The Transformative Arts of Surgery--and Origami

(Featuring the Weitlaner Retractor - an original paper-folding creation)

Arthur P. Delos Reyes, M.D.

NEOUCOM, Class of 2009

       The premise of folding a single square sheet of paper without cutting is known as origami, the Japanese art of paper folding. While other art forms like painting are additive (where paint is added to a canvas), and others are subtractive (stone is chiseled away from a marble slab), origami is purely transformative.  It starts with a single square, and after folding the completed model, it can be unfolded back to its original form.  

       In contemplating my approaching residency and career, I draw many parallels between origami and surgery.  Both are transformative processes, though not exactly the same.  Practicing origami and surgery place require a similar mindset and intense focus.  Both require hand skills for proficiency, and both are a series of steps, each closely dependent on the last.  Surgery within the operating room is an endeavor in perfection.  Like a folded paper model, the result can sometimes hide the struggle and flaws within its folds.  There is always room for improvement, and preparation can always be streamlined.  When done with precision, both origami and surgery are elegant in their execution and graceful in their completion.  

       Origami, for the enthusiast, is like playing a musical instrument—one does not necessarily need to create original works to be considered an artist.  I have been folding paper for years, and have yet to create a completely original origami model of my own.  I look to my current experiences in the operating room for inspiration.  

       For the medical student, their first exposure to the practice of surgery is the humble task of retracting.   Tissue and skin Retractors come in many forms—from delicate skin retractors (Sennes) to Army-Navy's, from Deavers and sweethearts to Richardsons (Riches).  For all its diversity, there is one thing common to all retraction: it usually involves being hunched over in an uncomfortable position for long periods of time, sometimes hours.  At the end of the day you feel it in your back, in your forearms, and in your legs.  After spending enough time in the operating room, you come to the realization that the attending physicians are doing you a great service.  Asking a student to retract is an invitation to take a front-row seat amidst the action.  It may be disconcerting to realize that surgery can be done properly without student retracting expertise.  Supplanting the student retractor is the self-retaining retractor which does the job without complaint.  The most common self-retainer, the Weitlaner,  willingly gives up its job for the sake of student learning.  The first of my original origami works is a tribute to Weitlaner, or the “Wheaty” as it is affectionately known in the operating room. 

YouTube Video - Dr. Delos Reyes's time-lapse sequence compressing two hours of paper-folding into two minutes of video: