
'It Was the First Time I Cried in the Operating Room' - Petiver
http://www.spiegel.de/international/world/surgeon-on-separating-siamese-twins-the-first-time-i-cried-in-the-operating-room-a-1189755.html
======
jacquesm
I'm so happy when I read this that my work does not include decisions as grave
as these. The medical profession is not short of heroes, but you'll hardly
ever know about any of this, this article is a great example of that. I know
one woman who works in a hospital that tends to children with cancer, I can
pretty much read how her charges are doing by looking at her. And nobody will
ever read about her in a newspaper.

~~~
acjohnson55
I used to be a teacher in Baltimore City, and I used to say, it's the most
stressful job that doesn't come with life-and-death decisions built in. I say
"built in", because I did have to deal with the consequences of death outside
the school building several times.

In any case, I really don't miss it. Some of my days were so insane that I
realized at some point that I seemed to be subconsciously wiping my memory of
it at the end of the day. Even as a founder trying to launch a startup, my
craziest days paled in comparison.

Not saying my experience is anything like separating a conjoined twins or
dealing with pediatric cancer, but just that I can relate to your thankfulness
of having a job that's not that intense, by any measure.

~~~
arca_vorago
I went to the east coast for the cyber boom and ended up doing IT contracting
for the City of Baltimore school system. I saw a large amount of the schools
and it was one of the most eye-opening and saddening experiences I've ever
had... and I'm an Iraq war vet. So don't discount your experience there.
Baltimore is not normal. Coming from Texas where at least I can concealed
carry I had a couple of really fucking hairy incidents that really bugged me
that I had no way to defend myself.

I wouldn't live there if you payed me, and certainly never with a family.

Side note, did you hear about the cop who was going to testify against the PD
and ended up dead? The PD there is corrupt as fuck.

~~~
prklmn
This was quite eye-opening for me:

Video Appears to Show Baltimore Police Officer Planting Drugs

[https://nytimes.com/2017/07/19/us/baltimore-police-video-
dru...](https://nytimes.com/2017/07/19/us/baltimore-police-video-
drugs.html?referer=https://duckduckgo.com/)

~~~
srtjstjsj
[http://www.baltimoresun.com/news/maryland/crime/bs-md-ci-
bod...](http://www.baltimoresun.com/news/maryland/crime/bs-md-ci-body-camera-
tampering-20180124-story.html)

> The fabricating-evidence charge is a misdemeanor, which carries a maximum
> penalty of three years’ imprisonment and a $5,000 fine. Misconduct in office
> is a common-law offense, which means that the court is free to impose any
> penalty that does not constitute cruel and unusual punishment.

> Prosecutors said the video prompted them to drop more than 110 cases
> involving the three officers in the video from Pinheiro’s camera.

That's 110 people who either were innocent and terrorized by the police, or
were guilty and escaped justice due to police incompetency. Either way, not a
good look.

Prosecutor in this case the same State's Attorney Mosby who tried (and failed
miserably) the Freddie Gray manslaughter/murder case.

~~~
DoofusOfDeath
>That's 110 people who either were innocent and terrorized by the police, or
were guilty and escaped justice due to police incompetency. Either way, not a
good look.

To play devil's advocate: If you're going to reason that way, you should also
consider the number of actual criminals who were punished only because of
planted evidence.

I'm not advocating corruption - I still think it probably warrants the death
penalty due to its cancerous and widespread impact on innocent people.

~~~
bdhess
No, because it's a decided question. As a society, we've already chosen that
we'd rather see a perpetrator walk free than imprisoned without proper
evidence.

We shouldn't have to revisit that decision on the merits just because some
police officer who disagrees with it unilaterally breached the social
contract. We should just punish him. Severely.

~~~
DoofusOfDeath
> No, because it's a decided question.

It sounds like you're suggesting that ethical reasoning done by previous
generations is somehow binding on future debates, almost like some form of
case law.

> As a society, we've already chosen that we'd rather see a perpetrator walk
> free than imprisoned without proper evidence.

I wonder if you're failing to make a distinction between what people will say
in public vs. their private thoughts on the matter.

------
keiferski
Essentially, it was a real-life Trolley Problem [1] - do you actively kill one
patient in order to save another? Or do you do nothing and “allow” them both
to die? I don’t blame the doctors on either side for their decision to
participate or not participate - it is an incredibly complex ethical decision.

[1][https://en.m.wikipedia.org/wiki/Trolley_problem](https://en.m.wikipedia.org/wiki/Trolley_problem)

~~~
jrs95
Maybe I’m oversimplifying here, but is it really that complex of an issue in
this case? The two of them together faced almost certain death. In most
versions of the trolley problem, the potential victim of action isn’t going to
die either way.

To me, the more interesting moral aspect of this is that a surgeon who hadn’t
done this before accepted the case because it would be interesting and
challenging. I’m only paraphrasing a little; that was basically his
description of it in the article.

~~~
jacquesm
You are technically correct, but that still did not make any of it any easier,
the doctor must have been fully conscious that severing the artery between the
girls would lead to an end of the weaker one, especially after testing it by
temporarily restricting the artery and seeing how fast the weaker girl went
down.

~~~
trhway
(IANAD of course, just too much of Grey's Anatomy and House) i wonder why they
didn't place her on bypass before the cut and didn't try to correct her heart
or find a heart transplant for her.

------
tomrod
This a fascinating and heartbreaking story. Medical science can produce
miracles, and I'm grateful for the consideration given to the ethics of
action.

------
michaelsbradley
It's a good example of the principle of double effect.

[https://en.wikipedia.org/wiki/Principle_of_double_effect](https://en.wikipedia.org/wiki/Principle_of_double_effect)

[http://www.catholicculture.org/culture/library/dictionary/in...](http://www.catholicculture.org/culture/library/dictionary/index.cfm?id=33215)

------
logfromblammo
This situation was recently dramatized by the television show _The Good
Doctor_.

The ethical anguish there was compounded by making the patients old enough to
tell the surgeons that they would rather sacrifice their own life to save
their sister, than to be the sole survivor--who would then live only because
her sister and lifelong constant companion is dead. The scriptwriters also
stirred the pot by putting one in a coma to remove the possibility of explicit
consent.

At the time, it stretched my suspension of disbelief.

------
lolsal
I would have loved to to hear about the discussions and arguments around the
ethics of their decision. I personally believe they made the ethically correct
choice. It could be argued that by not operating they were violating some sort
of 'do no harm' principal. By not operating they may have caused two girls to
suffer (especially in the case that they both survived into adulthood). Very
interesting and puts my work into perspective. Very humbling.

~~~
konschubert
The way I understood it, it was very likely that the girls would die before
adulthood if not separated.

------
Izmaki
In another life I want to be a surgeon.

------
baumbart
Imagine an artificial intelligence (surgery robot) making this decision.

~~~
Rexxar
There is no need to let robot take such decision. Robot are useful when there
is a lot of fast decisions to take.

------
harrisjt
I could never do this work, insanity. Props to all the nurses and people
behind the surgery technology.

------
nicodjimenez
This man is a hero.

------
invalidOrTaken
Oh, well that's not an impossibly heartbreaking story _at all_ , no sir!

