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Richard C. Karl

Across the Red Line
Stories from the Surgical Life

Richard C. Karl

The author of Across the Red Line speaks about his experiences as a surgeon.

Q: Dr. Karl, when you decided on a career in medicine—surgery, specifically—why did you choose to become an Academic surgeon? (It couldn't have been for the money!)
A: Academic surgery has it all: research, teaching and clinical care. It keeps you young. New students and residents push me, make me better. I get to see the world through their eyes, which protects me against the ennui many doctors feel. Plus, the politics are much more intriguing. And, we're not underpaid.

Q: So you've written Across the Red Line after practicing medicine for 31 years. Do the cases you relate in the book come from recent experiences, or over the course of your career?
A: I've collected these stories over a decade. At first, I was too busy concentrating on the care of the patient to let in the great drama I was witnessing. In time, I realized I was seeing and experiencing things that moved me, so I started writing them down. Initially it was haphazard, then I started looking for things that fit into the pattern of the life I've come to know. Now I've got other things I want to tell.

Q: The M&M (Morbidity and Mortality) session was very insightful about how doctors express their concerns about their work. How typical was the one you presented in Across the Red Line. I would think that these meetings can sometimes get out of hand. Did you choose this specific one for any particular reason?
A: It is a pretty typical representation. It was just the one that came along when I got the idea to write about it. Now I run the conference, so it is my obligation to keep things in bounds. I've let the medical students attend. I think they learn a lot by watching the immediacy of the conference and the difficult things that get discussed there. Everybody there has made a mistake at one point and I try not to let them forget.

Q: You sometime face frustrations with your patients—Joe, who suffers a massive heart attack after a successful kidney operation; or Sal, who injected cocaine through a stent you provided—how do you recover from these "losses" and move on to the next patient with the right frame of mind?
A: Loss is part of life. We live in a TV society were loss is only temporary. But in real life it is permanent. These losses make my life richer, fuller. I know that bad things can happen. I sit at the bottom of the funnel. (Read my introduction!) All this makes the usual everyday frustrations less compelling, less important. Sadness is not all bad.

Q: You write in your introduction that most of what you do is "wait and respond" is that patience something you had to learn, or does it come naturally from watching the body and its ability to heal?
A: You've got no choice. The patients I'll operate three weeks from now don't even know they have cancer yet. We've got to wait to find out.

Q: At one point you describe being a patient yourself. Did you find it difficult to be on the other side of the "red line"?
A: You bet. And this has given me a empathetic insight to the patient's dilemma. They want to please me, but it is I who must do a job for them. I view medical humor differently. I have a much greater respect for how tired patients feel, how scared they are. The young residents order chest x-rays for patients with fevers, so that their superiors won't yell at them. But for the patient, going down to the x-ray department, while they are sick and weak is the equivalent of going to the moon. I have lots more patience with patients!


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