The first cut

The First Cut

It was a different era.
An era that would be unrecognisable now.

Back then, surgeons could do almost anything — and allow almost anyone to do anything — provided there was trust, judgement, and a shared understanding of responsibility. Governance was lighter. Consent was broader. Apprenticeship was real.

I was a fourth-year medical student, enthusiastic in the way only someone not yet burdened by consequence can be. I had heard the rumours, passed quietly between students like folklore: there was a surgeon who let medical students do things. Not hold retractors. Not cut sutures. Actually operate.

One of my colleagues — super-motivated, tireless, almost evangelical in his commitment — had been turning up to this surgeon’s theatre list every Friday for a year. He told me he’d once been allowed to perform a spinal decompression. With hindsight, that sounds absurd. At the time, it felt just plausible enough to be true. And in those days, it might well have been.

So in my first week at that hospital, I went looking for the surgeon.

I introduced myself and asked if I could attend his Friday theatre lists. He looked at me briefly, asked what year I was in, and said yes. No form. No email chain. No learning agreement. Just a quiet nod.

From then on, I made it a point to turn up early every Friday. Earlier than necessary. Earlier than anyone else. I read up on the cases beforehand — not because I expected to be tested, but because I wanted to understand what I was watching. I learned quickly where I sat in the hierarchy: behind the registrar, the SHO, and even the house officer if they managed to escape the wards in time. I knew my place.

The atmosphere in theatre was good. Relaxed, focused, collegial. There was always cake on Fridays, which helped. The theatre team were motivated; people talked; learning happened naturally. Over time, through a combination of annual leave, nights, and rota gaps, there were days when I found myself as the only person available to assist.

That was when things began to change.

At first, instructions were precise. Exact. Almost scripted. Where to stand. How to hold. When to move. But gradually, as weeks passed, the guidance softened. There was less instruction and more expectation — the unspoken assumption that I knew what came next. That I understood the rhythm of the operation. That I could anticipate rather than react.

Then one Friday, there was a child with bilateral toe deformities.

At the time, the prevailing thought was that if a child needed surgery on both sides, it was better to do it in one sitting — fewer anaesthetics, fewer days off school, less disruption. The surgeon began on one side, and I assisted as usual. I watched closely, not knowing what was about to come.

When he finished the first side, he looked at me and asked, almost casually, whether I wanted to do the other.