The ‘Selective Genius’ of the Operating Room

And nopes, it is not the anaesthetists. I am here casually inferring to surgeons, the Lords of the operating theatre (as per their own flawed concepts). Do not get me wrong, I have no issues with surgeons. They are great at their job, at least most of them. Yet I can count on my fingers if I was asked- Who would you want to work with in private practice some day?

If intelligence were measured by fine motor skills alone, surgeons would rank among the highest forms of human evolution—perhaps even higher than concert pianists or master watchmakers. Yet, the surgical mind is a paradox: razor-sharp in the operating room but occasionally bewildered by the most basic concepts like – Why do I need an ICU bed for a patient with baseline Sp02 of 80% on room air? (The normal being 95% on room air)?

One of the best ones I had ever was on one of the night shifts: The patient is fine, we will just clean the wound on the leg. In comes the patient- some 150kg 60 years old gentleman with a short neck, puffing his life away to grab at whatever oxygen the atmosphere can offer him, and surprise surprise- a cardiac ultrasound showing a moderate aortic stenosis with an EF of 30, amongst all the other stuff. What does it mean for me, the occasional reader might ask? Well, 5 minutes cleaning for the surgeon, and a 30 minutes explanation to the surgeon about why putting to sleep isn’t a good idea if we will go back to the ward and he will have to be content with me getting a nerve block in.

The old joke goes, “Most surgeons are just dim-witted beings with good hands.” It’s a light-hearted jab at their often single-minded focus on the art of cutting and sewing, sometimes at the expense of broader intellectual pursuits. But there’s more than a grain of truth in it. While the rest of us struggle to button a shirt with sleepy fingers, they’re out there slicing through tissue with the precision of a Renaissance sculptor—except their marble bleeds while they hack away.

In his book Complications: A Surgeon’s Notes on an Imperfect Science, Atul Gawande reflects on the sheer mechanical nature of surgical mastery: “The training of a surgeon is not fundamentally different from that of a carpenter. Both must learn to use tools with precision and finesse.” Well, here is the reason he got on the hitlist of surgeons. How dare he compare them to a carpenter! ROFL. (Note- He is a surgeon.)

Surgeons are craftsmen in the purest sense. Their knowledge is practical, their dexterity is refined, and their work, despite being life-saving, is sometimes often reduced to muscle memory. They develop an almost supernatural ability to operate on autopilot, with hands moving independently of conscious thought. Basically, they are the Gods that will save you if you are bleeding out.

We might even surmise- Surgery is not just an art, it is a compulsion. You don’t choose to be a surgeon, you are chosen. Perhaps that’s why some of them seem to struggle outside of their element. Forget complex literature or philosophical debate—just ask a surgeon to inject anaesthetic drugs for you and watch them stare at the 3-way stopcock like they’ve encountered an alien artifact.

It’s not that surgeons lack intelligence—far from it. But their intelligence is often compartmentalized, with the prefrontal cortex seemingly taking a backseat to the cerebellum.

Arthur Conan Doyle, a physician himself, captured this dynamic through Sherlock Holmes, who famously stated:

“A man’s brain originally is like a little empty attic, and you have to stock it with such furniture as you choose.”

And yet, I work with some of the finest surgeons that can do basic anaesthesia and actually do understand why we simple-minded anaesthetists view the patient as a whole when planning a case. I can point out 4 off the top of my head- 2 are fellows in vascular surgery at Steve Biko, 1 is a cardiothoracic guy just finishing his training soon and the last one is a really sweet calm consultant in general surgery currently.

Surgeons, it seems, have chosen to stock their attics with an exhaustive knowledge of anatomy, physiology, and the art of the scalpel. The rest? Optional.

The result is a breed of professionals who can execute a flawless end-to-end anastomosis but may forget their own wedding anniversary. Who can operate on a beating heart yet somehow lock themselves out of their own car—twice in the same week. Mind you! It is not stupidity- it’s selective genius.

Is this a flaw or a feature? The ability to hyper-focus on a singular task is a hallmark of many great minds. Leonardo da Vinci, who straddled both art and anatomy, once remarked:

“He who loves practice without theory is like the sailor who boards a ship without a rudder.”

Some surgeons, however, seem to defy that wisdom. For them, practice is the theory. Experience trumps abstract contemplation. They don’t need a rudder—they have a steady pair of hands, and that’s enough to steer through the storm.

So perhaps it’s time to embrace the stereotype: most surgeons are not philosophers, poets, or tech support specialists. They don’t need to be. While the rest of us fumble with the mundane, they’re out there performing miracles with the flick of a wrist.

Well, here we are, celebrating the reason why some days, anaesthesiologists go home with massive headaches that need more than paracetamol- Ode to the anencephalic beings with fine motor skills. We salute you!