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Or: Why Mastery Is Knowing Which Details Are Load-Bearing 1. The Tamago Years In Jiro Dreams of Sushi there is an apprentice, Daisuke Nakazawa, who spends years trying to make one piece of egg sushi. Tamago. Sweet, layered, simple looking. He makes it; Jiro rejects it; he makes it again. By his own count he failed more than two hundred times before the old man tasted one and called it acceptable. Nakazawa wept. He had been made shokunin, a craftsman. What matters is not that

Why It Took 125 Years to Move a Mouth Graft into a Ureter, and What That Tells Us About Innovation in Surgery 1. Sapezhko in Kyiv As early as 1890, a surgeon named Kirill Mikhailovich Sapezhko, working in Kyiv, took oral mucosa from a patient’s mouth and used it to reconstruct the patient’s urethra. In 1894, he published a fuller account of this work, describing mucosa from the lip and mouth in patients with urethral disease. By the standards of the time, the operations appea

Why Surgical Training Never Really Ends 1. A Simple Procedure Early in my residency, I placed a suprapubic tube. It is a routine procedure, the sort every urologist is expected to do safely. A small incision is made above the pubic bone, a trocar is advanced into the distended bladder, and a catheter is passed. An attending appropriately supervised the case. I was neither unsupported nor unprepared. The patient died. The trocar created a small peritoneal defect. Urine leaked.

1. The Legend, the King, and the Hostile Abdomen On March 28, 1980, in a military hospital on the banks of the Nile, Michael DeBakey removed a spleen the size of a football from a dying exile. The patient was Mohammad Reza Pahlavi, the deposed Shah of Iran. The spleen weighed close to 2,000 grams, riddled with tumorous nodules from a lymphoma whose severity had been concealed from the Shah himself for years. The surgeon was the most celebrated figure in twentieth-century Amer