‘A small cemetery’: death and dying in the contemporary British operating theatre

Abstract

Surgeon Henry Marsh begins his autobiography, Do No Harm, with a quotation from the French practitioner René Leriche, “Every surgeon carries within himself a small cemetery, where from time to time he goes to pray—a place of bitterness and regret, where he must look for an explanation for his failures”. This article uses memoirs and oral history interviews to enter the operating theatre and consider the contemporary history of surgeons’ embodied experiences of patient death. It will argue that these experiences take an under-appreciated emotional toll on surgeons, but also that they are deployed as a narrative device through which surgeons construct their professional identity. Crucially, however, there is as much forgetting as remembering in their accounts, and the ‘labour’ of death has been increasingly shifted out of the operating theatre, off the surgeons’ hands and into the laps of others. The emotional costs of surgical care remain understudied. Indeed, while many researchers agree that undergoing surgery can be a troubling emotional experience for the patient, less scholarly attention has been paid to the emotional demands performing surgery makes on surgical practitioners. Is detachment the modus operandi of the modern surgeon and if so, is it tenable in moments of emotional intensity—like patient death?

Guilt, shame and negative emotion in undergraduate medical education: is there a role for Balint groups?

“…We had a long talk, in which our boss mourned the demise of several aspects of his training, most notably the traditional firm structure. The firm, where a team of junior doctors were responsible for the patients of a single clinician, has its origins in Victorian surgical training and persisted until the early years of the 21st century (Arnold-Forster 2020, 284 ). Changes in the wider health service and statutory limits on training doctors’ working have led to a more shift-based working pattern, and consequently the traditional firm has largely been abandoned.…”

Pulling our lens backwards to move forward: an integrated approach to physician distress

“…Burnout is fuelled by unsupportive work environments impeding sufficient autonomy, meaning, creativity and direct patient care at work (Wallace et al 2009). Physicians across the globe including in North America (Lemaire and Wallace 2017) and the UK (Arnold-Forster 2020a) are becoming more burdened by administrative tasks, clunky electronic medical record systems and chaotic work settings. Tensions may arise from customary models of care, such as those leading to mid-procedure handovers, frequent interruptions and unrelenting time pressures (Lemaire and Wallace 2017).…”

“…Some practitioners have long supported an integrated approach to patient health, with an interest in the emotional state and subjective well-being of patients (Arnold-Forster 2020a). George Engel challenged classic reductionist approaches to medicine (most notably the biomedical model) by introducing the biopsychosocial model of health (Borrell-Carrió, Suchman, and Epstein 2004; George and Engel 1980).…”

Shame as a moral mood in medicine

“…Physicians' emotional experiences are more than a matter of individual temperament. They are dynamically shaped and channelled through discourse, relational norms, technical modes of interacting and acting on the body, and other practices and structures 4 . These multifactorial matrices that shape and reshape emotional possibilities within local biomedical contexts–what can be called affective arrangements 5 –are shot through with shame, with detrimental impact on biomedical actors 6,7 .…”

“…They are dynamically shaped and channelled through discourse, relational norms, technical modes of interacting and acting on the body, and other practices and structures. 4 These multifactorial matrices that shape and reshape emotional possibilities within local biomedical contexts-what can be called affective arrangements 5 -are shot through with shame, with detrimental impact on biomedical actors. 6,7 Yet I draw on anthropologist Throop's concept of a moral mood 8 to provide a more ambiguous picture of shame's endurance and impact.…”