There’s no such thing as routine surgery, except yes there is

On a March Wednesday in 1653, a 20-year-old Londoner named Sam Pepys lay spreadeagled, four limbs tied to bedposts, screaming.

He was drunker than usual for nine in the morning, and for good reason: Sam was having surgery to remove a bladder stone. He was having 17th-century surgery, the only kind available in his day.

Joseph Lister was pioneering antiseptic surgery less than a mile from where Sam lay tied to the bedposts, but Lister refused to offer his new techniques to Sam’s physician, using all the old excuses: “My techniques are too new, my methods are untested, I’m living 200 years in the future,” blah blah blah.

The pioneers of anesthetic surgery were likewise unhelpfully unborn, but they had the additional excuse of working in a whole different country. So Sam Pepys’ doctor used what little science he had: he got the patient drunk, tied him to the bedposts, then stabbed and sawed away until, in a gush of blood and urine, out rolled a stone the size and shape of a King Edward potato.

Sam survived the surgery for some reason, celebrating the removal of the stone each year with a party on the same March day. Each year at that party, in the center of the table of hors d’oeuvres, mounted in a stunning teak box, sat the guest of honor, the founder of the feast—the stone itself.

Thanks to a hundred medical advances since the 17th century, I don’t even remember being tied to the bedposts when I had my gall bladder out, 12 years ago today. Four standard Band-Aids covered the relative pinholes through which a tiny camera and tools were deployed to remove the mutinous sac. I was told to avoid fried chicken for a while and sent home. Good century.

In the weeks leading up to the surgery, I had to decide whether to worry about dying on the table. There’s no such thing as routine surgery, they say. Google the phrase “routine gall bladder surgery” and you’ll find the phrase “what was supposed to be” pinned to the front of it, over and over, in articles on the deaths of Andy Warhol, Dan “Hoss Cartwright” Blocker, and Congressman John Murtha. Another man was rendered paraplegic by the same surgery and a woman sustained severe brain damage. It usually happens when one of the tools nicks the large intestine. Infection sets in, then sepsis, then (sometimes) death.

My son Connor, 14 at the time, heard these stories and started worrying about me. It was a good opportunity to chat about one of my favorite insights: the news paradox.

There are countless real dangers in the world, things that have a high statistical likelihood of taking us out of the game. But common killers like car accidents and smoking don’t make the news for a good reason: they are common. Something that actually hits the collective radar is uncommon by definition. Otherwise, it wouldn’t be newsworthy.

So a good rule of thumb: If you read about a threat in the newspaper or hear about it in the news—like terrorism, Ebola, or murder hornets—you can generally relax. It’s almost certainly not going to get you. It’s those things you don’t hear about, those pedestrian everyday killers, that deserve your cortisol.

Once I’d seen the names of the same three celebrity gall bladder victims for the fifth or sixth time—Andy Warhol, Dan Blocker, John Murtha—I knew the news paradox was in play, and I began to relax. When someone dies during open-heart surgery, it’s sad, but it doesn’t shock. But a handful of people go down after a “supposedly routine” operation and it leaps to the top of our consciousness.

Sure enough, the details often paint a different picture than the first glance. Take Warhol’s case, which was re-examined in 2017:

Warhol was dehydrated and also emaciated from having barely eaten in the previous month; had for years been taking a daily dose of speed; and was still suffering from the effects of a brush with death in 1968, when he was shot…He had been declared dead in the emergency room and had nine damaged organs. He was left with a lifetime of trouble eating and swallowing, as well as a split in his abdominal muscles that gave him a large hernia. (He wore girdles to hold in his bowels.) So in 1987, on top of the tricky gallbladder removal, Dr. Thorbjarnarson would have had no choice but to repair Warhol’s abdominal wall.

Okay then.

Of the half-million Americans who have gallbladders removed each year, 99.9% have no problem—and some of the others had been dehydrated, starved, jacked up on speed, herniated, and/or shot in advance. Good to know.