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Years ago, Dr. David Schneider was driving to the hospital, where a woman who’d suffered a gruesome foot injury—a bone was protruding from her ankle—awaited his scalpel. The Denver orthopedic surgeon was preparing himself to deliver dreadful news. She’d be lucky to keep the leg. But before he could, the patient relayed her own demands: I want to play softball this summer; I want my leg to work perfectly; and I don’t want to see scars. Schneider made all three wishes come true. The incident, however, spurred him to tell his assistant that no one appreciated how far surgery had come. “She said, ‘You should write a book,’ ” recalls Schneider, now 54. So he did. The Invention of Surgery was published in March 2020 and drew acclaim from the Wall Street Journal—and criticism from his industry. Recently, we spoke with Schneider to get the bloody truth behind surgery’s milestones.
5280 Health: In the 19th century, surgeons went from battlefield butchers to respected physicians. What happened?
Dr. David Schneider: Prior to the 1870s, no one believed in germs. You believed in bad air. Maybe it’s the planets. Maybe the gods. Then researchers proved bacteria are real, and Joseph Lister—probably the most important guy in the history of surgery—comes up with the idea of washing your hands before operating, which accomplished the unthinkable: that you could do surgery in the abdominal cavity.
So surgeons could suddenly operate in a sterile environment?
Exactly. You had these battlefield injuries where someone was stabbed in the guts, which you cannot survive if a surgeon can’t get in there, wash it out, close up the puncture, and get all the poop out [without leaving outside bacteria behind]. For the nonmedical person it’s tough to conceive: You have this long tube running from your mouth to your anus, and it’s filled with bacteria. Outside of that, it’s completely sterile. There’s not a single bacteria outside of the tube. If you’re stabbed, all that bacteria in the poop is in that cavity, and you will die. Always. And it will take two or three days. You’ll wish you were dead.
Fast-forward to today. You write that Americans are part of an uncontrolled experiment when it comes to joint implants. How so?
Unfortunately, the United States has been very slow to do true outcome research, what we call registries. If Scandinavians have a joint replaced, 100 percent of those people are then followed longitudinally to see how they fare. What that does is give us an idea to see, Wait, we shouldn’t try this type of implant on someone who has such and such disease. I’ve made surgeons mad at me, I’ve made hospitals mad at me, the device manufacturers are mad at me, insurance companies are mad at me, probably people in the government are mad at me. But all five of these groups should be interested in coming together and tracking patients. It would be costly, but it’s the right thing. You have a better idea of how a muffler is going to do on a Nissan Sentra than how a total shoulder implant is going to do in a human.
The future of implants, especially brain implants, sounds like science fiction.
Already, doctors can insert a six- to seven-inch needle into the brains of Parkinson’s disease patients and, by turning on a low level of current—it’s called deep brain stimulation (DBS)—almost completely make their bodies stop shaking. In Denver, we have one of the busiest DBS surgeons in the world, Dr. David VanSickle. He can turn off someone’s Parkinson’s by aiming for a one-by-one-millimeter spot in their brains.
That sounds like great news. So why did you write that “Homo electrus mostly freaks me out?”
Because in the future, your iPhone is going to be in your brain. We’re going to be able to communicate with each other via Bluetooth when we’re not even talking. Your lips aren’t moving. If you and I are in the same room, we’ll just be thinking to each other. Doesn’t that freak you out a little bit?
Schneider’s top tips for ensuring your implant surgery doesn’t kill you.
- Find a surgeon who specializes in the procedure you need. (You wouldn’t hire a plumber to fix your roof, would you?)
- Ask your doctor where he or she performs surgery and check that hospital’s outcomes (such as longevity, percentage of the time particular operations have to be redone, and infection rates).
- Access other countries’ registries to research the performance of the implant model your surgeon plans to use