Scalpel, Please

Scalpel, Please — Wrist to Risk Predictions

Killian Frances — Thu, 17 Jul 2025 10:30:21 GMT

“Surgeons can cut out everything except cause.”
― Herbert M. Shelton

The First Cut

While everyone else is worrying about robots replacing their jobs, healthcare keeps beating to its own rhythm. Sure, AI is coming—but if you're aiming for stability, meaning, and upward mobility, this field still delivers.

According to U.S. News, here are the top healthcare jobs heading into 2025—ranked by projected growth, salary potential, and future prospects. It’s a lineup worth noting, especially for those looking to enter medicine without committing to a full MD.

#1 Nurse Practitioner
Projected growth of 46% between 2023–2033
#2 Physician Assistant
5.5% increase in median salary from 2023 to 2024—on a steady climb
#18 Registered Nurse
Job satisfaction climbed to 52% in 2023, up from 36% the year prior
#42 Surgical Technologist
Low-cost entry with a median salary of $62,830
#45 Paramedic
6% job growth projected through 2033—above the national average

But here’s the flip side: if these alternatives are gaining traction, what’s happening with med school?

Scalpel, Please — The Robot Will See You Now

Killian Frances — Tue, 15 Jul 2025 10:31:08 GMT

“Poor is the pupil who does not surpass his master.”
― Leonardo Da Vinci

The First Cut

Good morning.

Self-checkouts didn’t ask for permission. They just showed up—and cashiers disappeared. Do you think anyone thought they’d be replaced by a machine?

Now AI is creeping into everything: code, copy, classrooms. And yes—even the OR.

This week, we’re cutting into the rise of surgical automation, revisiting a surgeon who once crossed

species—and ethical lines—in pursuit of a breakthrough, and scanning the latest in medical news and

tech. We’ll end on a lighter note—because even in the sterile field, humor survives.

We’ve always said, “healthcare will never go away.”

But does that mean we won’t?

Let’s Scrub In.

Prepped & Draped

In 2022, Axel Krieger and his team at Johns Hopkins unveiled STAR — the Smart Tissue Autonomous Robot — which successfully performed autonomous laparoscopic surgery on a live pig in a tightly controlled, pre-planned setting.

By 2024, at the Conference on Robot Learning in Munich, researchers from Johns Hopkins and Stanford showcased the next leap: a da Vinci robot trained with imitation learning and ChatGPT’s backend. After studying hundreds of real surgical videos, it mastered core tasks like lifting tissue and suturing. “A significant step forward toward a new frontier in medical robotics,” Krieger said.

He wasn’t bluffing.

By July 2025, Krieger’s team debuted the SRT-H — the Surgical Robot Transformer-Hierarchical — designed to perform an ex-vivo cholecystectomy with full autonomy. The robot learned by watching videos of Johns Hopkins surgeons remove gallbladders from pig cadavers, reinforced with task-specific captions outlining the procedure’s 17 key steps.

SRT-H performing an ex-vivo cholecystectomy

Though slower than a human — not unlike a surgical resident finding their footing — the robot successfully performed an ex-vivo cholecystectomy with 100% accuracy. More impressively, it adapted in real time to deliberately introduced challenges: anatomical variations, blood-like dyes, and shifting start positions.

Personally, I think this is a great feat — and incredibly ~~scary~~ interesting. The team at Johns Hopkins plans to test the model on more types of surgeries but stresses that “the real test will be how safely and effectively the findings of this study can be translated into human trials.”

The Mayo Memo

The Table-Mounted Titan

Dr. John Bookwalter, who passed in May at age 89, gave surgery one of its most reliable workhorses: the Bookwalter retractor. It’s not just a retractor — it’s an extra set of hands, a battlefield scaffold, and a fixture in major cases. If you've ever wrestled with the post or fumbled with the rings, you’re part of his legacy.

Photo courtesy of Atamaniuk

For those in the field — or those who may find themselves there someday — remember: every individual piece of the Bookwalter (or any retractor system) must be counted. It’s not just protocol; it’s protection against RSIs (retained surgical instruments), one of the most preventable yet devastating surgical errors.

Here is a great video breakdown discussing counting and assembly

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Past in Practice

While scrolling through famousbirthdays.com, I stumbled upon a man named James D. Hardy.
He was an American surgeon who performed the first successful lung transplant in 1963 at the University of Mississippi Medical Center. The patient, John Russell, made the case even more complex—he was serving a life sentence for murder at the time of his admission.

Hardy never spoke directly with Russell about his sentence, but state officials were contacted behind the scenes, suggesting they might look favorably on commuting it if Russell chose to “contribute to human progress in this way.” He died eighteen days later.

Hardy was a man of surgical firsts—and controversy.
Following his lung transplant milestone, he set out to attempt the first heart transplant. But this wasn’t the kind of transplant you’re likely imagining.

In the early 1960s, a handful of surgeons had transplanted chimpanzee kidneys into thirteen human patients—a bizarre but oddly encouraging precedent. Inspired by this, Hardy acquired four chimpanzees to keep on standby.

Then, in 1964, a patient named Boyd Rush was transferred to Hardy’s team after being found with a faint pulse. His stepsister signed a broad, open-ended consent form that read:

“I agree to the insertion of a suitable heart transplant if such should be available at the time.”

As Rush’s condition deteriorated, a trauma patient in the ICU—diagnosed as brain dead—was identified as a potential heart donor. But brain death was not legally recognized at the time, and using that heart could’ve triggered serious legal consequences, since the donor’s heart was still beating.

The Vote in the OR

Hardy convened his team in the operating room. He polled them:

One assistant abstained.
One gave a firm yes.
Two others nodded quietly.

The consensus—barely there—was enough. With the legal option off the table, Hardy proceeded with his backup plan.

He transplanted the heart of a chimpanzee into Boyd Rush.

It began to beat. And continued—for about an hour.

The aftermath was brutal. Hardy was met with “icy disdain” from colleagues, and his institution faced sharp public criticism. What had been a bold experiment in xenotransplantation was viewed instead as a reckless, premature leap.

Yet Hardy had moved the line of possibility forward. Three years later, South African surgeon Christiaan Barnard would perform the first successful human-to-human heart transplant—a moment that redefined modern cardiac surgery.

Hardy’s legacy is complicated. But it’s also a reminder that the frontiers of medicine are rarely advanced without discomfort, doubt, and an uncomfortable kind of courage.

Rounds Report

Prairie Dogs Plead the Fifth in Arizona Plague Case

A Coconino County resident has died from pneumonic plague, likely linked to infected fleas carried by prairie dogs. Human-to-human spread is rare, but the desert’s looking a little more medieval this week. 🔗 Read More

Surgery Meets Sleep: New Tech Targets Apnea at the Source

CHI Health is implanting a pacemaker-like device to treat obstructive sleep apnea by stimulating airway muscles during sleep. For some, it could mean ditching the mask for good. 🔗 Read More

A Mother’s Mission Turns Grief Into Action

Massachusetts State Representative Kate Donaghue is channeling personal loss into public service, pushing for stronger substance use education and prevention after losing her son. 🔗 Read More

The Second Count

Raytecs? 7-8-9-10.

That’s all for today — thanks for scrubbing in.

Stay sharp, stay curious, and above all: don’t lose track of your instruments (or yourself).

Check below for what is on the docket for Thursday as well as some information on how you could save a life.

Case to Follow

On Thursday: Consumer wearables, job market outlooks, crazy headlines and much more!

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Would You Carry Narcan?
Overdoses can happen anywhere — in a bathroom stall, at a concert, on your commute. Carrying Narcan (naloxone) is one of the simplest ways to be prepared to save a life. It's safe, easy to use, and legal to carry in all 50 states.

If you're interested in getting Narcan for free, check out Next Distro. Fill out a quick questionnaire and have nasal naloxone sent to your door, for free

Scalpel, Please — This Might Hurt a Little

Killian Frances — Sun, 13 Jul 2025 10:30:15 GMT

“Every intern makes mistakes. The important thing is neither to make the same mistakes twice nor to make a whole bunch of mistakes all at once.”
― Samuel Shem, The House of God

Welcome

I’m a Surgical Tech student currently finishing the didactic portion of my program and beginning my clinical residency. I love surgery and medicine, and I’ve chosen Substack as a platform to share what inspires me, highlight relevant news and stories, and create a consolidated space to provide resources for fellow Surgical Tech students.

While this newsletter is especially helpful for those on the surgical tech path, it’s designed to cast a wide net—offering value to everyone in healthcare, from patient care techs and first responders to nurses, nurse practitioners, physician assistants, and physicians.

What to Expect

Scalpel, Please is a twice-weekly dispatch from the world of surgery and medicine — equal parts educational, observational, and occasionally irreverent. It’s written for those who live in the operating theatre, those training to get there, and those simply fascinated by what happens beyond the scrub sink.

Here’s what you’ll find in your inbox:

Surgical spotlights — recent published articles, surgical innovations, and evolving technology, broken down without the jargon overload
Curated current events in medicine, health policy, and hospital culture — filtered through a surgical lens and a healthy dose of skepticism
Features on the strange, specific, and unseen — the tools, habits, and historical tidbits that shape the OR
Scut work & side notes — memes, links, things overheard, and whatever’s floating around the locker room this week
And much more!

This newsletter will evolve. As it grows, so will the content, so I ask that you please bear with me as I enter uncharted territory and my first leap into content creation. You might come for the clinical pearls, but stay for the oddly satisfying moments where medicine, policy, and human behavior intersect.

Thank you for taking the time to read and I hope you decide to come back.

Case to Follow

The official start of Scalpel, Please will commence on Tuesday morning. See you there!

On Tuesday: exploring AI in the operating room — what it's actually doing, what it thinks it's doing, and where the scalpel still beats the algorithm, plus much more.