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Just how psychopathic are surgeons?
These are the people we trust to hold a sharpened knife above our bare bellies and press down until they see blood. We let them tinker with our hearts, brains and bowels while we lie unconscious beneath their gloved hands. Surgeons live in a world of terrifying margins, where the difference of a millimetre can be the difference between life and death. That level of precision demands an extraordinary calm, or what you could also call a cold detachment. But what happens when that same self-possession curdles into something darker? In recent weeks, two surgeons have made headlines for all the wrong reasons. In France, Joël Le Scouarnec was sentenced for abusing hundreds of children – some while they lay anaesthetised in his care. In the UK, plastic surgeon Peter Brooks was convicted of the attempted murder of fellow consultant Graeme Perks, whom he stabbed after breaking into his home in Nottinghamshire. Today, Brooks was sentenced to life imprisonment with a minimum term of 22 years at Loughborough Courthouse. It would, of course, be absurd to taint an entire profession with the acts of two individuals. But it does resurface a long-standing, uncomfortable question: might the very traits that make a surgeon brilliant also mask something far more troubling? 'When people hear the word psychopath, they tend to think of serial killers and rapists,' says Dr Kevin Dutton, a psychologist and the author of The Wisdom of Psychopaths. 'But the truth is that certain psychopathic traits – focus, emotional dispassion, ruthlessness, self-confidence – can predispose you to success, and in an operating theatre, they really come to the fore.' Dutton has spent much of his career trying to prove that 'bad psychopaths' – people who have these characteristics but who can't regulate them – are the ones who commit crimes. A 'good psychopath', by contrast, is someone who can dial those qualities up and down at whim. He recalls one neurosurgeon who was regularly brought to tears by bits of classical music, but who also said, 'Emotion is entropy. I have hunted it to extinction over the years.' Similarly, a cardiothoracic surgeon told him that once a patient was under, he no longer saw them as a person – just a piece of meat. 'Once you care, you are walking an emotional tightrope,' says Dutton, 'but if you see the human body in front of you as a puzzle to solve, then you are more likely to save their life.' Gabriel Weston, a London-based surgeon and the author of Direct Red: A Surgeon's Story, describes her profession as one that requires you to 'flick off a switch'. Sent to boarding school at a young age (much of British surgery is the product of elite schools), Weston learnt early how to detach emotionally – a skill she found served her well in the theatre. 'If you asked my family, they'd say I'm very emotional in that I cry in films or at art or literature,' she says. 'But there's a ruthless part of me. I use that in surgery – and in other parts of life where emotion just gets in the way.' Over time, Weston learnt to distinguish between two kinds of surgeons: those who switch their feelings back on once they leave the operating room, and those who never do. 'They don't just have psychopathic traits,' she says. 'They live in that space permanently.' They can also come with a reputation for being not just difficult, but dangerous. Harry Thompson*, a British abdominal surgeon, describes a world of towering egos and simmering aggression. 'If you think about it, all surgeons were in the top five of their class,' he says. 'They are all very competitive, and many play sports: they want to prove they are better than everyone. And if you are at the forefront of major surgery, you think you are invincible. It's a boiling-house environment of jealousy, envy and hatred.' He recalls one consultant who stabbed a plain-clothes policeman with a disposable scalpel after being stopped for speeding en route to the theatre. Another smashed a ward office clock when a nurse arrived five minutes late. Physical assaults were, he says, more common than you would think. 'I was in one operation when a student, John, was an hour and a half late, because he overslept. The surgeon thumped the student's head against the theatre wall until he was unconscious, screamed, 'Nobody move!' then started kicking him. No one ever saw John again.' Nor is the patient always spared. 'When I was training, I saw one surgeon thump a patient for removing a drain from his own bottom after an operation because it had become painful,' says Thompson. 'The patient only admitted this (in tears) after the surgeon had made the nurses and junior doctors line up and interrogated each one in turn about who had done it.' Thompson used to work with Simon Bramhall – the liver surgeon who made headlines and was later struck off for branding his initials onto patients' livers using a laser. 'Simon had always been a bit mad,' says Thompson. 'He was fascinated by the programme Randall and Hopkirk (Deceased) and he always wore a white suit [like the character Hopkirk], tie, shoes and socks.' As for tattooing his patients' organs: the initials were discovered by his colleagues only during a second surgery when his once-subtle etching was now grotesquely enlarged by liver damage. While Bramhall's actions sparked public outrage, some in the medical community were nonplussed. Perhaps because this is a far more commonplace occurrence than we realise: an article in Harper's Magazine cited examples of anonymous ophthalmic surgeons who had lasered their initials onto retinas, and orthopaedic surgeons who had etched theirs into bone cement. 'Why would you do that? Ego, of course,' says Dutton, 'and it isn't incidental in surgery. It's selected for. From the moment you start training, you have to fight – quite literally – for your space at the operating table.' Dutton researched which of the various disciplines within the profession had the highest rates of psychopathy, and the results are revealing. Number one is neurosurgery (which is bad luck for any fans of Grey's Anatomy), followed by cardiothoracic or heart surgery and then orthopaedic. 'The last one is brutal as you have to smash people's bones,' says Dutton. 'Cardio more than anything is about life and death, but neurosurgery is particularly interesting to me. I think it's because this is the only branch of surgery where, if something goes wrong, you leave the patient permanently crippled or blinded or incapacitated, so only very few people can take such a calculated risk under pressure.' And though these traits are often seen as typically male, women are by no means exempt. Weston says the most difficult surgeon she ever worked under was a woman. 'She was very attractive and well-liked – mostly for being gorgeous and good at her job – but privately she made my life hell. Maybe she didn't like another woman being on the team but she did that horrible thing that women do of presenting this incredibly benign face while being very cruel in private. For months, she blamed me for mistakes that weren't mine, stole credit for my diagnoses, and made me feel like my surgical skills were terrible. She was truly villainous.' And yet, Weston admits, the operating theatre offers her a rare freedom: 'If you are a woman who is quite tough and unsentimental, surgery is a really amazing environment in which you can be yourself. There are many areas of my life – mainly motherhood, but also writing – where there is an expectation that I will be softer than I am. Like Simone de Beauvoir, I find it very freeing not to be pleasant.' Perhaps there is something in all of this (criminal and violent behaviour aside) that we, as patients, secretly find reassuring. We don't want our surgeons to hesitate. We don't want them to be emotional or anxious. We want them to be brilliant: laser-focused, supremely confident, even terrifying if that's what it takes to save us. In life, we dislike arrogance. On the operating table, many of us yearn for it. 'I had one boss,' says Thompson, 'a French surgeon. He used to say: 'There are the porters, the nurses, the managers – and then there are the surgeons. Above them, God. And above God? Me.'' *Names have been changed Broaden your horizons with award-winning British journalism. Try The Telegraph free for 1 month with unlimited access to our award-winning website, exclusive app, money-saving offers and more.
The Guardian
17-03-2025
- Entertainment
- The Guardian
Alive: An Alternative Anatomy by Gabriel Weston review – our bodies in an eye-opening new light
In the first week of medical school, my cohort was divided into small groups, given big sheets of white paper and assigned the task of drawing organs on a human outline, as our lecturer shouted 'liver!', 'ovary … other ovary!', 'appendix!', 'spleen!' It was startling to confront our ignorance and the exercise was formative for me in retaining humility when talking with patients and being curious about what I call their 'imaginary anatomy': how we think our bodies look inside. Despite the smooth, slim, cross-sections we see on the walls of GP surgeries, each of us has this imaginary space that is of interest not only in its deviation from textbook 'truth', but because the idea of our innards affects how we feel about ourselves and what we think our bodies can do for us. This might explain why I chose to become a psychiatrist rather than a surgeon. As Gabriel Weston writes in Alive, surgeons tend to think they 'own anatomy'. Weston is herself a rare breed of surgeon, having read English at Edinburgh University before reckoning with her single biology O-level to join a new course for humanities students who wanted to become doctors. This made her 'the least qualified medical student in the country'. Her 'soft, arts-loving brain' had to pass as a scientist – an outsider status I share – which got easier once Weston became fascinated by the operating theatre and the 'peachy slit' of the scalpel's opening incision. It's an obsession that is still evident everywhere in her writing. But she never lost her belief that medicine is dangerously resistant to seeing the body as more than mechanism, the person as more than a case. After becoming an ENT (ear, nose and throat) specialist, Weston stepped out of full-time practice to present BBC Two's Trust Me, I'm a Doctor and wrote an acclaimed memoir, Direct Red: A Surgeon's Story (2009), as well as a novel, Dirty Work (2013). Alive has been a decade in the making, shaped by the 'human prism' of ageing, giving birth to and raising twins at 43, a sudden bleed in her son's brain and a heart condition of her own, first detected as a murmur by her medical student boyfriend in their 20s (peer diagnosis while practising with stethoscopes is not uncommon). Compared with the dynamism and pace of discovery in physiology and pharmacology, anatomy can seem inert, bloodless, settled. It's a subject that tends to be taught through tatty dissected specimens and bones smoothed by hundreds of hands. Anatomy literally means 'to cut up' the body, and Alive's chapters do so organ by organ, challenging each's inherited wisdom with a feminist eye. Weston reminds us that awe is surely the correct response when considering the gut as 'the largest sensory organ' in constant communion with the microbiota living within it, the kidneys flushed through with 200 litres of fluid in one turn of the Earth's axis and a girl infant's nipples able to produce milk in response to maternal oestrogen from her first moments in the world. Bodies become more alive to us as they go wrong. 'Health is life lived in the silence of the organs,' wrote the French vascular surgeon René Leriche in 1936; if lucky enough to be free of pain and other disabling symptoms, our bodies can feel oddly dead to us. Reading Weston is like a series of jolts back to life: subcutaneous fat is 'custard yellow', the brain is a 'soft organ inside a tight box' and her dodgy mitral valve is 'like the swinging doors in a saloon bar after a cowboy has made his showy entrance'. Her prose is admirably clean and smart, though not at the expense of tenderness, and thankfully avoids the sentimentality that too often seeps into medical nonfiction. 'Why are we so ready to squander pleasure in the way we teach anatomy?' Weston asks, an approach that especially short-changes women. Knowledge about genitals needs a 'rewrite', she says: the clitoris, rather than the 'conduit' of the vagina, is the penis's true counterpart, but as female desire became pathologised by the Victorians, the clitoris was rubbed out. We have Australian urologist Helen O'Connell to thank for finally mapping the extensive innervation of the clitoris in 2005 (!) to help surgeons preserve its sensitivity. Many are deceived by the small size of the visible clitoral hood, and Weston despairs that we're all too hung up on what our bodies look like, rather than how they feel. Silicone breast implants undermine their erogenous surroundings, and the first breast enlargement in 1962 was performed on an indifferent woman in exchange for the surgeon pinning back her ears. Half of Britons can't label or describe female genitalia. You could argue – and Weston does – that expertise about the body's sensations from within and under our fingertips is a more important form of knowledge. But high rates of sexual dissatisfaction reported by women suggest no greater levels of expertise here either. Clinical practice is stubbornly loyal to the familiar. 'In a learned sphere like medicine, it's easy to assume that false ideas will swiftly be replaced by true ones,' Weston writes, but this is far from true. Doctors' conformity – hello, rule followers and guideline enthusiasts – is essential to make healthcare reliable and safe. But it carries risks too. The chance of surviving a cardiac arrest in the community, getting gold-standard treatment and being discharged home alive is half as likely for women than for men. This is partly because of a remarkable lack of curiosity and awareness about the biological differences of the female heart and the cardiological impact of circulating hormones, but also thanks to the ways women are primed to think about themselves ('Isn't it mainly middle-aged men who get heart attacks?'), which delay care, as well as the prejudices of healthcare professionals ('This looks more like a panic attack than a heart attack to me'). Weston rightly loses patience with 'protocols that claim to suit all bodies, when most of the data they're based on is taken from white male patients'. Change relies on people pushing against the heavy door of tradition – which Alive brilliantly persuades us all to do more forcefully – finding new ways to imagine and inhabit the space beneath our skin. Kate Womersley is a doctor and academic specialising in psychiatry Alive: An Alternative Anatomy by Gabriel Weston is published by Jonathan Cape (£20). To support the Guardian and Observer order your copy at Delivery charges may apply
