SEEING IS BELIEVING

It is a common and traditional practice for a surgeon to display a removed organ after his efforts.

The patient’s relatives go goggle-eyed as the surgeon describes graphically how difficult the operation was, how risky, and how brilliantly he managed the situation to save the patient.
The bigger the tumor, the better. If, however, a removed gall bladder has only one or two small stones, the surgeon is looked at ( “Oh, is that all? My mother, who was operated by Dr. Enviable, had two hundred and eighty stones”) with raised brows and curled lips, as if the surgeon was at fault for not having produced stones of adequate dimensions. The size problem always crops up to haunt men. The specimen removed at operation is, clearly, of great importance to people.

I have been perplexed in the past, when I was environmentally colored greener, by certain instances of human behavior (in this regard). Once, after doing a circumcision, I went to the parents to reassure them that all was well. The mother insisted on seeing the specimen (the foreskin). We had to scavenge the trash buckets to retrieve the small piece of skin. It seemed that unless I showed them the specimen, I would be clearly identified as a cheat who was charging for nothing, under the pretext of doing a surgery.

After hernia surgeries, people are very disappointed when I come out without any grotesque piece of flesh in hand. So, nowadays, I carry a packet of the mesh that is implanted in one hand and the bill for my services in the other.

When it comes to private parts, you will be amazed to know of peoples’ attitudes. If you asked a man to display his wife’s breasts to his relatives and friends, he would probably assault you. But that same man (in the company of six other people) may well ask to see the specimen of a mastectomy done for his wife’s breast cancer.

Today, I was operating at a hospital where the operation is normally shown live at the reception, where the relatives of the patient watch the proceedings. This patient’s husband was very eager to watch the operation live. The operation was a laparoscopic hysterectomy. As I was, from inside the abdomen, incising the vagina with my instruments (just prior to removing the uterus), I thought that this, most private, part of a woman’s anatomy was being displayed in public, though from the inside. No skin was visible, but the inside of the vagina was what was on sight.

Is a private part private only if seen from the outside? Or is it important only when the viewer realises what is being seen? The relatives, after the operation, wanted the specimen to be displayed, not realising that they wanted to see the innards of a woman, which they would never dare to otherwise.

Is there something here I am missing? I don’t understand people’s notions of private parts.

30 responses to “SEEING IS BELIEVING

  1. R-Doc: What an amusing post!

    And one that reminds me of the same hypocrisy/ double standards which require, for ‘culture’ and ‘respect’ reasons (reason??), newlyweds do not hold hands in front of elders but produce a baby in 9 months. Natch. I think in their minds they are thinking immaculate conception…

  2. Amusing indeed!

    I didnt know that we have got so advanced that hospitals actually offer live telecast of operations. Isnt the fact that every move of yours is under watch disturbing/distracting to you as a surgeon?

    As for people demanding to see the removed organ, i suppose its their last chance to see what they are going to miss for the rest of their lives! You cant blame them for that πŸ˜‰
    In that light, private parts probably become even more important!

  3. You actually do your operations while they are being filmed and shown.? My ( already high level of) admiration for you has increased 5 times now. I couldn’t cut an aloo if somebody was filming it!
    I think we consider our parts private only when they are healthy and in working condition. I have noticed people are quite willing to show their scars and wounds on their thighs and waists which they would normally want to hide securely from everyone.

  4. Shefaly:
    Ha, ha! Quite right, too!!
    AD:
    “In that light, private parts probably become even more important!”
    And in that darkness, too!
    Usha:

    I think we consider our parts private only when they are healthy and in working condition.

    Bingo! I think you said it!

  5. What a wonderfully unique post! Funny too.
    Reminded me of my cousin who talked for days (boasted actually) about how big a tumor came out of his tummy and how flat his tummy was now and how he used to keep blaming himself for his protruding tummy! Everytime I met him, the tumour that came out of his tummy seemed to have got bigger! πŸ™‚
    About what is private, well I guess that’s to do with society’s mores rather than anything else.

  6. Nita:
    Thanks. I am happy you like the post. As far as your cousin is concerned, it is not dissimilar to surgeons:
    with every passing day, memory acts as a size enhancer!

  7. It is a very cultural thing. At the Olympic games in Atlanta, the sellout event was women’s water polo, to everyone’s surprise, and only those engagements where one of the European nations was competing. The reason, it seems was that in this sport, the competitors upper garments snap off. Competitors from most countries quietly swim to the side where coach tosses in a new set which is quietly slipped on under water and the competitor resumes play.

    The honorable competitors from Holland and Germany, in particular, were loath to waste even those 30 seconds and played on regardless. There were scalpers who made thousands of dollars on woman’s water polo tickets!

  8. I wonder how the patients themselves feel. The relatives may be curious to see the part that caused the surgery – “this offending piece of flesh” or maybe, at some level, feel a little voyeurism. But shouldn’t the patients’ consent be obtained by the surgeon before displaying their body parts (or ex-parts)?

    Speaking of which, there is this new trend in the US of inviting friends to watch one give birth. Sometimes, friends insist on getting such invites. Even male friends. How does one categorize that?

  9. An enjoyable read, doc. I never knew people were so adamant about malignant chunks of themselves. As for the private part thing: to take the breast example, I think that only the outside image of breasts has become “private” in many cultures, not necessarily what’s inside. True, you’re still seeing breast meat when you’re showed a masectomy specimen, but it’s not anything you’ve probably seen before. If it’s not the notion of culturally established private parts, it might be the undying curiosity of the human mind to explore the unknown that compels so many people to examine what you are ready to throw into a biohazard bin.

  10. Awesome story.! Much food for thought… It really made my day. Thank you.

  11. i would venture to say that it is perfectly ok to show em the stuff if they dont realise that it is the private parts of someone.. clothes probably only evolved from a need to keep the sexual activities of men and women at bay (i don’t think most indians needed clothes to keep warm).. which means so long as sex is not on anyone’s minds it shouldn’t matter what they are shown.. even if sex is on their minds, it shouldn’t really make a difference i suppose..

    anyway, i too have always wondered about how exactly this concept of private parts have evolved.. our closest animal relatives, chimps and bonobos are known for their furious sexual fervour.. so are clothes really effective in controlling our desires?

  12. This is very amusingly insightful
    first a tech question – is there a video filming (sounds out of the world) or is the source of the live video signal split between your view eyepiece or lcd and the monitor at the family end.
    To most people big is always beautiful be it cars tvs or tumors.

    to u …the great key hole surgeon, insides of the vagina are interesting because they are the mens to an end – while to her husband and most of the world it is the outsides that matter . Maybe its because the sight of the vagina and breasts induce sexual stimulation but not the inside of it. (Hey the penis cant speak or it would surely protest ur intrusion on its domain)

    The amazing bit is that u can reach the stomach from the vagina and remove the uterus etc but what amazes them is the process or sight of the damaged organ that comes out.

    So my dear doc πŸ™‚ beauty beholder and likes or apna apna nazariya hai !

  13. πŸ™‚ ur closing in on the 3 lakh suckers mark!

  14. shefaly
    is it hypocracy or is it the victorian mindset enduced rule to prohibit affection in front of elders? Hey the elders have gone there – done that- no wonder we have come to this world

  15. correction
    are the means to an end

  16. Points to ponder :

    1. Men and women alike, when in pain and infront of a doctor, do not bat an eyelid to drop down to their birthday suits. For women, a male OBGYN in between their legs inches away is acceptable in the US. Even in rural India where the government OBGYNs could be males and customs-traditions are at it’s most conservative best, when in front of a doc, they do shed their inhibitions.

    2. How many staunch vegetarians have you seen that complain about the contents of a medicine ? Yours sincerely being one, used to get a routine dose of codliver oil pill.

    Per an old Kannada proverb ‘Only a fool would look for the roots of a medicine or a rishi’ — meaning, if you want to be alive, concern yourself with just the good and don’t go digging. If you do, you are digging your grave…

    @Lekhni,
    I saw something worse, on TV thankfully, where the placenta was saved and served in a party to friends. Have new found respect for Andrew Zimmern and Anthony Bourdain’s tripe cuisine post that ..

  17. Naren:
    πŸ™‚
    Lekhni:
    In India, the patient’s consent to anything short of gang-rape is automatic and presumed (now, don’t get scared: jus’ kiddin’). If you asked the majority of women patients which of two possible treatment options they wanted, they would say, “Whichever my husband decides”. That said, in India, even educated and modern-thinking patients do not bother about specimen exposure and live operation telecasting. But interesting to be reminded of the consent thing here!
    Bancheese:
    Pieces of meat generally go to the pathologist, not the bin! πŸ™‚
    Chokkathangam:
    “so are clothes really effective in controlling our desires?”
    On the contrary!
    Unduk:
    Thank you, and welcome.
    Prax:
    The video feed is transmitted live by splitting the LCD image. And, the 300,000 mark has come and gone…. Readership is slowly coming down because of my infrequent blogging. Or I could be wrong, and that this is only a ‘correction’!
    Athreya:
    Patients surprise you all the time: women patients are the ones that ask you (AFTER asking the husband to push off) if it is okay to have sex….

  18. Amazing post! I can picture it happening. Large numbers of relatives waiting for the surgeon to come out of the O T. The doctor appears and announces in a filmy style- mubarak ho operation kamyaab hua. The nurse following him with a tray with a few stones or a removed organ(whatever the case). All the people gather around them and start comparing it to the size of the removed organ they had witnessed in their ‘chacha’s case. For the elders of the family it would be a topic of discussion for months. I have heard these discussions many times and as Nita said the size of the tumour keeps increasing.
    //the relatives of the patient watch the proceedings// this sort of a thing could be really helpful. Standing outside an OT can be very very difficult. When the patient’s is your own flesh and blood and his life is under threat it is difficult to imagine what goes inside the mind.
    Those few hours when you don’t know what is happening inside the operation theatre are the most difficult hours of your life. I am saying that by personal experience. Forget about the size of the removed organ the expression on the doctors face is all that matters. A satisfied look on his face and life is beautiful once again.

  19. Athreya: That is gross! Isn’t that, er..cannibalism? You’re right, I thought only Anthony Bourdain could eat the creepy-crawlies 😦

    Rambodoc: Don’t they make patients in India sign a disclaimer before the C-section, then? If they do, then why not a consent form too? But you are right, patients are taken for granted in India, and most of them don’t protest either 😦

  20. @ Lekhni:

    Placentophagy is not uncommon; in fact, it is so common it has a Wikipedia entry. And in most groups that practise eating placenta, it is the mother who eats it.

    So Bourdain is a novice to the game. Someone else, as usual, has done it for years. He just writes a book and popularises it.

  21. What I would like to know is that did the lady who was being operated knew that she would be filmed? If she did, then she must be really brave.
    And you should be really proud that you could do all that with the camera rolling. I can’t write a single line of code correctly if someone is watching me. 😐

  22. amit
    that thought came to me too
    the doc requires the key hole camera to perform the surgery – the signal is split – so he is the director and the cameraman and that should not be a problem to him but could be a problem to the patient whose unders are being how do i put it – violated and that was what the doc was pointing to.
    – doc correct me if im wrong here.

  23. Amit, Prax, Lekhni:
    This hospital has got popular with patients for JUST this reason: no one else in Kolkata does this, apparently. So, usually the consent issue is moot. But it is proper that we take due formal consent in every case.
    Prax:
    You are partly incorrect: in that I have a camera man; otherwise I am lead hero and director, producer and scriptwriter!
    Amit:
    I have actually performed live surgery in front of 2000 surgeons at a conference. The only thing I may not be able to do well is screw (up) in public…
    πŸ˜€

  24. R-Doc: Unrelated in some ways but related in others, and also a utilitarian note (reading for your trip perhaps?), please see:

    http://www.ft.com/cms/s/0/e6b91df0-5455-11dd-aa78-000077b07658.html

    I think one of these days you could trump most of these books but for now, it will be great if you could read them and review them for the benefit of civilians comme moi πŸ˜‰

  25. πŸ˜€
    especially good for the patient!

  26. Er, I insisted that the gynaecologist and the plastic surgeon who removed tumours, did the hysterectomy and cut a swathe of abdominal wall of my mother, come and show me the specimens. I wanted to see ’em. Yessir, show em to me. Why? Perhaps I wanted to see what was being taken out of her body-disfigured, putrid or whatever it might be- it was a portion of her body/flesh and I had to see what they were throwing out.
    Perhaps Usha is right. Usually we can be inarticulate or put a foot in our mouth in social gatherings, but a great conversation breaker is disease and disfigurement and we are able to discuss and debate our sores, cuts, incisions with great alacrity. Skewed?

  27. R-Doc:

    I can see the possibility of some Rin-ad type social conversations… “Bhala uska tumour mere tumour se bada kaise?”.

    Yes, I know, it is rude but the more people insist on this, the more I am certain this is the driving factor πŸ˜‰

  28. Maami, Shefaly:
    Sorry for not replying earlier. I really don’t know if people discuss such things as part of a party chat. One would have thought it would have put them off the food, but who knows?

  29. R-Doc:

    It depends on their quease factor. I have doctor friends – as well as some non-medics – who do not get queased out so our dinner discussions are fairly vile… πŸ™‚

  30. Visiting after a really long time, and completely convinced that I should keep visiting more often.

    The only part of me I would ever like to see after it is removed from me is my child. Other parts are most welcome to go into the bio-hazard bin, out of my eye shot.

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