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Artist’s Statement: Surgical Anatomy

Ibrahim, Andrew M. MD

doi: 10.1097/ACM.0b013e31825ea4fa
Cover Art

Dr. Ibrahim is a member of the General Surgery Housestaff, University Hospitals of Cleveland, Cleveland, Ohio; e-mail: andrew.ibrahim@case.edu.

Most surgeons can vividly recall a moment, often in an operating room, that inspired them to enter the profession. Such experiences frequently involve a fascination with human anatomy and an ambition to harness a certain confidence and skill to invade and manipulate the body to make it better.

The painting Surgical Anatomy was inspired by my own vivid memory of the moment that brought me to surgery. As a medical student, I first saw the patient in grayscale, a CT scan of his abdomen declaring a swollen, motionless colon we would have to remove to save his life. Before ever meeting the patient, I stood at a metal sink sterilizing my hands with brown disinfectant up to the elbows. As the fourth pair of gloved hands around the operating table, I was initiated into surgical tradition by completing the “Kelly-Kelly, Metz, tie-tie, Mayo” sequence. The seamless and deliberate rhythm in which we operated mimicked what we hoped to achieve for this patient’s intestines. As the case progressed, all of our hands moved in concert ahead of verbal commands until the final stitch. Within just hours the patient had been transformed from septic toward vibrant, and my commitment to become a surgeon had crystallized.

The next day I went to see the patient and explain his new anatomy—the parts we removed and how the new ends connected. After my short explanation, aided by napkin-sized sketches, I offered to answer any questions. Sitting at the patient’s bedside, ungloved hands folded, I saw him willingly reveal a picture of himself more vivid than anything I saw on the CT scan or the operating table. He traced strokes of his life that were not yet complete: caring for his wife who had recently been given a cancer diagnosis; supporting his daughter through the final stages of wedding planning; editing a collection of his writings. He knew his anatomy after this operation wouldn’t be perfect, but he was thankful that he now had more time for a different kind of anatomy—to prioritize, plan, and place in order different parts of his life to realize a vision of himself. Seeking out this bedside anatomy, often expressed on the faces of our patients and seen best at eye level, helps us humanize and give context to the privilege of operating we spend years perfecting.

The anatomy that brought me to surgery was on the table within the frame of green towels and blue drapes, but the anatomy that sustains and drives me is at the bedside where the narrative is more visceral than any organ we touch in the operating room.

© 2012 Association of American Medical Colleges