The holy trinity

   I have not just watched the surgeons work but the scrub nurse and the anaesthetist too. This is how it seems to me to work.
   The theatre nurse is at the feet. They act as a gyroscope for all needs external.Tools and people are kept in balance by a constant shifting of focus and awareness of what will be required.Whilst training a scrub nurse I heard the head theatre nurse explain to her how she must give the surgeon options of tools that he is about to need but not require him to answer questions,
''just hand him things, he's sensitive, don't mess with his head.''

The surgeon is in the middle. The bio-mechanic who uses a vast knowledge of consequences.They must see the wood for the trees.The mental toolbox is vast and the decisions are theirs to make.
Voltaire said ''perfection is the enemy of good'' and many surgeons understand why this is true.

The anaesthetist is at the head. They act as a gyroscope for all things unseen; chemical, emotional and even your sanity. Their regard for their patient is the same as the nurses and surgeons but their skill is to think for the unconscious.They have a ''sixth sense for where that space may be''.
 (Helgi Johansson)

The procedure with no name

   Can you tell what is going on in this picture? A hybrid procedure with two interventions perhaps. What happens when you have to keep going back to work because it doesn't fit? For me with textiles it is my least favourite thing to do.Every time you unpick work you risk making the joins or seams more fragile. Excess is always cut away from corners or areas where there may be bulk so if you have to undo a seam you now have hardly anything to work with. However the result has to look as if nothing happened.
    If you are having to mend something where the fabric is older and less likely to hold the stitches do you patch or darn? Do you replace a section or mount the worn area onto a new unseen support fabric? Will the weakened area just tear away anyway? Is there just too much stress at that point and any fix is only a temporary fix.
   In surgery hybrid procedures have all of these challenges both with ageing materials and the uncertainty of what you will actually find when you get in there. Unpicking another persons work is a strange business. You can often find yourself wondering why they 'did that' but alterations are curious things requiring pragmatic thinking and creative problem solving. These are found both in art and surgery.

Pleats

 
   Nobody wants a pleat in their anastomosis but when joining one tiny tube to another it is difficult to assess the fit .The most common problem is simply that the harvested vein is wider than the artery it will join.
  When making clothes the attaching of the sleeve to the body section is a big anastomosis .The problem of mismatched sizing is on a bigger scale. This is usually deliberate e.g. when you want 'ease' over the shoulder blade in a man's suit, the fibres of the material can be compressed in that area to add volume without pleating.
    A problem to avoid though is when the sleeve fabric gets pushed around the armhole during attachment so that you end up with a pleat at the point where you started. Some fabrics stretch more than others and the effect is rather like the dragging on the handrail of an escalator which is moving at a slightly different speed. To prevent this you use marker points called notches. These quarter mark the armhole with corresponding marks on the sleeve so spreading out any excess evenly. Best practise is to tack (also known as basting) the sleeve in first (see image) but most people just pin baste and then sew.

A trip to the vets

   After many visits to watch human surgery it occurred to me that this was not the only form of surgery out there, that in fact much smaller work was being done every day just down the road to me. My local vet was very generous and allowed me to spend time backstage in his surgery watching operations and procedures on small animals and reptiles.
   I was immediately struck by how high tech but hands on it all was. The range of specialist equipment was remarkable; x-ray machine, mini lab, blood analysis,endoscopy facility etc. ,all in one space.In a hospital everything is on different floors and an appointment is needed for each one, here you walk in and your beloved pet is treated straight away.
   During surgery itself I found that the way a vet works is very similar to me working in my studio. He sat at a small table and without the advantage of a scrub nurse had to select and manage all of the tools himself. One patient was a beautiful dragon lizard with a damaged tail. The scales must not be spilt during stitching and care must be taken of the skin (some of which was partially shed revealing a beautiful hexagonal structure). The versatility of understanding different materials rang a chord with my own varied practise.
   A vet not only understands mammals but other species too.Reptiles are now a popular pet and have very specific requirements for their health which are very different to a mammals, even their breathing is different to ours. While we waited for the next patient other occupants were taken care of; canaries, terrapins and axolotls each again with very different environmental and dietary needs.It appears that my vet is also a keen gardener fond of tropical plants.The tiny garden around the surgery is packed with plants which again all have specific needs and all of them are taken care of.
   The multi life-form care at this practise was fascinating and all were there because of a passion to care for those that can not communicate their needs.As we went from the aviary via the palm trees to then feed the terrapins surrounded by trailing plants he explained that it was all there as much for his benefit as for the customers.His quality of life is improved by the green environment and the pet owners can see best practise for caring for non mammals. Combined with the very immediate attention and care the patients got and the direct access to all facilities I wondered how it would be if human medicine were more like this.
   The vets at this practise are independent and capable of performing complex operations but sadly they are a disappearing breed.Local vets are slowly being replaced by corporate 'chains' with less surgical experience referring work out to expensive specialists, supported by the growing pet insurance market. It is a word of warning for human medicine that when money takes over everyone suffers.