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
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!