Gut Feelings: Monologues of a Pediatric Surgeon

On the page of a Facebook friend, I noticed a reference to an autobiographical book recently written by Dr. Alberto Peña, a pediatric surgeon who revolutionized the way surgery is performed to correct anorectal malformations in babies in 1982. Considering I was born with such an issue in 1979, I was very curious to hear about Dr. Peña's life and the impact he made on his patients and their families. It only took me six days to read his book, and while it provided me insight into pediatric surgery, it also corrected a misconception I had about my own surgery in 1980.

For my third "Gut Feelings" post, I feel it's important to share my thoughts on his book and also revisit my own past a bit more. I'll start with the essential bibliographical information; take note that presently his book is only available through BookMasters/AtlasBooks.

Book Details:
Peña, Alberto
Monologues of a Pediatric Surgeon
n.p.: n.p., June 2011
360 pp. $25.00
0-9846432-0-6

Chances are that you have met someone who was born with an anorectal malformation, but you likely didn't know it. About one in 5,000 children are born with such an issue. Although Dr. Peña is a pediatric surgeon in the larger sense, the work he has done with anorectal and urogenital defects has been his primary legacy.  Dr. Peña is the founding director of the Colorectal Center at Cincinnati Children's Hospital.  He has impacted many parents and their children with his surgical techniques but also with his heart.  Although I've never met the man, his book provides an extensive background behind his life's work.

Dr. Peña's book, Monologues of a Pediatric Surgeon, is roughly divided into four sections: his personal autobiography, his specific surgical contributions, stories of parents and children he has known, and his observations and personal/professional advice in medicine.  While most books have a specific target audience, Dr. Peña instead reaches out to several audiences: parents, aspiring and expert surgeons, and the general population.  It's a strategy that risks losing his audiences at certain points of his book, but overall I found his book to be enlightening and entertaining.

As Dr. Peña notes himself, his native language is not English which made it a challenge for him to write this book.  It's noticeable when reading, but it does not take away from his stories.  There is also extensive medical terminology throughout, but he helpfully defines those terms with footnotes on each page.

Dr. Peña's beginnings in pediatric surgery were profoundly affected by a family tragedy, the loss of his young son to a congenital malformation, which later provided him purpose in caring for other children and relating to the parents of his patients.  He holds faithfully to the belief that doctors should listen and empathize with patients and their families, a values system that seems to be in danger in the changing medical field that emphasizes accountability and inhibits meaningful, caring doctor-patient relationships.

I found it striking that there are still many "facts" in the medical field that are based on theory, as Dr. Peña points out.  There is allegedly a structure located within every human body called the "puborectalis sling," a term coined by Dr. Douglas Stephens, an Australian doctor who was the first to do specific work with anorectal malformations in cadavers in the 1950's.  Dr. Stephens' research emphasized the importance of maintaining the integrity of the puborectalis sling when performing surgery.  However, Dr. Peña's research indicated such a structure doesn't exist.  Intriguingly, many doctors still believe it does exist - if one searches for the term on Google, it's all over the internet.  Since I'm certainly no doctor, I don't know who is right in this matter; but it's unnerving to know that the anatomy of the human being is still not fully understood.

Dr. Peña's research into anorectal malformations led him to create a surgical procedure in 1980, now called the Peña pull through procedure.  It was a drastically different approach partly because it involved a larger incision than was standard practice.  Prior to the Peña procedure, surgery to correct anorectal malformations was done blindly; one can imagine the array of complications that could occur when the site of surgery isn't even visible!  Today, thankfully, his procedure is the standard practice.

In all likelihood, my own surgery was done blindly.  Dr. Peña's procedure was not introduced publicly until 1982, two years after my surgery.  I am lucky, however, in that there were no significant complications, as far as I am aware.

Anorectal and urogenital surgery is not a common topic among the general public.  We as human beings tend to find it unpleasant.  Dr. Peña poignantly states in his book that history has shown, "it is not an elegant subspecialty because it deals with stool, urine and sex - all relatively awkward concepts to talk about socially."  I can plainly identify with this, as shame has been a constant companion when it comes to the personal issues I experience.  When compared to others with similar conditions as my own, my physical symptoms throughout life have been better on the whole.  But it does not take away from the fact that living with "issues of the bowels" can be socially challenging.  I envy those in similar situations who can take their conditions more lightly with humor. 

If you are a parent with a child with an anorectal, urogenital, or any type of congenital malformation, I think you'll find this book to be helpful.  It provides such insight into the thoughts and feelings of a pediatric surgeon who is among the most expert in these areas.  There are some truly heartwarming stories that Dr. Peña relates about the families he has met.  It helps to know you're not alone and that there are doctors who genuinely care. 

I also recommend joining the Pull-Thru Network, an organization that advocates for and supports families who are affected by anorectal malformations and colon diseases.  This group publishes a regular newsletter and holds a national conference every two years.  Dr. Peña is also a medical advisor for the Pull-Thru Network.