They also serve who only stand and wait

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CTSNet classification: 2, 4, 23

To the Editor:

I read with great interest, and a degree of nostalgia, Dr Kumar's editorial¹ on the second assistant.

It brought back memories of a time long ago, when I was young and thirsty for learning. I spent 18 months as a Senior House Officer (the most junior member of the surgical team) in Southampton, UK, where my only role in theaters was to harvest a length of vein and then stand next to the surgeon as a second assistant.

Dr Kumar offers great advice on how to make the most of this time.

As he suggests, I developed my habit of making notes with illustrations during that time. I still have that habit and have a large collection of these handwritten notes and drawings, to which I refer at times even now.

I would often get bored with the repetitive nature of my job of harvesting vein and closing the leg. During one such period of boredom, I started using my left hand (I am right-handed) to do parts of the procedure. I soon became adept at using my left hand as well, a skill that I use on many occasions now with great advantage.

Being a second assistant for a long time can, however, be a source of despair, especially if the opportunities to open or close the chest or do a top-end anastomosis do not materialize. “They also serve who only stand and waite.”² I would think of Milton.

Being a second assistant also allows the mind to drift without anybody noticing (at times). Daydreaming can be a wonderful experience (at times). I had chosen cardiac surgery to be a top-notch cardiac surgeon, nothing less. When I was 20-something, just holding the retractor as a second assistant did not make the goal seem nearer. Was it possible that the dream could go sour?

I had the opportunity to work as a second assistant with some great surgeons, and some not so fantastic. As Dr Kumar says, it is a very impressionable part of one's life and can have a profound bearing on one's later career.

But alas, the days of the second assistant are numbered. The European Union's working time directive³ has cursed the current and future generations of trainees with only 48 hours of work per week. This has resulted in severe manpower shortages in hospitals across the United Kingdom, and almost all our surgical procedures are now done with a single assistant. We have learned to adapt to this and now do not find the need for second assistants except for the most complex cases. The loss, however, will be that of the trainees who will miss out on such a wonderful training opportunity.

And for those lucky enough to have this chance, make the most of it. Look at it as an opportunity that has knocked on your door…and if you don't answer soon, it will go away forever.

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References 

1. Kumar TK. The second assistant in cardiac surgery: the challenges and answers. J Thorac Cardiovasc Surg. 2009;137:1311–1314
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2. Milton J. When I consider how my light is spent. In:  Ricks C editors. The Oxford book of English verse. New York: Oxford University Press USA; 1999;p. 168
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3. EUR-Lex [Internet]. Luxembourg: Publications Office of the European Union; c2009 [updated 2009 Nov 12; cited 2009 Oct 10]. Council Directive 93/104/EC of 23 November 1993 concerning certain aspects of the organization of working time; [about 1 screen]. Available from: http://eur-lex.europa.eu/LexUriServ/LexUriServ.do?uri=CELEX:31993L0104:EN:HTML
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