3 Reasons I Don’t Teach Surgery—Even to SurvivalistsEveryone deserves the chance to survive. If you’re a longtime reader, you know that motto propels my mission. Much of the information I share here and in my books and training course is normally reserved for trained medical personnel. But I believe you have a right to know it.

Even so, sometimes I get complaints about what I don’t teach—namely major surgery. The complaints usually go something like, “How can you claim to give information on when help is NOT on the way without providing such?”

Here’s my answer: There is a limit to how much help a layperson—sometimes even a surgeon—can give. I cannot responsibly teach most surgeries. Here’s why.

1. Bleeding and Blindness

Surgery is harder than it looks. First, there’s the bleeding.

Consider this scenario, which readers often ask about:

Your friend has been shot in the abdomen. There is internal bleeding. You can’t stop the bleeding with pressure. Can you perform surgery to stop it?

Well, sure, anyone could slice open the abdomen, but that’s just the first step in a complicated process.

After your incision, you’d find that you’d caused additional bleeding not just in the skin but in the muscles and fat, which also contain blood vessels. If you hit a larger vessel, there would be a lot of bleeding.

Let’s say you knew that would happen and planned for it: You recruited someone to help—to apply direct pressure to the bleeding area—and you had the ability to clamp or suture the vessels bleeding the most. Great.

But as soon as you got into the abdominal cavity, you’d still find one big pool of blood from the original internal bleeding, with many feet of intestines stuffed in it.

Somehow, you’d have to keep the abdominal wall open (which can be a lot thicker than you’d think, due to fat), wade through the intestines and blood, and basically blindly find the often tiny source of bleeding.

2. Cutting, Closing—and Surprise!

If, instead of internal bleeding, you were concerned about something like an appendix or gallbladder—another scenario readers often ask about—you may not encounter as much blood, but you’d still have to keep the wall open, wade through those intestines, and cut out the problem.

As I explain in The Survival Doctor’s Complete Handbook (which tells how organs can be palpated—pressed on externally—to find signs of appendicitis and such), even if you know anatomy, an appendix or gallbladder can hide. It’s often not in the place the textbooks show.

If you do find the problematic organ but you cut too much or too little, you could cause an intestinal leak. Or you could nick an artery.

Oh, and it’s not uncommon for even surgeons to think one thing is causing the problem and, during surgery, find out the culprit is totally different, requiring different treatment.

But let’s assume your diagnosis was correct. You’ve addressed the problem. Next comes suturing. You must close:

  1. The cut from where you removed the organ. You’d have to suture the thin bowel wall but not poke the needle all the way through it, exposing the bowel contents.
  2. The big hole in the abdominal wall. For the body to heal properly, you’d have to suture the wall back layer by layer: first the thin membrane (called the peritoneal wall), then muscle, then fat and skin.

3. Infection

This operation would likely not be sterile. In fact, in surgical terms, it would be downright dirty. Severe internal infection would be certain, and IV antibiotics would be a must for survival.

Likely Surgical Outcome

In summary, the chance of anyone surviving an abdominal operation done in field, with minimal instruments, is slim. Throw in the fact that someone with zero experience is performing the surgery, and the chance is very close to none.

Surgery to the chest would be even worse because you’d automatically collapse a lung or two and very likely nick a big artery.

There’s not usually much need for lifesaving surgery on arms and legs, other than amputation. The question on amputations would be when to perform one, and the answer would be dicey. In addition, trained surgeons might try to repair a muscle or nerve. We can talk more about amputations in another post.

What Happens With No Surgery

Surgeons go through four years of medical school and five years of extra training. They do multiple, multiple surgeries with an experienced surgeon showing them and being around in case something goes wrong.

Yet even a trained surgeon may opt not to perform surgery in a survival situation. The decision would depend on the surgeon and location. They’d need a clean place, and they’d need at least some local anesthetic or ether for pain.

Yes, the chance of survival with a ruptured appendix or severe internal bleeding is dire, but I submit it’s better than with amateur surgery.

With the bleeding, there is a prayer, however slim, that the vessel might clot off. For someone who has never performed surgery to try to stop it surgically, the chance of survival is very close to zero (in my opinion).

In the instance of appendicitis, the chances are a little better. Sometimes the body walls off the area of infection and it doesn’t spread. Or, as I inferred earlier, the diagnosis could be wrong. Maybe all they have is a bad stomachache.

I would never, ever recommended delaying expert evaluation and treatment, but if that’s absolutely impossible, I think watching and waiting, while providing appropriate supportive care (which The Survival Doctor’s Complete Handbook covers for these issues and others), along with antibiotics if available, is a better option than having an amateur do major surgery.

What About Those Surgery Survival Stories?

When my father was young, the local country doctor performed an appendectomy on him on my dad’s kitchen table. This was relatively common back then. But the doctor had experience doing such things. Even then, my father was lucky to survive.

And it is true that there have been some successful instances of people performing, and surviving, self surgery. Take the case of Dr. Leonid Rogozov. He was stranded at a base camp in Antarctica and performed an appendectomy on himself. But even then, he had basic medical equipment, along with assistants to hand him what he needed. In addition, he was in a fairly clean environment. And he was a surgeon who had performed appendectomies before, according to BBC News. Still, he must have had quite the pain tolerance and ability to focus. More than I, for sure.

One of the things people forget about surgery is the fact that there are often unforeseen complications: a nick in the artery, a puncture in the intestine, anatomy in the wrong place, some unexpected problem such as an abscess or cancer. So not only do you need a detailed knowledge of anatomy and of how to perform surgery, but you need to know what to do if something goes wrong. There’s a reason surgeons train for years—much of that hands-on.

So instead of worrying about the fact that you couldn’t perform surgery in a survival situation, I suggest doubling down on learning what you can do. There’s plenty of that to study.


Photo: Flickr/Thomas Quine, “Antique Surgical Instruments,” shared via CC BY 2.0.