Congressman Billybob Sez: Incision Decision in the Senate

This here's the 331st Report ta the Folks Back Home from the (More er Less) Honorable Billybob, cyberCongressman from Western Carolina.

The “silly season” is upon us. Entirely too many folks r runnin fer president. But thas a story fer another day. Today the subjeck izza las major political change ov 2002, ta become official this week, the choice ov Bill Frist as Majority Leader inna U.S. Senate.

Ma able assistant, J. Armor, Esq., has known a buncha doctors, some ov em fer 50 years. So I’ll turn this over ta him.

The title is not a misprint. On occasion, political reporters refer to “incisive” decisions by politicians. It means knife-like, cutting to the core of things. But with the election of Sen. (and medical doctor) Bill Frist as majority leader of the Senate, this concept becomes literal.

Sen. (and Dr.) Bill Frist gave an “acceptance” speech on TV, after his unanimous selection by the Republicans during a 51-party conference call last week. His speech was good -- but too long, too vague and disappointing to the press because he took no questions afterwards. Allow me to take a stab at explaining, better than Bill Frist did, why he's a good choice for the Republicans, for the Senate, and for the nation.

First, I put my political cards on the table. I met Bill Frist when he was running for Senate and making one of his obligatory trips to Washington to show the powers-that-be that he didn't have two heads. I like and respect the man. He was my preferred choice to replace Sen. Trent Lott. My reason for thinking he's a good choice mostly has to do with medicine, not politics.

I've known many doctors, for many years. Nine percent of my graduating class from high school became doctors. One of those, Dr. Karl Mech, is a dear friend of mine since age 11. He is also a “chest cutter,” a thoracic surgeon like Frist, whose work includes heart transplants. I know much about the dedication, integrity and decision-making abilities of doctors in general and surgeons in particular, both from watching Karl grow up from an ordinary boy into a brilliant doctor, and from knowing other doctors over the years.

In medicine, heart and brain surgeons are the best of the best of the best. The selectivity is high even to get the chance to become surgeons. First they must become doctors. As they do, they must show an aptitude for surgery. Then they must endure the longest of all medical residencies. Finally, they must earn the respect of their colleagues because their patients come almost entirely from referrals by other doctors.

Does this mean that all specialized surgeons are saints among men? Not at all. A few are failures for reasons of poor skills, or for personal failures such as alcoholism or drug addiction. (It is a credit to the medical profession that it does a far better job of policing its ranks than the legal profession -– to choose a nearly opposite example of professionalism, integrity, and self-policing.)

Let me use Mech, my lifelong friend, to prove the point. When we were growing up, he was -- like many of my friends in high school -- bright, able and minimally motivated. Though his father was both a general surgeon and a professor of surgery, Karl had no clear intent to become a doctor until he has halfway through college.

As a sophomore, he chose to aim for medical school. He stacked up on biology and chemistry. He worked hard for the high grades that were mandatory even to be considered for medical school. His commitment to the most demanding area of medicine -- surgery -- was confirmed when he was the chief resident at the University of Maryland Shock Trauma Unit.

Let me tell you about the decision-making process that is mandatory for doctors in the few, specialized shock trauma units in the nation. All of them must never be more than 15 minutes from their hospitals, seven days a week, 24 hours a day. That's because that's how fast a helicopter can get to the scene of a terrible accident (usually) and transport someone who is minutes, or seconds, away from death, from there to the operating table.

A typical incident came one night when Karl was playing bridge at my home. His beeper went off just before midnight and he was on his way. Three days later, he told me (without any names of course) about his patient that night. A young man had been in a head-on crash. As Karl said, the list of his fractures covered two-and-a-half pages. Yet, six months later, that young man walked out of shock trauma, with a normal life ahead of him.

Here is the decision-making process in such a surgical theater with a patient with critical injuries. It has direct relevance to what we can expect from Sen. (and Dr.) Bill Frist. Around the table are gathered medical experts in all the needed areas. The lead surgeon has to decide in minutes -- seconds if possible -- what injuries are immediately life-threatening, and set the team to work on those. Step by step, as each most critical problem is under control, attention shifts to the lesser problems.

For heart surgeons, every operation is as critical as that. Every patient's life is on the line. The surgeon never takes a poll to determine what to do. He has to have the basic knowledge in his head and the necessary skills in his hands, when he scrubs and steps to the table. Then, he has to anticipate, and deal with immediately and correctly, any of a host of emergency situations which sometimes occur during surgery. Every other person in the operating room, including the other doctors, carry out their tasks immediately, and at his/her direction.

The responsibility for the outcome -- usually good, but sometimes fatal -- belongs entirely to the lead surgeon. He must bear that burden every day of his professional life.

The surgeon must have ability, knowledge, skill, decisiveness. And he must be fully responsible for his decisions. As the punch line of an old joke goes, the surgeon must not only know how to cut, he must know where to cut and why. That is the nature of “incision decision-making.”

The only thing missing from what is found in the best political decision-makers is a sense of humanity. There are surgeons who are “excellent knife men,” but who are cold and aloof with live and conscious patients. Looking at Frist’s career in voluntary medicine in Africa and elsewhere, I think he is amply qualified in that area.

As the biographies of the greatest political leaders in history demonstrate, they must be able to bear down on the problem at hand, make a decision, and be confident in the outcome. That's so even when they are a majority of one, as President Abraham Lincoln once remarked before his Cabinet. In short, no matter what issues come before him, Senator Frist will never exhibit the qualities of the mediocre politician -- blowing in the wind before changing tides of public opinion, however poorly measured.

There is another characteristic of surgeons the American press will have to get adjusted to, in dealing with Senator Frist. Surgeons are not men/women of words, but of action. They speak not with well-honed phrases, but with real-world results. Frist is not a very good speaker now. I doubt he will ever become much more than an average speaker. But America has had enough examples of political “leaders” who talk a good game but play it incompetently. I think the press and the people will adjust to the style of Frist’s leadership.

Then they will come to appreciate and respect his leadership. I expect that settling-in period will take up to a year.

I have not only known a number of doctors for many years, I have watched several surgeons as they worked. (Most of my surgeries have been done under local anesthesia, so I got to watch the procedures. It has been a very educational process). Surgeons act quickly, accurately, correctly and decisively. Those are excellent characteristics in any decision-maker. But they are relatively rare in the poll-driven, appearance-controlled world of national politics.

I have much more experience with lawyers. Far fewer of them have those qualities and even those that do often lack the last, essential quality of integrity. In short, I am certain that the leadership qualities of Senator Frist will be a refreshing change from politics as usual in Washington. At first the national press will be confused by Senator Frist because he does not fit the template of what they expect in politicians. But in the long run, the press, like the people themselves, will conclude that “incision decision-making” is good for the Republicans, good for the Senate, and good for the nation.

This would be true in ordinary times. But in life-and-death times like the present, this will be especially true. Majority Leader Frist will not have to “grow into the job.” He is already big enough and strong enough for the job. The details he yet has to learn are far less demanding or difficult than the myriad details learned in his medical career.

I expect two things to occur. I expect Senator Frist to be highly successful in his new position. And I expect the national press, especially the pundits within the Washington Beltway, to be vastly surprised. I make that prediction because the political press do not begin to understand decision-making in a surgical theater, so they cannot project how it will apply in the realm of the U.S. Senate.

One comment about the hypocrisy of the Democratic attacks on Lott: Do I agree that he had to go? Absolutely. He had damaged himself, his party, and the Senate, beyond his personal ability to repair. On the other hand, there are many Democrats who have said and done things far worse and far more dangerous to the health of the Republic, than Lott did. Yet those Democrats were not forced from leadership positions.

The difference between the Republicans and the Democrats is this: The Republicans tend to dispense with their problems. The Democrats tend to protect and promote their mistakes. This explains why the American people are currently less likely to believe or respect Democrat leaders, than Republican ones.

This difference, leading to Republican successes at the polls, seems likely to continue into 2004 and beyond. And the contrasts between the leadership styles of Majority Leader Frist and Minority Leader Tom Daschle in the Senate will make a significant contribution to that result. Although all the press coverage of Frist’s selection has noted that he is a surgeon, none to date has yet laid out the special decision-making abilities which he necessarily has as a result of that.

Mark my words. Frist possesses incision decision-making. That will make all the difference.

(About the author: Congressman Billybob is fictitious, but prolific, on the Internet -- the invention of John Armor, who writes books and practices law in the U.S. Supreme Court. Comments and criticisms are welcome at CongressmanBillybob@earthlink.net).

Given the story out of Florida about Majority Leader (and Doctor) Bill Frist, this morning, the timing on this column could not possibly be better. (Even a blind pig can find an acorn every now and again.)

I think my colleagues on FreeRepublic will appreciate this.

My ex-aunt in-law was telling me all about her two sons who were lawyers. She was bragging about how wonderful and talented her sons were. She told me how hard they worked and that she we so proud.
It told her it might be true but I also told her no one works as hard as doctors do. I told her about the work my uncle had done. Also adding the hours he put in until he worked himself to a early grave. She did not like the words but her husband (ex-uncle in-law) was beaming from ear to ear. He was one of the hard working doctors all his life.

My Prepschool graduated about the same number of Doctors and about the same number of Priests, Nuns and other hard left subversives, about 30% of the graduating class.

We need to play hardball, is the Sen going to play?

"It is a credit to the medical profession that it does a far better job of policing its ranks than the legal profession -– to choose a nearly opposite example of professionalism, integrity, and self-policing..."

True, but doctors don't know squat about spin. Mark up your phony accounting ledgers and people say that you've doctored your books, not lawyered them...

< GRIN! >

Your column, unlike Bob Novak's "Frist is too nice" column, is more spot on. My sister works with surgeons as a surgical nurse. Their personalities are as you have said; they may be polite, but they don't mess around.

Great column, Congressman Billybob!

There must be a differing medical culture in this part of the country than where you are. The heart surgeons in Houston are, ( no pun intended ) heartless, cold, uncaring and show no compassion whatsoever to the point that I have eschewed a needed triple-bypass operation because I refuse to be a slave to their whims.

Don't avoid surgery because the surgeon is a cold and autocratic person. I can offer an example. I had a hemicolectomy two years ago, to deal with a situation that beforehand looked like cancer. Thank God it was precancerous, so the surgury was a complete cure.
My surgeon was one of those I describe in my article as a "good knife man." Just before my surgery, after I had signed the consent form and in front of one of the nurses, I told him I did not want a total colostomy, and if he thought that was necessary, I wanted to be closed up, informed of the situation, and give an informed consent at that point.
He said nothing, but walked out of the room in a huff. Finally, he returned, agreed to my conditions, and the operation proceeded. And he was a "good knife man." The surgery healed quickly and was a complete and uncomplicated success.
You just have to make clear to the surgeon that it is your life, and your body. Every professional -- surgeon, lawyer, whatever -- works for you, not you for them. Some tend to forget that. You just have to firmly and clearly remind them of that.
Get your surgery. And best wishes.
Cordially,

John / Billybob

In a few months the Dems will not know how to handle their "Frist Problem".

People like and trust doctors a whole lot more than lawyers or politicians. Frist will remind them more of a doctor than political hacks like Daschle and the rest of the crooks up there. They will trust him right away.

I agree. I want a man who can do the job - and better a cold fish with a steady eye and hand than a sob sister whose hand shakes . . .

Of course, if you can get a surgeon who's a hoot, so much the better. I too prefer surgery under local (general makes me REALLY sick) and had a lump (like yours turned out to be benign) hoicked out of my breast by one of the best surgeons in Atlanta, who is also an ex-Navy surgeon and a first-class raconteur. He told me funny stories throughout the surgery and had me and the nurses laughing so hard that at one point I said, "Doc, is your scalpel gonna slip because I'm having hysterics up here?" He laughed and said "It'd take worse than that, honey!" Best comment of the operation: "I'm afraid you won't be able to dance at the Gold Club (local nekkid lady bar since shut down by the feds.)" (Actually, he did such a good job that I COULD have . . . assuming that I was otherwise qualified for the job . . . :-D )

Unfortunately, my doc's not at all interested in going into politics . . . .

And good call, Congressman, on the timing. You done good!

I agree with that. I had to have a dangerous surgery to save my life, and I insisted on the best surgeon in Houston. He was not known for his "bedside manner."

Well, I didn't want mommy, I wanted the best surgeon, so I dealt with the fact that he assumed I had the IQ of a gopher, and I'm glad I did.

Great column, by the way. Frist isn't a jerk like my surgeon, but his surgical training will serve us well.

Disclaimer: Opinions posted on Free Republic are those of the individual posters and do not necessarily represent the opinion of Free Republic or its management. All materials posted herein are protected by copyright law and the exemption for fair use of copyrighted works.