Dominique Jean Larrey, the chief surgeon for Napoleon’s army, is regarded as the father of modern military surgery. His was a remarkable career. Observing how many injured soldiers lay on the battlefield, he created small carriages that could swiftly pick up the injured and transport them back to the rear: the first ambulances. He advocated for early amputation of severely injured limbs when standard practice was to allow them to fester because of the mistaken belief that infection and pus were the initial stages of healing. He was a skilled surgeon who performed major amputations with an astounding survival rate of over 50 percent.
Larrey’s greatest legacy, however, was his indifference to whom he was treating. General or private, friend or enemy: all received his utmost efforts. During the Battle of Waterloo, the Duke of Wellington surveyed the battlefield and noticed a French medical officer treating the wounded. Informed that this was Larrey, Wellington ordered his troops to fire away from where the doctor was working. Such was the respect accorded him, even by his enemies. Napoleon called Larrey “the most virtuous man I have ever known.”
I’ve been a plastic surgeon in Lake County, Florida, for 35 years. I worked as a resident in the general surgery program at the U.S. naval hospital in Oakland, California. When we were notified that emergency medical services were bringing in trauma victims, we would mobilize to receive them. The injured could be members of a family in a terrible automobile accident or the drunk driver who hit them. It could be a policeman shot at a routine traffic stop or a criminal shot while resisting arrest. None of this mattered. The victims’ race, ethnicity, sex, religion, and station in life were irrelevant. All patients received our utmost efforts.
To a surgeon, every patient is a human being with a need that we are uniquely equipped to meet. I have always felt pride knowing that, in a world full of strife, violence, prejudice, and suffering, a surgeon’s job is to provide excellent medical care and to do it calmly, dispassionately, and competently.
Two things bind all surgeons, whether in treating trauma victims or performing elective surgery. One is the oath that we take. Medicine is one of the few professions in which initiates are bound by a sacred pledge. The Hippocratic Oath and its less commonly used alternative, the Oath of Maimonides, read like anachronisms with their promise to the Greek god Apollo and reference to antiquated practices. They are, however, timeless in their command to honor those who taught us our craft, to teach this to our students, and to do our best for every patient while avoiding willful harm or injury. Both oaths are encapsulated in the dictum Primum, non nocere, which means “First, do no harm.” This charge infuses all medical practice.
The second thing that binds us is the legacy of our predecessors, such as Larrey. The commitment to treat all equally raises medicine from a simple occupation, or even a vocation, to a sacred calling.
When the leaders of the American College of Surgeons, often referred to by its members as the “House of Surgery,” tell us—without evidence—that the ACS is structurally racist, that we surgeons ourselves are irredeemably racist, and that our racism is to blame for disparities in the outcomes of surgery between different racial groups, they lose legitimacy and cease to represent us. When they install diversity departments, embrace ideology such as antiracism, and create training mandates that promote the message of systemic racism, they abandon their mission to promote excellence in surgery and become yet another radical group pushing an illiberal ideology of racial intolerance, group identity, and victimization. One sure sign this has happened is that the ACS leadership shuts down debate by silencing members who voice concerns about the organization’s embrace of ideology over excellence.
It is up to those of us who still hold to the traditional role of the physician and surgeon to push back. Larrey surely would have done so. His example is enough to instruct us in how to proceed.
Photo: Moonik, CC BY-SA 3.0, via Wikimedia Commons
