How a surgeon of experience and integrity acts

Screen Shot 2016-04-02 at 17.58.19Dalrymple has an example in his family history

of a surgeon who acted in a way that would now be deemed ethically reprehensible, and perhaps actionable, but which seems to me to have been in the very highest tradition of his profession.

His name was Cox,

and I don’t know whether he is still alive: by now he would be very old. I thanked him insufficiently at the time.

Dalrymple was in Africa when he telephoned his mother.

She was about to go to America on a visit, but she told me that she had been bleeding intestinally. I told her she must abandon her visit and see a surgeon at once, which she did.

It was cancer.

She underwent an operation within the week. I returned home before the operation.

Dalrymple mère

said that she wanted nothing hidden from her; she wanted to be told everything, and made me promise that I would hide nothing.

Dalrymple mère exuded

pride in her own rationality.

After the operation, the surgeon Cox

spoke to me. Whether he was franker with me than he would have been with a son who was not a doctor I do not know; but he told me that, while he had excised all the cancerous tissue that he could see macroscopically, histology demonstrated that my mother’s prognosis was very bad. There was an 80% chance of recurrence within a year.

Dalrymple said that Dalrymple mère had made him promise that he would tell her everything.

The surgeon said that, on his estimate of my mother’s character and personality, this would not be a good idea. He advised me against this course of action; and since he was clearly a man of experience and integrity, I took his advice.

Dalrymple mère asked Dalrymple, when she had recovered sufficiently from the operation, what the surgeon had said.

I told her that, as far as he could see, he had cut out all the cancerous tissue. This was the truth, but of course not the whole truth, and I rather dreaded further questions, to which I might have to reply with outright lies: and I might not prove to be a very convincing liar. My mother was perfectly well aware that removing all cancerous tissue to the naked eye was not the whole of the matter, but to my surprise – and relief – she enquired no further. Despite her protestations beforehand, she did not want to know everything.

In the event, Dalrymple mère

lived another 19 years without recurrence and relatively free of anxiety about her cancer because the surgeon had ‘cut it all out’.

Dalrymple was impressed by the surgeon Cox.

It seemed to me then, and seems to me still, that he had acted as the model of a fine medical practitioner. He was technically accomplished, it goes without saying; the operation went smoothly, with no avoidable complications. But more than that, he had given consideration to my mother as a person, as a human being; and on the basis of limited acquaintance with her – at most, a few examinations in the clinic – he had come to a shrewd and, I believe, accurate assessment of what was best for her, better indeed than my assessment.

Surgeons

are often accused of being brash, mere technicians without human subtlety, but this was certainly not the case with him.

The surgeon Cox

is a hero to me.

His

understanding of the requirements for decency was much more sophisticated than that of modern medical ethics. He understood that people generally live in a social situation, not as isolated beings, and that it is sometimes right for relatives to know more about an illness than the ill person him or herself.

Dalrymple is sure that the surgeon Cox

knew that truthfulness can descend into indifference to suffering or even to sadism. To try to force people to know what they do not want to know can be cruel, and ineffective into the bargain.

Screen Shot 2016-04-02 at 17.36.46

David Rijckaert III, The Surgeon, 1638. Musée des beaux-arts de Valenciennes

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