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Expedition medicine for surgeons - from Shackleton to Syria

Surgical training is increasingly structured, and for good reason. Tensions between service and training, together with reduced working hours, making it important that explicit training opportunities and objectives are identified. In the UK, speciality-specific curricula, combined with exit exams and online portfolios, make a robust pathway that aims to deliver safe day one consultant surgeons. That said, there is a great value (both intellectual and spiritual) in taking some time off this conveyor belt.

How, why, where, and when a surgeon may step away from training or service is extremely varied. Well-trodden options include developing specific tertiary skills in high volume centres or completing a research degree. What about broadening horizons even further? A surgical career can be a long one; a new start trainee in the UK can anticipate retirement in their mid-seventies. Staying interested, motivated, and avoiding burn out is crucial. Here we consider some ‘expedition medicine’ roles that may appeal and might help to keep that spark lit.

Expedition medicine encompasses a broad spectrum of opportunities. They range from the largely benign, such as supporting a short charity cycle ride, to the much more intense, such as medical cover for a high altitude mountaineering expedition or providing surgical services in resource-poor or remote war-torn environments. Arguably the most extreme end of the spectrum is exemplified by David Nott. A general and vascular surgeon who works in London, he punctuates a ‘standard’ career with work as a volunteer surgeon in war zones and austere environments. More recently, this has expanded to fundraising and running educational programs to raise the profile of humanitarian surgery. His work is deeply inspiring, sometimes harrowing, and definitely not for the faint of heart.

From the sublime to the somewhat ridiculous (and shamelessly self-indulgent) is performing the role of doctor on Bear Gryll’s The Island. In this TV series, a group of ‘ordinary British men and women are challenged to see if they can survive for five weeks, abandoned totally alone on an uninhabited Pacific island.’ Negotiating six weeks away from your training program might be a tougher ask for this one… Such opportunities bring benefits to the surgeon themselves and also to others, depending upon the context. A change is a good as a rest, said the Victorians, and stepping away from one’s normal front-line to another one can counter-intuitively be recharging. Taking skills learnt at home and deploying or sharing them in challenging environments can also be deeply rewarding, and of course, the skills transfer works in both directions.

Like many good ideas, there is a historical precedent. Shackleton’s ill-fated expedition in the South Atlantic in 1916 is an often quoted and much-publicised feat of remarkable human survival. Spoken of less is the contribution of the ship’s surgeons. Marooned on Elephant Island during an Antarctic winter, after the expedition ship Endurance has sunk, they managed to administer a chloroform anaesthetic to a crew member and amputate frost-bitten extremities. All this whilst managing the obscure pharmacokinetics of the volatile anaesthetic chloroform in sub-zero temperatures*. All survived!

Mark Hughes

Director, eoSurgical

Clinical Lecturer in Neurosurgery, University of Edinburgh

 Email: mark.hughes@eosurgical.com

Twitter: @eosurgical

* Firth PG. Of Penguins, Pinnipeds, and Poisons: Anaesthesia on Elephant Island. Anaesthesiology. 2016. 125(1):25-33.