Thursday, October 14, 2010

In the Theater of Learning - A Socratic Dialogue in Medical Education

My good friend, Anthony Carnicelli, has recently embarked on the long journey that will lead from medical school to earning an M.D. Tony, whom I met several baseball seasons ago at a game at Fenway Park, is a true Renaissance Man. How many people have you encountered who are medical students whose undergraduate degree is from Berklee College of Music?

Tony recently shared with me a fascinating and enlightening dialogue that he had via e-mail with one of his professors at the University of Rochester School of Medicine. With the permission of Tony and Dr. Caldwell, allow me to invite you into the operating suite of their interdisciplinary conversation.

The exchange begins with Anthony’s “Thank You” note to Dr. Caldwell:

Hi Dr Caldwell,

I’d like to take a moment to thank you again for generously volunteering your time to show me around the
Highland Hospital OR today. I can tell you that this was a most enjoyable and informative experience. As we discussed earlier, my goals for today were to explore the different surgical subspecialties, learn what it is like to come to work daily as a surgeon, and learn about the process of deciding to pursue a career in surgery. I feel as though I was able to gather a solid introductory knowledge of these concepts and I am excited to learn more about surgery in the future.

Probably the thing that struck me the most about today was the high level of precision and efficiency with which the surgeons at
Highland Hospital worked. As you now know I often equate things in life to music. The musical correlation that first came to my mind while watching the laparoscopic hernia repair was that of an orchestral composer choosing notes in his orchestral voicings. Each piece of music is different in its own way, so not just any note will suffice just as not just any incision, surgical instrument, or procedural guideline will suffice. Maybe that which makes a fine surgeon is also that which makes a fine composer? Either way, my time with you today has given me much food for thought.

Thank you again and I look forward to working with you again in the future.



Dr. Caldwell’s thoughtful response follows:

Dear Anthony,

Thank you very much for your kind note. I am pleased to learn that the experience met your goals for the day. It was a wonderful experience for me as well - you demonstrated uncommon observational skills and the ability to ask penetrating, interesting (and, at times, unanswerable questions!). I was intrigued by your analysis of repetitions in music - the need for familiarity/connection (I had never thought of it this way).

And no one in my many years of teaching has likened an operation to orchestral voicings. I think that is an insightful analogy, but I would also point out that the surgeon often deals with the unexpected, the unknown anatomical terrain (as we saw today in the redo gastric bypass) and thus has to improvise. He was treading where there was no script, no immutable notes to follow.

Most incisive of all was your question as to what makes for the "great" surgeon. I hope I gave a halfway decent answer to a question never before asked of me by a medical student! I should add that those who cannot "slice" (I love that verb!) correctly, who do not have good results as measured by the weekly reviews of outcomes, will soon lose their operating privileges in that hospital. The more I think about it I believe it is fair to say that all the surgeons you saw/met today are competent surgeons. It is true that the outstanding surgeons in academia are those who are innovative or, at the least, deal with the most complicated cases successfully - something the average surgeon could not typically accomplish. What distinguishes most others as being "good" surgeons is their ability to communicate - their ability to listen, to be responsive to the individual patient's needs, to be empathetic.

So, as the experience today has given you much food for thought, so too have you given me a new perspective on surgery and its connection to the world of music.

I look forward to more time together, so please do keep in touch.

With kindest regards,

Dr. C.

P.S. Did you know that the operating room is often referred to as the "theatre"? This stems from the fact that in medieval times anatomical dissections and operations were performed before a gallery of students in a "theatre" (steep banks of benches overlooking the dissector, the surgeon - the "performer").

These thoughts and sentiments truly resonated with me, since they echo many of the interdisciplinary themes I often address in The White Rhino Report, and that have made up the subject matter of The White Rhino Intersection and Intersection 2.0. So, I wanted to explore if it might be possible to share this unique interchange with my readers. Here is Anthony’s gracious request for permission to share publicly what had begun as a private conversation:

Dr Caldwell,

Thank you for this email and for your insight. Earlier today I was actually sharing your thoughts with a very close friend of mine who writes Internet articles about cross-disciplinary integration, often in the realm of humanities and sciences. His name is Dr Alan Chase. He was very intrigued and is wondering if he could use some of the information from your email to write a piece about
“The Operating Room Theatre.” Would you be opposed to him writing about this? Please feel free to tell me if you are. Thanks again



And here is Dr. Caldwell’s equally gracious reply:

Dear Anthony,

I am flattered that Dr. Chase would want to write something about the "theatre". Of course, he should feel free.

I checked out his blog and profile and found that he is indeed a Renaissance man. He must be delightful to talk with.

I was very interested to learn that he attended
Governor Dummer Academy from which my father graduated before attending MIT. I remember so well my father talking about the academy and thinking what a really dumb name for a school.

In checking out his blog I was further interested to see his review of Bill Bryson's latest book. Have you read any of his books? I started "A Short History of Just About Everything," but found the going a bit heavy. However, before our trip to
Australia I read "In a Sunburned Country". Without a doubt it is one of the funniest "travel" books I have ever read (and informative). His description of the rather "tedious" (my word) game of cricket is hysterical.

I am enjoying our conversations Anthony.

With warm regards,
Dr. C.


A final note of thank from Anthony to Dr. Caldwell:

Dr Caldwell,

I will most certainly pass on your permission to my friend Dr Chase. You are absolutely right about his being a renaissance man. I am very lucky to have Al as one of my dearest friends, we have shared much over the years and he has taught me a great deal about life.

Actually I have not yet had the chance to read any of Bill Bryson’s work, but I’ll now be adding him to my growing post-HSF reading list. Please don’t trouble yourselves too much in searching for goggles. I do appreciate the effort very much, but if need be I have no problem with taking frequent trips outside the lab for a brief formaldehyde reprieve.

Have a nice night and I look forward to seeing you again soon.


If it is in the mode of this kind of a free-wheeling Socratic dialogue that the next generation of physicians are being trained, the future of medicine looks bright. Clearly, Dr. Caldwell and the future Dr. Carnicelli and their ilk bring a dual commitment to mastering the technical aspects of medicine and surgery and the intangible skills and world view that allow them to view the patients as a whole human being – more than a fascinating collection of organs, systems and symptoms.

I forgive Dr. Caldwell his remark about the name of my alma mater Governor Dummer Academy. The Board of Trustees must have agreed with him, because that venerable institution has been re-christened “The Governor’s Academy.”

A hearty thank you to Dr. Caldwell and Anthony Carnicelli for graciously inviting us to overhear their conversation in the “Theater of Learning.”



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