--by James W. Squires, M.D.
Cut, Cut, Cut. Wherever I go this word dominates websites, newspapers, talk shows, local meetings and letters to the editors. Cut what? Budgets – be they federal, state, municipal, town, or county. All this “cutting” talk takes me back to my surgical days where, to no one’s surprise, “cutting” is an important part of what surgeons do. But from day one of surgical training, one learns the opposite of cutting and that is: what not to cut.
All physicians learn early in their careers the timeless doctrine of, “first do no harm,” that comes from the Latin expression premium no nocere, and is especially significant in the practice of surgery. I remember a professor gently moving my hand a few millimeters because where I was going to go would result in some major-league damage.
I could probably teach a college biology major to cut away almost anything; cutting is easy. Put the tissue under a bit of tension, take scissors or scalpel in hand and slice away. Removing the thyroid is a good example: A little dissection here, a bit of cutting there, control the bleeding and presto, the entire thyroid is on the way to the pathology lab. As for harm? The patient may no longer be able to speak, will require hormone replacement for the rest of their life while their calcium metabolism is permanently damaged.
I don’t hear much about the likelihood of doing harm with budget cutting. And even worse, those likely to be harmed are characterized, by some, as “lazy system abusers” who don’t deserve support and, if on the odd chance someone may be really in trouble, well that is someone else’s problem. Perhaps some elected officials would benefit from a few days in surgery school and then again, I wonder if the doctrine of do no harm would ever sink in.
During the twenty five years I practiced surgery there were a number of patients whose clinical outcome was far from expected and in certain instances, a slow and painful death was the result. Care was needed during these periods of suffering and I became involved in supporting these patients and comforting their families. These patients remain forever in my mind’s eye. During my four years in the New Hampshire Senate, I seldom, if ever, had occasion to spend time with New Hampshire residents who may have suffered as a result of my vote. So to me, the stress and pain of surgical misadventures was significantly higher than the stress of voting, causing me to wonder just what is meant by a “painful” vote.
I conclude by wondering if a better awareness of the consequences of one’s voting decisions might be achieved by a visit to a community mental health center, a food kitchen, a homeless shelter, a foster home and countless other organizations along with boards of selectmen, school boards, and elected municipal officials who will soon, I believe, be directly confronted by their neighbors and friends who knock on the door of public assistance and discover it locked. The state’s budget crisis is real. Cuts are inevitable. But, like any good surgeon, legislators should do some outreach and gain a better understanding of what will constitute one cut too many.
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