“Our general attitude around here is that we want to play par surgery. Par is a live patient.” Several years ago, when I was preparing to apply for trauma fellowship, someone called me a meatball surgeon. I thought it was a lame nickname that meant our job was mindlessly easy. For the first time ever, I recently Googled meatball surgery. The term "meatball surgery" was used to describe the damage control interventions performed in MASH. Yes, I am proud to say I am a meatball surgeon for our soldiers. Telling me I save lives is a compliment…not an insult. 

Meatball Surgery

     Military surgeons are frequently deployed to far forward environments to perform damage control surgery- stopping bleeding, stopping gross spillage of bowel contents, stenting vascular injuries, etc. This allows the patient to be evacuated to the next level of care. The goal is NOT definitive repair of injuries. All general surgeons deploy in this role- so maintaining trauma operative skills and the skill of "thinking like a trauma surgeon" is crucial. This is being increasingly provided between deployments with skills labs and military civilian partnerships. There is still a significant gap between recommended case volume and actual case volume.

     Recently, the suggestion to train non-surgeons to do “just a bit of damage control surgery" in the deployed environment has been proposed in several forums, including on social media. Short version: “You can’t convince me that pelvic packing, laparotomy, vascular control, thoracotomies are difficult.” 

     Why is this a problem? As mentioned, its hard enough to train our general surgeons well-trained to perform in this environment. It would take significant changes in our current training rhythm to get Pas and non-surgeons adequately proficient to provide this skillset. It is NOT easy being a trauma surgeon. A lot of surgery residents are familiar with the oft repeated quote, "you can teach a monkey to operate". It's not meant to insult trainees and compare them to monkeys. It's meant to explain that the difficult skill of being a surgeon is the judgment to decide who needs surgery, what surgery is needed and how to anticipate the next step. There are many algorithms in surgery. They are excellent guides to optimal patient care. But they all have the same caveat (although some might not state it as explicitly)- they are not to be used in isolation, but instead in the setting of sound clinical judgment. To gain this expertise, surgeons endure 4 years of undergraduate education, 4 years in medical school, 5-7 years of surgical residency, and 1-2 years of fellowship. And even after I spent all this time training, I’m still not done learning this art. If you say these are "not difficult” procedures, I encourage you to complete a general surgery followed by a trauma fellowship. The military actually does need more trained trauma surgeons. 

     But no, I’m not interested in training a non-surgeon to do “just a little bit” of trauma surgery. I can't imagine any trauma surgeon who would be willing to teach a watered down version of our skill to a non-surgeon and sign off that they’re qualified to care for our soldiers. Please don't insult our expertise. I would never presume to be an expert in another persons specialty. This would be similar to suggesting that I can be easily trained to be special forces. Anyone can be taught to shoot a weapon, evade the enemy, decide the best tactical approach, etc. You may say that’s an exaggeration. But it’s the absolute truth. 

A field surgeon is NOT a surgeon. 

A brigade surgeon is NOT a surgeon. 

A flight surgeon is NOT a surgeon. 

A division surgeon is NOT a surgeon.     

A battalion surgeon is NOT a surgeon.      

The Surgeon General is NOT a surgeon.