Feb. 5, 2026
The 100-Year Journey From Surgeons with Reputations to Robots with Precision
Send us a text If you're an engineer trying to figure out where you can create value, this episode shows you where to look: where values themselves are shifting. In this episode of The Engineering Passion Express, I take you on a 100-year journey from open surgery to surgical robots through three lenses: First, a sick man in 1910 traveling to New York to pick the right surgeon. Second, Dr. John Wickham, who coined 'Minimally Invasive Surgery.' And finally, Fred Moll, who founded Intuitive Sur...
If you're an engineer trying to figure out where you can create value, this episode shows you where to look: where values themselves are shifting.
In this episode of The Engineering Passion Express, I take you on a 100-year journey from open surgery to surgical robots through three lenses: First, a sick man in 1910 traveling to New York to pick the right surgeon. Second, Dr. John Wickham, who coined 'Minimally Invasive Surgery.' And finally, Fred Moll, who founded Intuitive Surgical, who along with a team of engineers brought surgical robots to the forefront.
Join me and learn how many times before an invention comes along, the values of an industry need to shift to make it the right time for the adoption of the technology to be a benefit.
The Engineering Passion Express is about growing knowledge and the passion for engineering.
If you are a conference organizer and are looking for an engineering or scientific speaker to inspire or educate in a keynote presentation, please reach out to me on LinkedIn. You can find my profile below.
Thanks for listening,
Brandon Donnelly
Please connect with me on linkedin @ linkedin.com/in/brandondonnelly
WEBVTT
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You're on the train to find a surgeon.
00:00:21.519 --> 00:00:26.960
Like those guys who use the engineered robots invented to cut you open and fix stuff inside you?
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You don't know what a robot is.
00:00:30.239 --> 00:00:31.839
What year is this?
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1910?
00:00:34.560 --> 00:00:39.439
Yikes! We must have really switched to the wrong track somewhere along the line.
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Oh well, we'll let you out here.
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We'll catch up with the proper timeline and the invention of those robots later.
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See you in the future, and enjoy the New York of 1910.
00:00:55.039 --> 00:00:57.920
I step off the train and I look at my watch.
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It's been ten days since I left on the journey from Texas to New York to the minute.
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I was seeking a surgeon, and the journey was long and arduous.
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I've had the fear of sinking in a riverboat, being robbed on a train, and I've spent a fortune of time and money all while being sick to get here.
00:01:17.920 --> 00:01:25.439
Surgeons of the 1910s have reputations built from newspaper and radio, but that's not necessarily the same as surgical skill.
00:01:25.760 --> 00:01:30.959
I braved all that on the journey to New York because that's where people say the best surgeons are.
00:01:31.280 --> 00:01:34.480
On its surface, that could be entirely false.
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There are a few things that indicate there must be good surgeons here.
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One, there's a big population.
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Lots of people means lots of sources of talent.
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Two, there's money.
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And if you're skilled and you like money, you're seeking that.
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And three, there's a reputation.
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And that reputation draws in those looking for talent, and those customers draw in the talent.
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A virtuous cycle culminating in something that started as a possible fiction, becoming a truth if the reputation persists long enough.
00:02:07.760 --> 00:02:11.280
Now that I'm here, New York City feels louder than it needs to be.
00:02:11.520 --> 00:02:15.199
Carriages, horns, voices layered on top of one another.
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Brick buildings rise too close together, as if even the streets are competing for space.
00:02:21.280 --> 00:02:30.159
Everyone seems to be in a hurry, including the men in white coats, indifferent to the sick old man trying to find a hospital in a crowded city he's never been to.
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Of course this city is loud.
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Everyone is selling something.
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Being louder than the other guy is the way some people, like the newsies, for example, survive.
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Inside the hospital, the smell hits first.
00:02:54.479 --> 00:03:02.479
Chloroform, antiseptic, something sweet and chemical that makes it hard to tell whether this place exists to heal or to harm.
00:03:02.800 --> 00:03:09.680
I sit on a wooden bench, hat in my hands, watching names move through the building before I ever meet them.
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Names whispered by porters, names printed in newspapers, names repeated with confidence by people who sound like they know what they're talking about.
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One surgeon, Lawrence Ashford, is famous.
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His reputation even arrives before he does.
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I hear about his confidence, his decisiveness, the speed with which he works.
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While another surgeon, Samuel Smith, blends in.
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Dr.
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Samuel Smith.
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A name that doesn't announce itself.
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No stories trail behind him.
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No one lowers their voice when they speak his name.
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Dr.
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Ashford and Dr.
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Smith, they both seem capable, they both seem calm.
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They both wear the same coat.
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But I don't really know how to tell which one is better.
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How does someone make a life or death decision?
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Based on reputation, when skill is what matters.
00:04:02.639 --> 00:04:04.319
No charts line the walls.
00:04:04.479 --> 00:04:05.840
No numbers are offered.
00:04:06.080 --> 00:04:11.520
There is no ledger of outcomes, no public record of who lived cleaner lives afterward and who did not.
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There is only reputation.
00:04:14.879 --> 00:04:17.920
And reputation is unevenly distributed.
00:04:19.279 --> 00:04:21.600
I notice how people stand straighter around Dr.
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Ashford, the famous one.
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How his answers to questions are shorter, and how doubt seems unwelcome in his presence.
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With Dr.
00:04:29.920 --> 00:04:32.399
Samuel Smith, the questions linger longer.
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He listens more.
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He answers carefully.
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Seemingly competent, seemingly thoughtful, but seemingly isn't certainty.
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And my life is on the line.
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I make my guess.
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It's not a decision.
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Those require weighing out facts.
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There are none of those here.
00:05:04.240 --> 00:05:07.920
As they prepare me for surgery, I wonder if I've chosen wisely.
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As the mass lowers, the smell of chloroform thickens, and who knows what happens next.
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I have no idea how we've arrived in London.
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In this place, in this time, you can feel that the values of people are in plus.
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I'm sure the ships will in the history.
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We'll see it when we get fully back to the correct timeline, I'm sure.
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All you've done is get off the tree.
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The hospital's just around the corner, and it's time you see your patients.
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No more waiting.
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Gibble, gibble, gibble, gibble.
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It's the kind of smell that grows on a man after thirty years.
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The smell of familiarity.
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After being paged, I enter the room.
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A patient rests quietly.
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Sheets pulled to the chin, John Wickham hovers nearby, checking the chart, murmuring notes to himself.
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My eyes are scanning the patient and the chart.
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Dr.
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Wickham points to a column of data that I haven't seen before.
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What is this?
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I ask.
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I've never tracked these numbers before.
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Wickham glances at me.
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Recovery times.
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Complications that don't appear on mortality stats.
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Measures of trauma we can minimize.
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I've spent decades optimizing for outcomes.
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The ones the industry rewarded.
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Mortality.
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Obvious complications.
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Textbook recoveries.
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What was Wickham trying to do?
00:07:30.879 --> 00:07:34.959
So I ask him, and you care to measure these things?
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Why?
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Wickham smiles faintly.
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Because patients care.
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If we can shorten the time it takes to return to their life, isn't that what matters too?
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I look at the numbers again.
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Unsure.
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I don't have these numbers tracked for my patients.
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Do I need them?
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Back in my own office, Jack, my next surgical consult, is asking me questions.
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Your mortality rates?
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He asks.
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I present my record.
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Decades of experience, a steady hand, results that have stood the test of time.
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The patient nods, appreciating the history and data.
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I do nothing without multiple opinions, Jack says.
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That's wise, I tell him.
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Many patients return after other consultations because my experience carries weight.
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Later, as I walk past Wickham's office, I notice that he's speaking with Jack.
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Wickham's voice is calm, precise, careful.
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He's talking about his own mortality statistics.
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Slightly higher than mine, but still within safe ranges.
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Then he moves on to what no one else has measured.
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My focus is recovery, Wickham says.
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On average, patients return to normal life two months faster.
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Less pain, fewer complications that linger beyond the hospital.
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This is what matters to you, isn't it?
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The patient listens, eyes widening.
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You can tell for the first time he imagines life after surgery.
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Not just survival.
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His questions about mortality fade into the background.
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He is drawn to the life he could regain.
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Not just the life he could keep.
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Down the hallway, I continue eavesdropping.
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My chest tightening slightly for some reason.
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I've been in the upper echelons of surgical prestige, yet here a younger surgeon, less experienced in years, is teaching the patient about things I hadn't considered.
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Ignoring most of the hellos and Dr.
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Hawthorne attempts at my attention, my mind is fixated on these new metrics.
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They don't seem right to me, and I can't seem to focus on anything else at the moment.
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I reach the hospital administrator.
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I'm not sure what came over me, but I forgot to even knock.
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Instead saying, Do you know Dr.
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Wickham is tracking statistics no one else in the industry measures?
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And he's sharing them with patients to draw them here.
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The administrator raises an eyebrow, the kind of look you often see from administrators and bureaucrats who don't understand your technical concerns.
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Yes, and it's wrong.
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We've tracked mortality rates for decades.
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If optimizing these new metrics starts to affect those rates, or even just appears to, what will happen to the hospital, to our doctors, to our reputation?
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The administrator leans back.
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Dr.
00:11:25.200 --> 00:11:27.200
Wakeham is trending in the right direction.
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His mortality rates aren't rising.
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In fact, he's improving outcomes.
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Why is this panic necessary?
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I slammed the desk.
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Because it's uncontrolled.
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We built a hospital with prestige on mortality rates, and now he's rewriting the rules.
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The administrator remains calm, unconvinced by my fear.
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Most administrators are fed doom and gloom reports all day long.
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So they're like an impenetrable wall when it comes to emotional pleas.
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Perhaps it's time the rules reflected what patients actually care about, the administrator exclaims.
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Since mortality rates started as a measure, everyone has worked hard at making theirs exceptional.
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It's now hard to stand out as a hospital on that alone.
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We need something else to bring patients here.
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Rather than choosing to just go to their nearest hospital.
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In my opinion, Dr.
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Wickham is on to something good here, and his work is leading to lower costs for the hospital too.
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Less readmittance, less blood transfusion cost.
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I leave flustered, my chest tight, my mind racing.
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Am I a relic of the past?
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Is Wickham the future?
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Is my career hanging in the tension?
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It's been ten years since that day in the administrator's office.
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My career has reached terminal velocities since that day, and I've become a dinosaur.
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Dr.
00:13:07.759 --> 00:13:10.559
Wickham, on the other hand, is a star.
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He coined the term minimally invasive surgery.
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He's opened an institute to train others, creating culture where patient-centered measures drive practice by tracking data that matter to patients, not just what the industry measured.
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He has reshaped surgical priorities.
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And following that shift in value, he's reshaped the techniques that are used.
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Laparoscopic surgeries guided by cameras are now the norm rather than open surgeries.
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Training programs integrate these new methods.
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Mortality rates remain excellent, but recovery time, patient comfort, and long-term quality of life have become metrics surgeons cannot ignore.
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The field itself has bent.
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Most experienced practitioners are following reluctantly towards the values Dr.
00:14:06.480 --> 00:14:08.240
Wickham has championed.
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In fact, I'm stepping on a stage to present to a medical conference.
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Fifty surgeons seated in a medical theater designed for knowledge share.
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I've reached the tail end of my career and I have some lessons for those with decades left to go.
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Up on the stage, I begin my talk, opening up the conference where Dr.
00:14:29.200 --> 00:14:30.879
Wickham will speak later.
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While I'm a bit envious of Dr.
00:14:33.519 --> 00:14:45.120
Wickham, I'm also humbled that even though he was my junior and relied on my expertise at the beginning of his career, I had a privilege of working with a man who changed the entire industry.
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The lights dim and my presentation begins.
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I'm Dr.
00:14:51.200 --> 00:14:54.720
Reginald Hawthorne, 40 years as a surgeon.
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I should have seen this coming.
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I've been a doctor for decades.
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I've seen the evolution of surgical practice, recovery care, anesthesiological developments, diagnostic tooling developments.
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Nothing stays the same in this field forever.
00:15:12.000 --> 00:15:14.639
It's likely I should have been the one who saw what Dr.
00:15:14.720 --> 00:15:17.519
Wickham saw, and perhaps I did it one time.
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I just didn't care enough to experiment, to be a champion for the patients, and then once I had my data, campaign it across the industry.
00:15:27.039 --> 00:15:27.360
Dr.
00:15:27.519 --> 00:15:28.720
Wickham did.
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In fact, it's likely because I was focused in the wrong place.
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I was spending most of my available time honing my hands further, trying to make them legendary.
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Unfortunately, due to my bullheadedness and not realizing there is a plateau on the mortality metric beyond which hands have no further influence, I spent decades focused on the wrong problem.
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Rather than my hands going down in the history book as a surgeon, Dr.
00:15:59.679 --> 00:16:02.879
Wickham will be known as the man who changed surgery.
00:16:03.440 --> 00:16:14.240
Focusing on getting us all to understand, for two doctors with the same mortality rates, the one who has patients recovering the fastest is the most skilled.
00:16:14.639 --> 00:16:16.639
He's an admirable man, Dr.
00:16:16.799 --> 00:16:17.440
Wickham.
00:16:18.240 --> 00:16:23.519
You all are in attendance to hear from him, and it's my great honor to open for him.
00:16:23.840 --> 00:16:27.200
But before that, I want to share something honest with you.
00:16:27.600 --> 00:16:30.480
Years ago, before all of this caught on, Dr.
00:16:30.559 --> 00:16:32.639
Wickham was working on this alone.
00:16:32.799 --> 00:16:37.600
When I found out about these metrics he tracked, I was distracted and I was upset.
00:16:37.919 --> 00:16:40.399
My mind wouldn't get off of why.
00:16:41.120 --> 00:16:43.679
My frustration all those years back is gone.
00:16:43.840 --> 00:16:46.559
I'm too old to change what I focused on.
00:16:46.799 --> 00:16:51.360
However, I would let this be a lesson to all those pursuing fields like medicine.
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Values shift.
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Keep your eyes open on ways to do things better rather than following the same metrics as everyone else.
00:17:00.559 --> 00:17:14.160
If you hear of a doctor doing something that gets you fixated, angry, or otherwise emotional, sit with it longer, calm down, rationalize, try to understand whether they are correct.
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I didn't do enough of that.
00:17:17.599 --> 00:17:17.920
Dr.
00:17:18.079 --> 00:17:28.400
Wickham is an anomaly, a man so focused on how to do things right, to track things that matter to patients, yet also a risk taker and a change maker.
00:17:30.000 --> 00:17:31.519
This industry needs less Dr.
00:17:31.680 --> 00:17:35.279
Reginald Hawthorns, and it needs more Dr.
00:17:35.440 --> 00:17:36.640
John Wickham's.
00:17:37.920 --> 00:17:39.039
And that was it.
00:17:39.519 --> 00:17:49.519
I stepped off the stage, considering it an honor to even be in the same event with my protege, my colleague, my friend, John Wickham.
00:17:50.160 --> 00:17:50.559
Dr.
00:17:50.799 --> 00:17:51.839
John Wickham.
00:17:52.319 --> 00:17:56.640
And that was the last bit I ever contributed to the medical field.
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I couldn't help but wonder who out there is the next Dr.
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Wickham.
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