Surgeon The importance of sang-froid

Life is short, and the Art long
Aphorism, Hippocrates

Next year will mark the two hundredth anniversary of surgery as a medical profession. You're probably thinking: two hundred years is not a long time for such a venerable profession. For most of its history, surgery has been considered a manual skill. The Greek root of the word for surgery, cheiro, means simply `to cut off'. Until the late eighteenth century, surgeons were grouped with crafts who demonstrated a kindred dexterity with sharp instruments. In the 1750s, the premier surgeon of France served as chief of barbers and wigmakers. Can you imagine making an appointment with a surgeon for advice on hair style?

The professionalisation of surgery has come at a cost. Those very craft skills which once distinguished the dextrous surgeon have now been overshadowed technical innovations: technology has standardised theatre procedures to the point where a capacity to operate can be taken for granted -- it's knowing which operation to perform that becomes critical.

The almost daily impact of technological change in surgery was presented to me when I visited the anaesthetics unit of the Austin Hospital to research this article. With evangelical enthusiasm, a man in shorts came dancing into the office shouting `It's the end of long surgery'. Were hospitals trying to be more efficient by prohibiting time-consuming operations? No, he'd just returned from a conference in Portland which set up yet another revolution in medical technology to reduce the opportunity for physical contact between surgeon and the patient's body. `Minimally invasive' procedures like endoscopies make the surgeon less of a carpenter and more of a technician.

Why then, did the Austin hospital commission two glass panels for the office of its coronary unit? What's heart surgery got to gain from an association with someone who works not in dense, wet living tissue, but in sterile, brittle, transparent rock?

On being a glass ...?

It's difficult to give a label for David Wright's particular techne. The usual term `stained glass artist' fails to measure the breadth of a practice which includes painting and shaping glass. It's unfortunate that the word `glazier' extends only to those who offer a same-day service. Vitrier? Hyalographer? Let's just call Wright a `glass worker' as an uncommitted term within which his techne might define itself.

Wright traces the origins of his career back to a school production of `The Man of All Seasons'. It was his task to paint mock stained glass on the stage backdrops. Having successfully imitated the form, Wright then wondered how the real thing might be produced -- a curiosity encouraged by his art teacher, Ronald Millar. Where does someone go in Australia to learn how to make stained glass? The usual answer is Europe, particularly to those sorrowful countries in the east like Poland. This is one of the several unusual turns in Wright's history in glass -- a turn that is not a turn at all. Rather than travelling afar, Wright simply went to a local glass merchant and asked him how to make stained glass.

Wright's formal training is not in stained glass, but in architecture. Learning how to use glass outside an academy has given Wright's work a unique style. Unlike many others making stained glass, Wright had no prior conceptions of the limits of technique, and so has found ways of cutting shapes that have previously been thought impossible. At the same time, Wright feels free to draw inspiration from the colours of the Australian outback, rather than be restricted to European tones.

So how does a glass worker trained in architecture find himself in an operating theatre? Wright claims to be interested in how technology affects our sense of `where the self begins and ends'. Before receiving the Austin commission, Wright had already exhibited work inspired by birth technology. The purpose of his work, according to Wright, is to provide a symbolic order which makes sense of new technologies. This is a problem that has parallels in his own medium: specifically the difficulty of fusing different qualities of glass.

In carrying out his commission, Wright found it important to understand closely the experience of being a surgeon. Wright described being `filled with wonderment at the incredible cleverness of technology'. The heart surgeon behind Wright's commission, Ian Nixon, kept a video camera on his head to capture any images that might be useful. But it wasn't all techno-serious. Wright was struck by the relaxed nature of the surgical team and found them discussing a recent BBQ while in the middle of a heart operation.

What resulted from this experience are two glass panels in the office of the coronary unit. The panels are structured almost like Venn diagrams: the leading is carefully arranged to give the sense of overlapping shapes, thus giving depth to what is normally a two-dimensional medium. This interconnectedness is reinforced with a liquid texture of bubbles and streams that surround the foetus-like patient. The panels draw on one of the sensual mysteries of glass -- how something that seems so definitely shaped can emerge from a molten form. Wright's work might be compared to other almost alchemic attempts to fuse glass with organic form, such at the Harvard Museum of Glass Flowers or, closer to home, Graham Stone's hyalonemic forms. The success of Wright's commission is demonstrated in the request soon after from anaesthetists for a work in their unit.

Wright's commission reveals a creative response to the mysteries involved in heart surgery. The question remains, however, why Wright's work sits in a hospital and not in a church or an art gallery.

On being a heart surgeon

Ian Nixon finished his surgical training at John Hopkins University in 1986. Prior to graduation, his achievements included restoring a vintage car and building a boat. Rather than carpentry, however, Nixon chose surgery because he wanted `to do something worthwhile'. The skills pertinent to surgery for Nixon include accuracy and alertness to situations of risk. The ability to conceptualise in three-dimensional space comes in quite handy when developing surgical manoeuvres, but there's a great difference between working on an inert material and tinkering with a delicate human body. The reward of surgery, according to Nixon, is the `indescribable feeling of good work: it raises the hair at the back of neck'. This is the `soul' of surgery: `it's a gift you give to someone'. Nixon presents himself to me as someone who incorporates surgery into his ethos and as a result is sensitive to the implications of tinkering with another person's body.

When I prompted Nixon for the reasons behind the Wright commission, I first got a plain account of the deal struck with a company called Meditronics who supply medical technologies, including their most famous product, the pacemaker. According to Nixon, the whole deal took ten minutes to organise over the telephone -- `It just had to happen'. Nixon had purchased a glass table from Wright back in 1976 and thought stained glass panels in the office would give the unit `something extra'.

I decided that the direct line of questioning was not the best way of discovering the secret of this commission. Instead, I asked Nixon if he ever thought of what he did as a `craft'. What was interesting about Nixon's reply was not so much the parallels between the manual skills required by a surgeon and those which characterise the crafts, but the very difference which marks his material: unlike the substance of traditional crafts, humans are alive.

Given the urgency often associated with their intervention, a heart surgeon tends to establish close relationships with patients. One of the disciplines of the theatre is to put that relationship at a distance. According to Nixon, it can be terribly confusing to be thinking about your last conversation with someone whose heart you have in your hands.

The complexity of operation adds to this stress. Nixon told the story of a recent operation for the removal of a heart tumour. Once extracted, this tumour left a sizeable hole between two chambers. A rough job at this point would have decreased the pressure required to pump blood. The solution demanded an internal visualisation of the problem in three dimensions. Nixon solved this with a deft use of the sac in which the heart is contained. This kind of operation rewards the surgeon with a kind of practical enjoyment.

A life and death struggle is transformed into a stimulating manual puzzle -- the steady calm of the workshop acts to temper the urgency of the operating theatre. According to Nixon, the craft model is not only important for the composure of the surgeon. It helps put the patient at ease as well. One common technique of calming an anxious pre-operative patient is to describe the forthcoming operation as `just a bit of plumbing'. Nixon says to his patients: `just think of me as a plumber'.

In cold blood

In 1743, the renowned medical educationalist Dr Laurent Ferret was lecturing in the Paris Faculty of Medicine. The principle of surgical training for Ferret was `Fabricando fabri fimus' (the worker is formed by working). He recommended that training commence with anatomical skills from 12 years old. The purpose was `to acquire the sang froid needed for his craft.' The history of medicine that followed entailed a repression of this craft component in favour of the more noble and abstract ideals of knowledge. But there comes a point, when the surgeon has the life of another person in his or her hands, that a little craft attitude seems important.

In interior design, something like sang-froid can be engineered with the introduction of aquariums: the aimless movement of fish, the deep watery colours, and the occasional bubble surfacing. In David Wright's glass panels, the Austin Hospital has acquired a work that offers consolation not only at a sensual but at a symbolic level -- a place where the discrete techne of the world intermingle in a burbling combination: architecture, woodworking, glassmaking, coronary surgery, plumbing. Different lives, but similar commitments.


Nixon now takes some pleasure applying his newly acquired knowledge of lead-lighting to the restoration of his Federation House. And David Wright sits in his studio contemplating his latest commission: a glass panel for Cabrini Hospital, a service of the order of the Sacred Heart.

This article was originally published in Craft Victoria, Dec 1993 (23.222): 7-9.

Kevin Murray©1995