Expected Miracles

Expected Miracles explores the world of surgeons from their own perspective - how they perceive themselves, their work, colleagues, and communities. Recognizing that surgery is an art, a craft, a science, and a business, Joan Cassell offers, through poignant, painful, and thrilling descriptions, a vivid portrayal of the culture of surgery. Cassell has entered a realm where laypersons are usually horizontal, naked, and anesthetized. Using the central metaphor of the surgical "miracle," she illuminates the drama of the operating room, where surgeons and patients alike expect heroic performance. She takes us backstage to overhear conversations about patients, families, and colleagues, observe operations, eavesdrop on gossip about surgeons' performances, and examine the values, behavior, and misbehavior of surgeons at work. Said one Chief of Surgery, "You couldn't have a good surgeon who didn't believe in the concept of the Hero." Following this lead, Cassell explores the heroic temperament of those who perform surgical "miracles" and finds that the demands and pressures of surgical practice require traits that in other fields, or in personal interactions, are often regarded as undesirable. She observes, "surgeons must tread a fine line between courage and recklessness, confidence and hubris, a positive attitude and a magical one." This delicate balance and frequent imbalance is portrayed through several character sketches. She contrasts the caring attention and technical mastery of The Exemplary Surgeon with the theatrical posturing of The Prima Donna and the slick showiness and questionable morals of The Sleazy Surgeon. She also identifies the attributes that surgeons admire in each other. They believe that only peers can really evaluate each other, and, while doctors might not speak negatively about colleagues in public, the community of surgeons exerts considerable pressure on its members to perform competently. Unlike "doctor-bashing" chronicles, Expected Miracles seeks to understand the charismatic authority of surgeons, its instability, and its price - to surgeons and to patients. Author note: Joan Cassell is a research associate in the Department of Anthropology of Washington University and the editor of Children in the Field: Anthropological Experiences (Temple).