Surgery is a contact sport. It seems obvious that surgeons touch their patients. We enter their bodies in a way that is both impersonal and incredibly intimate. But beyond the act of operating on someone, touch is a therapeutic tool. I never leave a patient’s room or the exam room without touching my patient in a nonclinical way. It may be a handshake, a light touch on the arm, a reassuring squeeze to the top of a foot as I pass the end of their bed. It has become so internalized that I hardly notice. But the patient does. They tell me that it helps them recognize that they are still a person and not totally consumed by their disease. The longer the patient is ill, the more important the touch becomes.
I always knew I wanted to be a surgeon. From the time I started grade school, it’s all I ever wanted to be. It was one thing to want to be something but another to really understand what it meant to reach inside another body. The first time, as a third year medical student, that a cardiac surgeon invited me to lay my hand on the beating heart, I fell in love. The feel of the life pumping through the chambers was intoxicating.
“Touch is a therapeutic tool. It may be a handshake, a light touch on the arm, a reassuring squeeze to the top of a foot as I pass the end of their bed.”
Over time, with training, I learned to distinguish the feel of diseased from healthy tissue; the hard scabrous feel of a cancer from the smooth hardness of ordinary scar tissue; the slick softness of the bowel wall from the rubbery softness of the mesentery. I do much of my surgery by feel rather than sight. Even with the laparoscope, I can feel the consistency of tissues through the long instruments, the same way a chef senses the stiffness of the egg whites through the whisk or the doneness of the steak through the tongs. This is a form of healing touch as well, but one that takes place without the patient’s direct participation.
The value of the therapeutic touch is being marginalized by the pressures of time and the diffusion of responsibility through the emphasis on team care. No one takes ultimate responsibility for the patient, and although other team members touch the patient, touch without the investment of responsibility carries no sense of caring and no therapy.
Bruce Davis, MD, is a Mesa AZ based general and trauma surgeon. He finished medical school at the University of Illinois College of Medicine in Chicago way back in the 1970’s and did his surgical residency at Bethesda Naval Hospital. After 14 years on active duty that included overseas duty with the Seabees, time on large grey boats and a tour with the Marines during the First Gulf War, he went into private practice near Phoenix. He is part of that dying breed of dinosaurs, the solo general surgeon. He also is a writer of science fiction novels. His works include the YA novel Queen Mab Courtesy, published by CWG press (and recently reissued by AKW Books as the e-book Blanktown). Also published through AKW Books are his military science fiction novel That Which Is Human and the Profit Logbook series, including Glowgems For Profit and Thieves Profit.