Confessions on my dead skin

The crack, crack, crack of broken ribs 

with each chest compression greeted me 

at the door. The death clock had started

Paul Ruggiere, surgeon and writter, in: Confessions of a surgeon

    When I die, if my body doesn't putrefy immediately and still remains for a few hours under the equatorial sun, I will ask my children and my wife, accustomed to tattoos, to hire a good tattoo artist to ink in the middle of my chest the classic phrase by René Leriche: Every surgeon carries within himself a small cemetery, where from time to time he goes to pray – a place of bitterness and regret, where one must seek an explanation for his failures.

    May this phrase weigh on my chest like a cross of angelim-pedra wood, the same that every surgeon carries throughout his work, but remains unconfessed and circumspect. May it remain corrosive, marked with iron and fire, on raw flesh, since there will no longer be pain. Afterward, just lower the coffin and say the final prayer over the body.

    These granular confessions, sometimes thorny to those who lack nerve, don't lead me to think there's a flaw in our academic training, or some common deviation in surgical education. It's that the retinue of Ambroise Paré lives with their souls downcast, with bulging eyes in society since the times of Hammurabi.

    Let me explain. For many years of my life I worked in emergency rooms. I won many battles, but lost some. With each loss, a part of me went away. When I returned home to confess, I reflected on what I could have done better to save that young man who arrived with a gunshot wound in the middle of his lung, or at the edge of his heart. I confessed by leafing through books; I searched for the maneuver I didn't perform, looking at the tip of my shoe stained with drops of blood.

    It was many years in this routine, until one day the book by physician and historian Luis Mir fell into my lap: Civil War and Trauma – trauma in the sense of physical traumatism, urban violence. It was a gift from a friend. In that tome of almost a thousand pages I found the pearl I needed: Trauma forces surgeons to recover for medicine a more attentive dimension of human limitations, definitively abandoning any temptation or more hidden delirium of omnipotence. That was what I needed to read. I felt consoled and, if I carried some god beneath my skin, that stoic reading made me lose my omnipotence.

    I would also ask my family for a second tattoo. Now on my back. I would ask them to have this text by Mir printed there.

    When that young man left Marajó Island heading to the capital, searching for a solution to his bronchial tuberculosis, I immediately thought I was capable of correcting that idiosyncrasy with new concepts and techniques I master, not to mention the alliance with technology. I hit a brick wall. It was shards of wisdom in every direction. Few pieces remained of what I had learned from my masters and read from the greatest authors.

    That Saturday, upon arriving home, I sat before the bible, this kind of cemetery that Leriche proclaims, to confess this latest failure. My gaze shifted to Mir's book – right in front of me. I saw myself impassive, fragile and almost boneless. That syncopated reading welcomed my tears to that confession.

    The prayers of René Leriche and Luis Mir have significance for surgeons who confess on their knees, although we know that not all recognize themselves within them.

    They are words that adorn the silence.

Roger Normando - Professor of Thoracic Surgery, University of Pará.