Tuesday, 19 December 2017

A prank too far

How would you react to finding out that your surgeon had carved their initials on your liver while they were operating? Would you be horrified or would you just shrug it off as a childish prank?

I pondered my own possible reaction when I read about Simon Bramhall, who autographed the livers of two liver transplant patients. Nobody reported it at the time, and he might have got away with it, except that another surgeon doing a follow-up procedure noticed the initials and duly reported it.

He has just been found guilty of "assault by beating" and will shortly be sentenced.

My first reaction was to dismiss it as a rather trivial incident that did no harm to the patients. In fact one former patient, Tracy Scriven, said "Is it really that bad? I wouldn't have cared if he did it to me. The man saved my life."

But then I thought, no, if my surgeon had done that to my liver, I wouldn't have the same trust and confidence in them. I would feel they hadn't taken my operation seriously but were fooling around. And it wouldn't just damage their reputation but the reputation of other surgeons.

And yes, he saved a patient's life, and of course the patient is grateful, but that still doesn't justify what he did.

It's one thing to carve your initials and a romantic message on a tree trunk. It's quite another to carve your initials on someone else's liver while they're under general anaesthetic and oblivious to whatever you're doing inside their body. It's not just taking advantage of an unconscious person, it's a total lack of respect for them.

Hopefully there aren't any initials on what's left of my prostate....

NB: Assault by beating doesn't literally mean beating. It refers to the use of unlawful force on another person

45 comments:

Mike Goad said...

Actually, carving anything into a tree can be fatal to the tree, depending on the species. That tree looks like an aspen, which are very susceptible to diseases when their bark is damage. In Colorado, defacement is one of several causes that has led to the death of more than half of lower elevation aspens.

The only way that a surgeon should do anything other than the necessary surgical procedures is if he has the patients permission, unless something happens during the surgery that necessitates additional actions.

Nick said...

Mike: You're right, tree carvings can be harmful as well.

Yes, whatever he/she does should have the patient's permission, unless there's some medical emergency calling for something unanticipated.

Rummuser said...

I felt horrified when I read that story. What a sick mind the surgeon's mind must be to do something like that,

Ursula said...

May everyone hold their horses of outrage.

First of all, that liver wasn't the patient's in the first place. Secondly, anyone who saves a life, improves health, is welcome to "sign". After all, it's what artists do. What harm was actually done? None. Bloody hell, if Christiaan Barnard (remember him? I had a god almighty crush on him) had carved CB onto the world's first successfully transplanted heart who are we to complain?

U

Dave Martin said...

This is a tough one. Surgeons have my utmost respect, but this guy clearly crossed a line.
He did a stupid and morally questionable thing, but nobody died so should his career be destroyed?
At the same time, my faith in someone in a position of trust who would do such an irresponsible thing would be very much in doubt.

Nick said...

Ramana: Not so much sick as just showing-off to the rest of the operating team.

Ursula: I disagree. He may save lives but he was fooling around with someone's innards while they were unconscious and ignorant of what he was doing. It was totally unethical.

Nick said...

Dave: Sure, nobody died and a life was saved. But it was still utterly self-indulgent. I don't think his career is in ruins. The article says that although the GMC gave him a formal warning, they haven't stopped him practising medicine.

Joanne Noragon said...

Carving on a tree is outrageous. The tree has to spend time and effort growing new capillaries around the damage, and making other repairs. Not murder, but serious harm. All I have to say about liver carving is not fit to print; the carver is reprehensible and should forfeit the ability to carve.

tammy j said...

total agreement with Joanne.
there is no reason other than to make the person or persons feel special.
well... feel special somewhere else where you don't have to do any damage. how OLD is this surgeon? that seems like a childish prank.
it's just silly and useless in both cases. actually in the tree's case it can cause it to die. a stupid loss if so.

Bijoux said...

I found the story to be disturbing. And shame on the nurses or whatever OR staff that didn't report him at the time. He sounds like he has an ego the size of Trump. It's just sick.

nick said...

Joanne: I agree, except that I think he should be allowed to keep his job, seeing as the NHS is desperately short of qualified surgeons right now and he seems to be pretty skilled.

Tammy: He's 53. Exactly, he just wanted to feel special, and never mind what the patient might have to say about it.

nick said...

Bijoux: It's very disturbing. I agree, someone in the operating team should have reported him. But there's still a culture of deference in the NHS, that you don't criticise someone higher up the heirarchy, even if they're obviously making some huge blunder. Unlike flight crew, who're encouraged to report flight deck mistakes immediately.

joared said...

I think any doctor or surgeon who did that was mentally ill, or momentarily lost his senses. There’s nothing cutesie or humorous about it in my view. I find it distressing that none of the medical personnel who would have assisted him in the operating room apparently did nothing to halt the behavior or, if unable to do so, did not immediately report him afterward. Some action should have been taken against them, too.

nick said...

Joared: Indeed, he momentarily lost his senses. He simply didn't realise the gravity of what he was doing. Yes, someone should have reported him, but see my reply to Bijoux just above.

Ursula said...

May I pipe up once more in support of my earlier comment?

Two quotes from the same article:

"The renowned liver, spleen and pancreas surgeon used an argon beam, used to stop livers bleeding during operations and to highlight an area due to be worked on, to sign his initials into the patients’ organs. The marks left by argon are not thought to impair the organ’s function and usually disappear by themselves."

"Following reports of Bramhall’s suspension, his former patient Tracy Scriven told the Birmingham Mail that the surgeon should be immediately reinstated. “Even if he did put his initials on a transplanted liver, is it really that bad? I wouldn’t have cared if he did it to me. The man saved my life,” she said."

You and some of your other readers mention "ego". What ego? It's hardly as if anyone will see this surgeon's handiwork once the liver is safely enclosed in the body's cavity. I rather have my liver tattooed than walk around in an expensive T-shirt with the designer's name emblazened on it (that's "ego" - the designer's).

I do understand that what he did is, ethically, not palatable for some; I also think the reaction is totally out of proportion to the "crime". You know what I find not exactly disturbing but sure tasteless, yet understandable? The way surgical teams will make "in-jokes" whilst the patient is unconscious. It's a way of letting off steam. In the name of compassion, we need to give these guys who work under extreme pressure and high tension a break and not be prissy and precious about irrelevancies.

U

Ms Scarlet said...

I think the word 'carve' is inflammatory when used in conjunction with liver.... it makes me think of someone going to town on the Sunday roast with a big ol' carving knife. I would like to know how the surgeon 'carved' his signature on the liver. I'm guessing it's a more delicate procedure than what immediately springs to mind.
Sx

Ms Scarlet said...

Okay... have just read Ursula's information regarding the argon beam!! Should have read this first :-)
Sx

nick said...

Ursula: I agree that a designer t shirt is egotistical, but it's the wrong word for a monogram hidden in someone's body (I don't think I actually used the word ego). But there's a difference between swapping medical in-jokes, which have no physical element, and carving your initials on someone's liver, which is fooling around with a physical organ. Of course surgeons work under extreme pressure and stress, but not all "safety valves" can be seen as legitimate.

nick said...

Scarlet: I think carve is the right word, as it simply means cutting into a hard material. Though it does conjure up unfortunate images of the Sunday roast, as you say.

Ms Scarlet said...

The word 'wrote' could have also have been used! 'He wrote with an argon beam' is far less inflammatory. Or 'etched'. The media used the word 'carve' to inflame interest in the story... no livers were inflamed by the surgeon :-)
Sx

Ms Scarlet said...

Are livers hard then?
Sx

nick said...

Scarlet: I agree, "carve" is a bit inflammatory. I also agree, livers aren't hard. That's a thumbs down for carve, then....

CheerfulMonk said...

He admits it was wrong, and apparently at least one patient thinks he should be reinstated, so maybe a sincere apology and let patients decide if they trust him?

nick said...

Jean: Given that he's a very skilled surgeon, it would be crazy to stop him practising because of one stupid prank. The article does say that although the GMC issued a formal warning, they haven't banned him from surgery.

Wisewebwoman said...

I've seen this on the news. My first reaction was the old adage "how he does one thing is how he does all things" and I wonder what/who else he abuses. I'd call it abuse.

XO
WWW

Linda Sand said...

To me it shows poor judgement. I would not want a surgeon with poor judgement operating on me.

nick said...

www: You do have to ask that. In my eyes it inevitably damages his reputation as a surgeon.

Linda: Well, poor judgment when it comes to a surgical "prank" maybe, but not necessarily poor judgment over the surgery itself.

kylie said...

There are many, many women who suffer birth trauma because midwives or doctors don't give the patient their rightful bodily autonomy. There are many interventions that are done to birthing people without their consent and it causes problems in a range from annoyance to major trauma.
Obviously an unseen marking on a liver is different in scale and repercussions than say, an episiotomy without consent but they come from the same place which is a surgeons disrespect for the patient and inappropriate sense of entitlement. It is very definitely abuse.

For those who are saying a surgeon is within rights to do a procedure without consent when information comes to light during surgery, it is not ok. Every procedure on every patient should have full and informed consent.

having said all of that, I think it would be a loss to the NHS or any other medical system to deregister this doctor but there should be significamt counselling and maybe a fine.

nick said...

Kylie: That's my main objection, that he was showing disrespect to the patient. Yes, ideally the patient should have consented to everything the surgeon is planning, but I guess if there's some medical emergency during the operation and something unplanned is necessary to put things right, then the surgeon has to go ahead anyway. You can hardly let the patient die for lack of consent.

Anonymous said...

Your use of the plural "their" in place of "his/her" detracts from your message. You did not listen in 6th grade. From The Grammar Nazi. (Now tear apart my comment, but I'll continue to watch your grammar.

Nick said...

His/her is cumbersome. Their is more succinct and is widely understood to mean his or her. From the Grammar Pragmatist. Happy Christmas!

Polly said...

This is a tough one to answer, especially for a Libran like me.
Surgeons have ENORMOUS egos, they are second only to God, they save lives, and I would be eternally grateful to the man if he saved my life, and if my liver was intact and functioning it wouldn’t really matter if his initials were on it. But it is the respect thing, he showed a complete lack of it, the patient is just another notch on his scalpel.

Polly said...

PS Merry Christmas.

nick said...

Polly: This it, he probably did a brilliant bit of surgery, but the initialising implies a total disrespect for the patient.

Merry Christmas to you too.

Secret Agent Woman said...

I think this clearly violates the "first, do no harm" portion of the Hippocratic Oath.

nick said...

Agent: But presumably he would argue that there was no real harm, just a slightly defaced liver - and that the initials would eventually disappear.

Secret Agent Woman said...

I don't know, Nick - I talked with my son's neurosurgeon once and he said very strongly that you don't ever do anything that removes or scars tissue unnecessarily. This is clear malpractice - what the guy did was strictly in the service of narcissism.

nick said...

Agent: Okay, I defer to the neurosurgeon's opinion! As another comment pointed out, though, it wasn't really narcissism as his handiwork wouldn't be visible to anyone else. It was more a bit of reckless self-indulgence.

helen devries said...

I would have his balls for cufflinks. No respect for the patient...the professional equivalent of graffiti.

nick said...

Helen: Those are roughly my own thoughts as well. And I still think it's appalling that none of the operating team felt able to report him for fear of the consequences.

Jenny Woolf said...

It's unacceptable, because that is his job. If you work in a cafe you don't carve your initials on the tables, if you work in a library you don't scribble your name on the books. the patient's liver didn't belong to him and he had a job to do. And it does show contempt.

nick said...

Jenny: The analogy with other people's jobs is a good one. What this surgeon did is a similar act of vandalism. And the vandalism of a grown adult who should well understand why it isn't acceptable.

Polly said...

Hi Nick, I've just seen on the BBC news that he has been fined £10,000.

Polly said...

PS and sentenced to a 12 month community order.

nick said...

Polly: Yes, that seems like an appropriate penalty to me. He won't be vandalising anyone else's liver in a hurry.