perspective on the complicated life of a surgeon. Many reacted viscerally to the graphic descriptions of my operating room experiences and unfiltered personal opinions. I was happy to see that.

Since the last time I tossed a malfunctioning surgical stapler against the operating room wall, much has changed with myself and my profession. Some of this change has improved surgical patient care. Some has been detrimental to it.

Change has made my job inside the operating room easier and more difficult at the same time. Throughout all that has unfolded over the last decade, there is one constant in what I do for a living. People continue to live, die, and experience everything in between. Life inside the operating room continues to remain complicated no matter how I cut it.

Since my last confession, my profession has dramatically modified the way it trains and treats its surgeons. I was born out of a different generation of surgeons, training in an era where instruments were thrown at walls without consequences, egos went unchecked, and fear was the prevailing feeling. It was a generation molded by mentors who consciously weeded out the weak.

There was no political or social correctness to how we were treated. No one apologized for the lack of sleep, sex, or family life. Naps and workplace hour restrictions existed as topics in academic papers. No congratulations for getting something right, just criticism for screwing up. Due to the lack of supervision, and chronic fatigue, human mistakes were part of the training processall crucial in the making of a surgeon, despite the collateral damage to patients. Those of us who were fearless, thick-skinned, or had nowhere else to go kept moving forward. Those who could not deal with the unique stress of surgical training dropped out, were fired, or became radiologists.

Todays making of a surgeon is a much kinder process. The training is less intense, the supervision almost too heavy-handed, and the learning expectations tempered, forcing surgeons to extend their training years.

Since my last confession, the practice environment in which surgeons have operated has also dramatically changed. Independent surgeons have been overshadowed by a corporate business model with little use for nonproductive surgeons, particularly those in the sunset of their careers. I am part of a disappearing breed of surgeons who worked for patients, not corporations, for most of their careers. I am part of a generation of surgeons who had complete control over their professional lives and the patients under their care. I am part of a unique generation respectively connecting the past era of open, big-scar surgery to the present era of minimally invasive, robotic surgery. I am the last of a generation to run away from the laptop computer and refuse to let it replace my stethoscope. I am part of a generation immensely proud of its illegible handwriting and the throwback black pager attached to my belt. I am the last of a generation swept into the ranks of the employed, surrendering to the changing political and financial winds blowing through my profession.

Since my last confession, the way in which surgeons have operated on patients has dramatically changed. Most of the operations I now perform are carried out through small incisions. Today most patients go home the same day after their operation and no longer linger in a hospital bed for days recovering. What was considered the standard of care for some operations decades ago might border on malpractice today. The medical devices I used on patients when I started are now antiquated and frankly, dangerous.

Robots have now infiltrated every hospital throughout the country. Over twenty years ago, they started arriving in operating rooms like alien pods. In the 1970s, a robot was a character on the television show Lost in Space. Danger, Will Robinson. In the 1990s, robots were gifts for children during the holidays. Ten years ago, robots were busy vacuuming and cleaning floors while you were out having dinner. Today robots are your surgeons removing gallbladders, prostate glands, and uteruses and repairing hernias. Their presence is crucial to the survival of operating rooms, along with the professional identity of all newly trained surgeons.

Since my last confession, operating rooms have morphed into high-tech revenue bastions, crucial to the economy of any hospital system. Many have unique personalities, their own names, staff, and revenue streams. They no longer belong to your surgeon. Along with changes in the operating room, the entire health-care business model has morphed into a corporate monster with a veracious appetite for revenue and cutting costs. As a result, key aspects of your health care are secretly being outsourced to physicians in different zip and country codes. Physicians you will never meet are making decisions that will drastically affect your health care. Your future operation is being handed over to a surgeon you barely know anything about. As a result, the relationship between surgeon and patient has dramatically regressed.

Everyone in the health-care industry is being pressured to do more with less, or just do more with nothing. Throughout all these changes, hospital systems in this country are under intense pressure to survive. Most have circled the wagons, in an attempt to capture every dollar at the expense of patient and practitioner choice. On top of all this, I cant even begin to tell you how a pandemic has permanently changed the way health care is now delivered in this country.

Since my last confession, surgeons have also changed. I still remain the quiet, confident, imperfect surgeon who will do whatever it takes to improve the quality of life of my patients. However, I am now cognizant of my own aging skills. Keenly aware of my own limitations. I am at peace with the overall quality of care I have provided over the course of my career. Every muscle in my upper body aches longer each time I leave the operating room. After experiencing two major operations myself in the last ten years, I now have a deeper appreciation for the vulnerable situation in which I place my patients every day.