Complications (11 page)

I arrived early, and already the auditorium’s fifteen hundred seats were filled. Hernias were SRO. I found a place to stand in a crowd along the back wall. I could hardly see the lectern up front, but a giant video screen provided close-ups of each of the talking heads. Eleven surgeons, one after another, took the podium to flash up Powerpoint slides and argue about data.

Our research indicates, the first surgeon intoned, that the Lichtenstein method is the most reliable way to repair hernias. No, the next surgeon rejoined, the Lichtenstein method is inadequate; the Shouldice technique has proven best. Then a third surgeon stepped forward: Both of you are wrong—it should be done laparoscopically. Now another surgeon was up: I’ve got an even better way to do it, using a special device that I happen to have patented. Things went on this way for two and a half hours. Tempers sometimes flared. Pointed questions were thrown out from the audience. And no answers were reached. But at the end the room was as full as it was at the very beginning.

In the afternoon, I went to the movies. The organizers had set up three theaters seating three or four hundred people each to show reel upon reel of actual operations all day, every day. I scooted into one darkened room and was instantly riveted. I saw daring operations, intricate operations, ingeniously simple operations. The first movie I caught was from Memorial Sloan Kettering Cancer Center in Manhattan. It began with a close-up of a patient’s open abdomen. The surgeon, unseen but for his gloved and bloody hands, was
attempting an exceedingly difficult and dangerous operation—the excision of a cancer in the tail of a patient’s pancreas. The tumor lay deep, enveloped by loops of bowel, a latticework of blood vessels, the stomach, and the spleen. But the surgeon made getting it out seem like play. He plucked at fragile vessels and slashed through tissue millimeters from vital organs. He showed us a couple of tricks for avoiding trouble, and the next thing we knew he had half the pancreas on a tray.

In another film, a team from Strasbourg, France, removed a colon cancer from deep in a patient’s pelvis and then reconnected her bowel entirely laparoscopically—through tiny incisions that required only Band-Aids afterward. It was a startling, Houdini-like feat—something akin to removing a model ship from a bottle and constructing a working car in its place using just chopsticks. The audience watched wide-eyed and incredulous.

The most elegant clip, however, was from a Houston, Texas, surgeon who unveiled a procedure for repairing a defect of the esophagus known as Zenker’s diverticulum. This is an abnormality that normally requires an hour or more to repair and an incision in the side of the neck, but in the film the surgeon managed to do it through a patient’s mouth in fifteen minutes with no incision at all. I stayed and watched movies for almost four hours. And when the lights went up, I walked out into the day silent, blinking, and exhilarated.

The clinical sessions were lined up until 10:30 each night, and they seemed to all go like those first two I attended—veering between the pedantic and the sublime, the mundane and the remarkable. If such programs were supposed to be the meat of the meeting, however, it was often hard to tell. The convention, one soon realized, was as much trade show as teaching conference. Ads for cool new things you had never heard of—a tissue-stapling device that staples without staples, a fiber-optic scope that lets you see in three dimensions—ran night and day on my hotel room television
and even on the shuttle bus to and from the convention center. Drug and medical device companies offered invitations to free dinners around town nightly. And there were over five thousand three hundred salespeople from some twelve hundred companies registered in attendance here—more than one for every two surgeons.

The centerpiece of their activity was a teeming, soccer field–size “technical exhibit” hall where they had set up booths from which to market their wares. The word “booth” does not come close to capturing what they had built. There were two-story-high kiosks, pulsing lights, brushed-steel displays, multimedia presentations—one company had even assembled a complete operating room on-site. Surgeons are people who buy two hundred–dollar scissors, sixteen thousand–dollar abdominal retractors, and fifty thousand–dollar operating tables as a matter of course. So the courting can be intense and elaborate.

It was also unavoidable. The convention organizers had given—or more precisely, sold—the salespeople the convention’s most prime real estate: their exhibit hall was adjacent to the registration desk, making it the first thing surgeons saw upon arriving at the convention, and our only path to the scientific exhibits was through the glittery maze. Heading through to see a molecular biology exhibit the following afternoon, I never made it to the other side. Everywhere you looked was something to stop you in your tracks.

Sometimes it was just chintzy, free stuff. Booths were offering free golf balls, fountain pens, penlights, baseball caps, sticky pads, candy—all stenciled with company logos, of course, and handed over with a spiel and a brochure about some new technology a company was marketing. You might think six-figure surgeons would be oblivious to this kind of petty bribery. But you would be wrong. A drug manufacturer ran what seemed to be one of the busiest booths in the place handing out sturdy white canvas bags with the name of one of its drugs emblazoned in four-inch blue letters along the side. Doctors lined up for the bags, even when they had to give away their phone numbers and addresses, just to get something to hold all the
free merchandise they were collecting. (Still, I heard one physician muttering that the pickings were not as good as in previous years. He’d gotten Ray-Ban sunglasses once, he said.)

Sometimes the companies relied on more subliminal methods to draw surgeons in—putting three smiling young women at a booth, say. “Have you seen our skin?” one leggy brunette with eyelashes like springboards and a voice as vaporous as smoke breathed to me. She meant her company’s new artificial skin for burn patients, but how could I resist? The next thing I knew, I was poking with a pair of forceps at an almost translucent white sheet of engineered skin in a petri dish (ninety-five dollars for a four-by-six-inch piece) thinking, “This stuff is pretty neat, actually.”

The companies’ most effective tactic, however, was simply to put out the goods and let surgeons play. The salespeople would bring out a tray of raw meat and their latest gizmo, and we would flock around like crows. I was sucked in that afternoon by a fresh, yellowy, thirteen-pound turkey on a cookie sheet (cost: about fifteen dollars) and a line of harmonic scalpels (cost: about fifteen thousand dollars)—electronic scalpels that cut through tissue with ultrasonic shock waves. For ten whole and happy minutes, I stood at a glass counter, slicing through layers of turkey skin and muscle, raising thin flaps and thick flaps of tissue, trying deep gouges and intricate dissections, and testing the heft and feel of the various models. At another booth, I donned surgical gloves and tried sewing closed an incision in chicken meat with several lengths of a new fifty-dollar-a-yard suture. I would have stayed throwing knots and practicing my locking stitches for half an hour if four other surgeons hadn’t been stacked in line behind me. In the course of the afternoon, I cauterized cold cuts, used advanced laparoscopic equipment to remove “gallstones”—actually, peanut M&Ms—from inside a mannequin’s abdomen, and used an automated suturing device to sew closed a wound in a weirdly human-looking piece of flesh. (The salesman was coy and would not tell me what it actually was.)

Having given up totally on making it to anything else that day, I spotted a crowd of some fifty surgeons swarming around a projection screen and a man wearing a suit and a headset microphone. I went up to see what all the fuss was about, and what I found was the live televised image of a patient undergoing excision of a large, prolapsed, internal hemorrhoid in an operating room somewhere, apparently, in Pennsylvania. The manufacturer was showing off a new disposable device (cost: two hundred fifty dollars) that it claimed shortens the usual half-hour procedure to one that takes less than five minutes. The emcee in the headset fielded questions from the crowd which he then put to the surgeon as he operated a thousand miles away.

“You are putting in a purse-string suture now?” the emcee asked.

“Yes,” the surgeon replied. “I am putting in the purse-string suture in five or six bites, two centimeters from the base of the hemorrhoids.”

Then he put the device before the camera. It was white and shiny and lovely. Against any high-minded desire to stick to hard evidence about whether the technology was actually useful, effective, and reliable, we were all transfixed.

When the show was over, I noticed just a few steps away a forlorn-looking pockfaced man in a rumpled brown suit sitting alone at a tiny booth. People flowed past him like minnows, not one stopping to examine his merchandise. He had no video screens, no brushed-steel displays, no free stenciled golf tees—just a computer-printed logo-less paper sign (“Scientia,” it read) and several hundred antiquarian books of surgery. Feeling pity for him, I stopped to browse and was stunned to discover what he had on offer. He had, for example, Joseph Lister’s actual 1867 articles in which he had detailed his revolutionary antiseptic method of surgery. He had the first 1924 edition of the great surgeon William Halsted’s collected scientific papers and the original 1955 proceedings of the world’s first conference on organ transplantation. He had an 1899 catalogue of surgical
instruments, a two-centuries-old surgical textbook, and a complete reproduction of a medical text by Maimonides. He even had the 1863 diary of a Union Army Civil War surgeon. There was a trove of jewels in his crates and on his shelves, and I ended up absorbed in them for the rest of the afternoon.

Leafing through those yellowed and brittle pages, I felt I had finally discovered something genuine. Throughout the convention—on the commercial floor, to be sure, but in the lecture halls as well—I noticed myself having to be constantly alert to the possibility that someone was taking me for a ride. There were undoubtedly new drugs and instruments and machines of real and lasting value to be found. With all the glitz and showmanship surrounding them, however, you could never be sure which they were. This was one place where I knew I had found something worthy of awe.

There was another place at the convention where you could be confident of seeing great things going on. Well away from the main halls—where the movies were shown, the practical sessions were held, and the merchandise was hawked—was a cluster of small meeting rooms where the “Surgical Forums” took place. Here each day researchers of all sorts discussed the work they had under way. The subjects ranged from genetics to immunology to physics to population statistics. The discussions were sparsely attended and mostly went over my head: it is impossible nowadays to have a working understanding of even the basic terminology in all of the fields under consideration. But as I sat there listening to the scientists talking among themselves, I caught a glimpse of where the edges of knowledge were, the approachable frontiers.

A recurring topic this year was tissue engineering, a line of research devoted to grasping precisely how organs develop and then using that knowledge to one day grow new organs from scratch that could replace injured or diseased ones. Progress, it became clear, was occurring surprisingly quickly. A couple years before, there had been pictures in all the newspapers of the famous ear grown in a
petri dish and implanted on the back of a mouse. But more complex structures, and certainly human trials, seemed a decade or more away. Now, however, scientists were presenting photographs of heart valves, of lengths of blood vessel, and of segments of intestine they had already grown in their laboratories. The problems they discussed were no longer how to do such things but how to do such things better. The heart valves, for example, worked well when experimentally implanted in the hearts of pigs, but didn’t last as long as they would need to for humans. Likewise, the intestinal segments proved to be amazingly functional when transplanted into rats, but they did not absorb nutrients as well as desired, and the researchers still had to figure out how to grow them in lengths of feet rather than inches. A team at Cedars-Sinai Hospital in Los Angeles had actually gotten far enough along to begin human trials of a temporary, bioengineered liver.

The researchers presented data from their first dozen patients. Each of the patients had reached the end stage of liver failure, a stage in which 90 percent usually die waiting for a liver transplant. But with the bioengineered liver, the researchers reported, all of them survived long enough to find a donor liver—in many cases ten days or more, which was an unheard-of accomplishment. More remarkably, four patients who had been in end-stage failure from drug overdoses wound up never needing a transplant. The bioengineered liver had kept each going long enough for his or her own liver to recover and regenerate. Sitting in the audience, I experienced a sudden giddiness upon realizing what these doctors had done. And I began to wonder if it was at all like what Joseph Lister’s colleagues at the Royal College of Surgeons had felt when he first presented his findings on antisepsis, nearly a century and a half ago.

Was any of this—the teaching, the trade show, the research—what brought thousands of surgeons to spend a week of hard-to-find vacation time in overcast Chicago? There was another convention taking place in town that very same week: the Public Relations
World Congress, “the annual meeting of the planet’s public relations professionals.” (Theme: “Building Our Talent in a World of Tough Issues.”) They too came in droves. Between the surgeons and the flacks, the hotels were booked solid. And our proceedings were almost identical. The publicists had, just as we had, a slew of educational sessions. (Among the events were workshops on managing Internet PR disasters and on starting your own PR firm, as well as a lecture entitled “Conference Calls: A Cost-Effective Tool to Reach Clients and the Press.”) They too devoted a full day to research presentations. They had corporate ads everywhere and a lobby filled with exhibits from PR firms, media release services, and the makers of ultrahigh-speed fax machines. Their week closed, just like ours, with a semi-celebrity keynote address. The elements of the conventions were so weirdly alike that you had to think that they were the core of what drew people to come. Wandering the publicists’ convention one morning, though, I found their meeting rooms no more than half-filled and the crowds instead out in the halls. Even at our convention, you could sense the enthusiasm for actually learning something quickly wearing thin. By midweek, finding a seat at lectures was no problem. And among those attending, a large chunk either dozed off or left early to stroll the corridors.