Tuesday, October 14, 2008

Reinterpreting Dylan in the OR

For many years now, I have (unsuccessfully) tried to understand the creative process -- especially in music and writing. I am a fairly one-dimensional, black-and-white kind of a guy, and it is difficult for my underdeveloped right brain to reach its tiny tentacles out and get a grasp on, say, songwriting. My daughters, graced with the musical talents their father so plainly lacks, can explain the rudiments of music theory to me, but that's sort of like showing a watch to a pig. I have read an interview with Stephen King, who once stated that at one highly creative point in his life, he simply could not type the words tumbling out of his brain fast enough. Joan Baez described Bob Dylan at one point as a songwriting machine:

Even in the summer of 1964, when they were enjoying an idyllic affair, Ms. Baez notes, ''He was turning out songs like ticker tape, and I was stealing them as fast as he wrote them.''
Somewhere along the line, that process slowed -- I don't believe these folks run out of creativity, but perhaps they become a bit more selective in what they choose to produce.
Back in April 1991, Dylan told Paul Zollo that "there was a time when the songs would come three or four at the same time, but those days are long gone...Once in a while, the odd song will come to me like a bulldog at the garden gate and demand to be written. But most of them are rejected out of my mind right away. You get caught up in wondering if anyone really needs to hear it. Maybe a person gets to the point where they have written enough songs. Let someone else write them." (source)
Just as interesting, and frankly just as opaque to me, is the process of adaptation --- reworking another's song or story and making it uniquely your own. Dylan's songs have probably been retooled more times than any other songwriter in the past few decades --- an aching and plaintive song, "Make You Feel My Love," has been covered by Billy Joel, Garth Brooks, Neil Diamond, Trisha Yearwood, Joan Osborne, Timothy B. Schmit, Bryan Ferry (sorry, but this is the worst of the lot), some British pop tart named Adele, and Lord knows who else. In some ways, I would say that when truly successful this is perhaps harder than writing a song of one's own --- the best example of this I know of is Lyle Lovett's version of the Tammy Wynette classic "Stand By Your Man" (trust me, it's quite a piece of work). If you are anything like me, it is often the first version of a song you hear that becomes your favorite.

I wonder, though, how musicians react when they are given a truly difficult --- maybe even awful --- song that they absolutely must perform. And then what would they do if, rather than their own finely tuned instruments, they were given K-Mart Blue light specials? If you will pardon my stretch into the creative world, I would like to make the case that such is the fate of the average surgeon.

Take, for example, the right hemicolectomy. This is standard fare for lower level surgical trainees, an operation that is relatively common and which generally requires the application of straightforward surgical principles, regardless of whether it is performed laparoscopically or with an incision. And, when everything goes as planned --- the uninitiated would say "as expected" --- it is nice, elegant procedure. What could be better?

Let's change the scenario, just enough to get a surgical "musician" off key, perhaps. Add 75 pounds to the patient's frame, and you turn a relatively straightforward operation into one which will take longer, is more difficult, and has a higher likelihood of postoperative wound infection. Adhesions from previous surgery can obscure the "score" the surgeon must read from, requiring a bit of improvisation; anatomic variations call for more of a virtuoso performance, appearing without warning and generating confusion.

You see, not every patient arrives in the OR with a body straight out of a Netter drawing. And complicating factors such as diabetes, sleep apnea, heart disease, anticoagulation use, and the like means that the average general surgeon may be less like a virtuoso than a journeyman musician who has to play whatever instrument he is handed on any given night --- which may be a Stradivarius or a plastic ukulele.

Don't let me fool you into feeling sorry for me. This is, in large part, what makes my job interesting. And it is about as creative as I ever expect to get.