Invited Commentary

Article Outline

• Copyright

The article by Dr Kumar on the virtues of being a second assistant and its forgotten benefits is one that struck a helpful and very instructive tone for me. It brought back fond memories of my days as a medical student and junior resident on the surgical services of a number of great surgeons and highly respected physicians with whom I had the honor of working.

Likewise, it brought back memories of some real tyrants and difficult men (I had the misfortune of having no women as mentors) who were to be my role models and subconsciously I admired and wanted to emulate.

In the end, my career choices were most fortunate to bring me to San Antonio, where a fairly young Dr Kent Trinkle and Dr Fred Grover exposed me to a substantially different kind of cardiothoracic surgeon.

After considerable reflection about teachers, students, and all those we work for, it is important to note that we have responsibilities to each other. It includes treating each other with dignity and respect in all situations. There will be times that errors in judgment or technique or advanced patient disease causes unplanned pain, disability, or death. The resultant conflict, anxiety, and any anger produced by the situation must remain focused on the problem produced and not directed to the individuals trying to administer patient care.

Equally important in his article, Dr Kumar has identified and emphasized the worth and high position of a second assistant in cardiothoracic surgery. He notes several great habits from which we can all learn. First, be prepared, do your reading, and review the patients' anatomy and symptoms beforehand. Understand why the patient has agreed to lie down for a life-altering procedure with significant risks. Second, keep your mind engaged and thinking about the next steps. Anticipate the flow of the procedure and, as an assistant, remember to expose the anatomy for the surgeon and resist the temptation to poke your head into the field and complicate the procedure for the operative team. Third, Dr Kumar makes a great point of having personal debriefing sessions of what went well and what did not. Make notes for yourself. This is something that Kent Trinkle did and taught me to do as well. I still have a box chock full of 3×5 cards on my desk of procedures done over the years of the tricks that worked, the tricks that failed, and steps that backfired or worse.

For those of us who are now senior and able to think back to that day of being a second assistant and reflect critically of themselves and their personal growth as done above, realize that many folks are looking up to you and looking for some sign of acknowledgment or encouragement, however small. I remember being called a “zero” as a medical student by a senior cardiac surgeon and feeling great about it because he had just called his junior partner and the fellow “minuses.” The ability to make those supporting you feel needed and important is crucial to the survival and health of your team. Calling a junior person by name or paging someone to thank them for their work on the service as an intern or student has at times lasting value and merit. For me, this article is simply a wonderful reflection of the great times that are to be had in surgery at all levels and a call for all of us to continue to grow professionally and personally in an effort to honor those we serve.