What does it take to become a surgeon?

What would it be like to be a surgeon, with the power to decide if and when an operation is performed?

What is life like in current times for a general surgeon in private practice approaching middle age, amidst all the changes in health care?

If you’re interested in these questions, you’ll want to read the new memoir by Dr. Paul Ruggieri, a New England surgeon who suffers from a case of cacoethes scribendi (‘writer’s itch’). Fortunately, Dr. Ruggieri’s attempt at a cure for his condition gives us all a window into his life and his thought processes. Previously the author of three surgical texts, this is Ruggieri’s first book for a general audience. He writes clearly and vividly, and has the twin gifts of writing in non-technical language and an ear for dialogue, both internal and external.

His book is as much about his conversations with himself, his doubts, and his surgical tools as it is dialogue with patients, their families and nurses.

Ruggieri calls his book a “love letter” to his patients. In many ways, the narrative is a mea culpa: he expresses guilt over mistakes that he’s made, doubts about his abilities and his motivation, and outright anger over the worsening state of practicing surgery in America.

He saves his deadliest venom for what he views as absurd mandated policies (usually regarding superflous documentation in the name of safety) that infringe on his right to practice his craft and provide neither greater safety nor better outcomes. His chapter “Thoughts on Death and Lawsuits” provides candid insight into the culture of fear that pervades medical practice in the U.S.

Ruggieri comes across as a ‘typical’ surgeon. He admits that he doesn’t like to be a team player. He takes full responsibility for his actions. He has a militaristic style; he demands accountability from those that serve under him (Ruggieri served three years in the Army). He has a temper, and he prefers single malt whiskey. Besides his work, that’s one of the few personal details we learn about him.

No one ever said surgery isn’t all-consuming. But I would have liked to learn more about Dr. Ruggieri’s life outside the hospital.

Maybe that’s the point.

If you’re interested in an excerpt, the Wall Street Journal ran a piece in its Weekend edition.