Tutorial for surgeons by Lawrence Peter Berra
Chicago, Illinois, United States
|The above photograph is from the archives of the Cook County Hospital when it closed. It was taken in the amphitheater in the main building. Autopsies were an indispensable part of surgical learning in the past. In this photograph two autopsies are being carried out simultaneously. The year is not known. Image courtesy of Dr. Bohdan Iwanetz.|
Since the turn of this century, and more so over the past decade, surgeons at various stages of their careers have been dissatisfied with their work and the surgical lifestyle. The main reason for their dissatisfaction seems to be an ever-increasing burden of administrative work, leaving them with little time for what attracted them to surgery in the first place, i.e., helping patients. In the foreseeable future it is unlikely that conditions will revert to those of more congenial times. Surgeons may therefore have to modify their expectations and attitudes to regain funktionslust, a term coined by Karl Bühler meaning “pleasure taken in what one does best.” A reappraisal of some of the aphorisms of Lawrence Peter “Yogi” Berra (May 12, 1925 to September 22, 2015) may help us get there.
Berra became one of the best catchers in baseball by mastering every skill required of a catcher. First, he had intimate knowledge of the strengths and weaknesses of the players on the opposing team and was aware of what they would do in specific situations. In a game that Joe Garagiola was broadcasting, Yogi whistled to Mickey Mantle, a great centerfielder in his own right, and moved him around. After the game, when asked why he did so, he told Garagiola, “Mickey didn’t know that the guy hits there with two strikes.”1 Second, he communicated succinctly and without hesitation with his teammates, as illustrated by the previous example. Third, he could concentrate for long periods of time under uncomfortable circumstances. At the age of thirty-seven, he crouched behind the plate for the entire seven-hour game on June 24, 1962, in which the Yankees beat Detroit in twenty-two innings.2 He was also ambidextrous, or as he would say “amphibious,”3 since he batted left-handed and threw the ball with his right.
These same characteristics would be invaluable for surgeons. They should know everything about the condition they are about to manage and what to expect during the operation, to communicate succinctly with the operating room team, and concentrate on the task at hand even when working under uncomfortable conditions. Being ambidextrous is also a great asset. Words of wisdom from Berra, who excelled at his job and clearly relished it while also unabashedly exulting in life, are still valid not only for neophytes wondering what they have got themselves into but also for the jaded older surgeon who needs a shot in the arm. If one gets past his unique choice of words and distinctive sentence construction, each of his messages contain pearls, although he did declare: “I really didn’t say everything I said.”4
If one substitutes surgery for baseball, surgeons would agree with his sentiment that “If I didn’t make it in baseball, I won’t have made it workin’. I didn’t like to work.”5 Another way in which he could have said that was, if you like what you are doing it is not work. Only when surgery becomes a vocation does one take pleasure in executing even the most insignificant procedure perfectly. On occasion, surgeons do experience “déjà vu all over again.”6 Then they should stimulate their temporal lobes and recall what previously they had seen, heard, or read about that issue and how best to deal with it.
When Yogi said, “You’ve got to be careful if you don’t know where you’re going, because you might not get there,”7 he was advising people to make careful plans before undertaking any task. Berra also said, “When you come to a fork in the road, take it.”8 During an operation, surgeons may be faced with more than one option and have to decide which one would be the best in that situation. The well-prepared surgeon makes the right decision without wasting time. When Yogi said, “You don’t have to swing hard to hit a home run. If you got the timing, it’ll go,”9 he meant that an expert achieves effortlessly what a novice struggles to carry out. We have all seen master surgeons who operate deliberately and without wasted effort or time while others sputter, strain, and sweat trying to carry out the simplest of procedures.
Yogi’s next three pieces of advice are directed to every surgeon. The first of these pearls is, “You can observe a lot by watching.”10 In other words, watch and analyze another person’s actions carefully to learn how to deal—or not deal—with a particular problem. Second, in 1949 he inimitably said, “Dickey’s learning me his experiences”11 when the great Yankee catcher Bill Dickey, his coach at the time, was teaching him the finer points of catching. In other words, by watching and listening to a veteran, a novice can benefit from that vast store of knowledge. The third, equally important piece of advice was, “If you can’t imitate him, don’t copy him.”12 Yogi said this to a young Mets hitter who was failing despite having adopted Frank Robinson’s batting stance. A verbose and less interesting way to make the point would be that unless you know the why, the when, and the how of Robinson’s swing, it does not matter where you stand: the outcome will not change. These words of caution are also particularly valid in surgery. Blindly copying an accomplished surgeon’s flourishes without understanding the nuances of the maneuvers and the circumstances under which to employ them is a prescription for disaster.
Another particularly telling piece of advice was, “Make a game plan and stick to it. Unless it’s not working.”13 Quite simply, do not give up on a logically planned operation too soon, make an honest effort. However, recognize when it becomes futile to persist and it is time to adopt a different approach. His way of telling people to concentrate only on the job at hand and leave extraneous matters for later was, “You can’t think and hit at the same time.”14 He came to that conclusion in 1946 when he was playing Triple A ball with the Newark Bears. His manager told him, “Yogi, next time you’re up think about what you’re doing.” The result of following that advice was that he struck out in three pitches! He also believed that when things go wrong one must try to improve rather than blame others or make excuses. His way of saying it was, “I tell the kids, somebody’s gotta win, somebody’s gotta lose. Just don’t fight about it. Just try to get better.”15 To avoid trouble in an operation, one should perform every step meticulously and precisely without taking any shortcuts—or, in Yogi’s words, “Little things are big.”16
His most important statements included: “If you ask me a question I don’t know, I’m not going to answer.”17 We might all do well to keep our mouths shut unless we know what we are talking about. When the Yankees failed to win a fifth consecutive American League pennant in 1959, he explained, “We made too many wrong mistakes.”18 That is, errors must be eliminated to get the desired result and every mistake must be carefully analyzed to prevent it from happening again. Before making light of his saying “wrong mistake” it is worth remembering that Sir Alexander Fleming discovered penicillin by making the “right mistake” of leaving a pile of dirty Petri dishes in his laboratory when he went on vacation.19 Berra’s most famous saying, “It ain’t over till it’s over”20 requires no explanation whether one is referring to baseball, an operation, a career, or life itself.
The underlying theme in his self-deprecatory and seemingly nonsensical statements was that you should take your job earnestly and carry it out to the best of your ability, but do not take yourself too seriously. Lorenzo Pietro Berra12 knew how to make his point so it would never be forgotten. A renewed focus on his approach would make life better for all of us.
- Garagiola J (1975): Garagiola looks at his best friend Yogi. The Gadsden Times Sunday August 10, 1975 p 24.
- Trimble J (1962): The Longest day-Yanks win in 22. Detroit June 24 in New York Daily News Monday June 25, 1962.
- Murphy J (1963): Yogi’s A Comic-book character, but no clown to the Yankees. San Diego (CA) Union. 23rd. October 1963. p B-5 col 1.
- Berra Y (1998): The Yogi book. “I really didn’t say everything I said” New York, NY Workman publishing. p 21.
- Scott N (2019): The 50 greatest Yogi Berra quotes. USA Today Sports March 28, 2019 #48.
- Berra Y, Kaplan D (2003): What time is it? You mean now? Advice for life from the Zennest master of them all. New York, NY Simon & Schuster ISBN 0743244532, p 137.
- Berra Y, Kaplan D (2003): p 39.
- Berra Y, Kaplan D (2003): p 33.
- Scott N (2019): #46.
- Berra Y, Kaplan DH (2008): You can observe a lot by watching: What I learned about teamwork from the Yankees and life. Hoboken, NJ John Wiley & Sons ISBN 9780470079928.
- Daley A (1950): New York Times May 22, 1950.
- Blount R Jr (2014): Yogi: What did Berra say, when did he say it and what does it all mean? Sports Illustrated September 16, 2014.
- Mielach D (2012): Yogi Berra on baseball and business. Technology Media Network April 4, 2012.
- Berra Y (1998): p 25.
- Scott N (2019): #18
- Berra Y, Kaplan D (2003): p 69.
- Berra Y, Kaplan D (2003): p 101.
- Gardner H (1960): “HY GARDNER CALLING: So what else is new”. The New York Herald Tribune February 29, 1960 p 11.
- Radhakrishnan J, Ezzi M: Nobel laureate surgeons. World J Surg & Surg Research 3; article 1206, March 12, 2020 http://www.surgeryresearchjournal.com/vol-3.php
- Garagiola J in Berra Y (1998): p13.
JAYANT RADHAKRISHNAN, MB, BS, MS (Surg), FACS, FAAP, completed a Pediatric Urology Fellowship at the Massachusetts General Hospital, Boston following a Surgery Residency and Fellowship in Pediatric Surgery at the Cook County Hospital. He returned to the County Hospital and worked as an attending pediatric surgeon and served as the Chief of Pediatric Urology. Later he worked at the University of Illinois, Chicago from where he retired as Professor of Surgery & Urology, and the Chief of Pediatric Surgery & Pediatric Urology. He has been an Emeritus Professor of Surgery and Urology at the University of Illinois since 2000.
Highlighted in Frontispiece Volume 14, Issue 4 – Fall 2022