Hektoen International

A Journal of Medical Humanities

Pain versus survival

Marissa Armoogam
Trinidad & Tobago, West Indies


Jan De Doot who suffered pain to remove a bladder stone
Painting of Jan De Doot by Carel van Savoyen. 1650s. Portrait Collection of the Laboratory of Pathology, Leiden University. Via Wikimedia.

Pain has long been a given in any surgical procedure, but thanks to the many advances in medicine and particularly in anesthesia, the experience of insurmountable pain has been greatly quelled. There have been, however, cases when men or women have been thrown into the all-consuming grasp of pain by mere unfortunate circumstances. In history there are records of such persons who made the choice of enduring pain in order to survive.

One such man was a Dutch blacksmith named Jan De Doot, who performed his own open cystolithotomy with the assistance of his relatives. He had the stone cutter perform earlier similar procedures but could not handle the pain inflicted by another’s hand so, he took it on himself to remove a bladder stone that was causing unbearable pain. He made an incision and removed a bladder stone the size of a chicken’s egg, which it is rumored he kept and later painted gold. The memory of this was later immortalized in a painting of De Doot and his egg, displayed in a laboratory in Leiden.

Another such man was Aron Ralston, who in 2003 was climbing in the mountain area in Utah when he fell and his arm was trapped by a falling boulder. He tried unsuccessfully to free himself by breaking the boulder apart with a knife, and time was against him. After five days, his food and water had become depleted, and he even had to drink his own urine. As the days passed, he was becoming weaker and even carved his name and date of birth into the rock in case his body was found after his death. He had to act fast and decided to use the weight of his body to break the bones of the trapped arm, then used his knife to cut through layers of flesh, tendons, and muscle until he completely severed his arm. Before he left, he took one last picture of his hand. He was later found and taken for emergency care.

In another case, the twenty-seven year old Soviet doctor Leonid Rogozov was stationed in Antarctica when he became ill and developed appendicitis. He and his team were so isolated that help had not been able to arrive in time. As the only doctor on his team, he knew that to survive he would have to perform his own appendectomy. His team helped him prepare and he used local anesthetic on his abdominal wall but began feeling pain the minute he began to handle his internal organs. The surgery lasted two hours. Before the surgery he had made sure to instruct his staff on what to do were he to pass out from blood loss or pain.

Aron Ralston who suffered pain to remove his own arm
Aron Ralston in the mountains of Central Colorado. 2009. Collection of Aron Ralston. Photo by Michael Alvarez, Aron Ralston. Via Wikimedia. CC BY-SA 3.0.

In 1921, Dr. Evan O’Neil Kane also removed his own appendix. This was not planned or even needed as he was already in the operating room waiting for the surgeon but decided to do it himself. He directed the staff of the theatre to stand by, positioned his body, and made an incision using mirrors. When he leaned too far forwards and spilled his intestines out his abdominal cavity, he simply put them back and continued the procedure. He finished within thirty minutes. Later he died after attempting to do a hernia repair on himself.

Trepanation, the procedure of making a hole made through the skull to the surface of the brain, was first used on domestic animals to treat infections. It is used to remove tumors or treat other conditions. In the early 1970’s Amanda Feilding believed she was in dire need of trepanation to improve the quality of her brain. Turned down by several medical practitioners, she decided to do it herself. Being an English drug policy enforcer, she had in hand some anesthetic drugs which she administered to herself and later used a dental drill to perform the trepanation. Later that evening she bandaged her head with a head scarf and went out for the afternoon. Feilding ran for the British parliament twice in 1979 and 1983 in an effort to promote trepanation along with many other medical practices, and founded many groups and organizations.



  • “Auto appendectomy: a case history”, International Journal of Surgery, vol.34, iss.3, pp. 100–102, March 1921.
  • Murphy LJT (1969). “Self-performed operations for stone in the bladder”. Br J Urol. 41.
  • Jenkins, Mark (August 1, 2003). “Aron Ralston – Between a Rock and the Hardest Place”. Outside Online.
  • Carhart-Harris RL, …, Feilding A, Nutt DJ (2016). Neural correlates of the LSD experience revealed by multimodal neuroimaging. Proceedings of the National Academy of Sciences, 113(17), 4853–4858.



MARISSA ARMOOGAM is a phlebotomist by profession and has spent the past 20 years working at a general hospital on a small Caribbean island called Trinidad. She is a self-taught writer and has several published pieces of writing and poetry. She also writes on her personal devotional blog. She is the mother of two teenagers. She has been writing since she was 22 and has found writing to be one of her dearest passions and avenue for expression. She hopes it becomes one of her greatest accomplishments and dreams of publishing her own novel someday.


Fall 2021  |  Sections  |  Surgery

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