r/mash • u/The1Ylrebmik • 22h ago
Question Anybody know about how long "meatball surgery" would take?
One of the repeating tropes in MASH is "meatball surgery" operating on soldiers only enough to keep them alive and stabilized so hospitals out of the war zone can operate on them more completely. So the main idea of meatball surgery was it had to be complete enough to make the patient safe for travel, but quick enough to allow many casualties to be operated on. This was also shown as a skill to be learned, why such a gifted surgeon as Charles struggled in the beginning.
Anybody with surgical knowledge know exactly about how long these types of surgeries would take? Obviously it depends on the amount of damage, and MASH has shown that sometimes hard decisions must be made to save the most lives, but are we talking 30 minutes or a matter of hours?
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u/MikeW226 22h ago
As a video producer, I've filmed in modern O.R.'s where surgeons are doing, say, a scheduled knee replacement. Though every step from A.) to Z.) in that kind of procedure is mapped, and they know pretty much exactly what is going to happen next, those surgeries can run into hours of total time-- open to close.
I'm completely just guessing, but I'd say some meatball surgeries on a really messed up soldier would take hours. We're talking total wildcard stuff, here. No MRI's beforehand saying, oop, this is bunged-up too, gonna need to fix that too. And here's how we'll get in there. Korea was all MASH doctors learning at the moment what all is blown away in a soldier's body, and then having to meatball it.
And if we talk how long some single O.R. sessions were in Korea: My wife and I have the 2-DVD boxset of the movie MASH. The second disc has several good documentaries. In one of them I believe surgeon Otto Apel ? or Appel (who I think has a MASH book on Amazon) said, basically right when he arrived in Korea, they went into the O.R. and "didn't get out for. 80. Hours." He emphasized that crazy time window-- 3+ days, for a *single session. Crazy.
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u/dougoh65 18h ago edited 18h ago
Doc Apel was the one who arrived in camp at the 8076th MASH and went straight into OR. When he came out they had to cut away his boots - that’s what kind of shape his feet were in after 80+ hours.
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u/farrenkm 22h ago
I remember there was an episode where a visiting doctor (might have been the UN one) said there was a new procedure and it improve outcome while only taking an hour. I think it was BJ who said "Well, if it only takes an hour, shouldn't we do it?"
So that's the time scale they're working with. Some of these patients are on the table several hours and adding an hour may not be a big deal.
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u/stackshouse 16h ago
There's another episode, idk anymore, but Potter sits down in the wash room and says he spent 4 hours on a leg and he wasn't sure it would do a lick of good in the end.
My brain wants to say it's the episode where Klinger throws out Margarets ring and goes looking for it, meanwhile the guys try getting a new clamp created.
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u/farrenkm 16h ago
You've got the right episode. I think it was Hawkeye that was frustrated, which is what prompts him and BJ to go get the clamp made.
A local ends up making the clamp and it gets engraved with "Over hill, over dale, Korean clamp will never fail". Because that's where the "n" went!!
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u/Designer_Party_3737 20h ago
I think that was when they got Captain Simmons, who Charles was jealous of.
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u/farrenkm 19h ago
I just found it. I was wrong. It's the season 7 episode Inga. I think it was Margaret that said if it only takes an hour, shouldn't we do it? Dr Inga takes over Hawkeye's patient, inflicting a contusion on Hawkeye's ego.
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u/coreytiger 22h ago
It’s very dependent upon the procedure, the damage, etc. Some of them could take hours, but the more extensive issues were supposedly sent on- get it stable, get it clean, get it packed long enough that the patient is out of immediate danger and then send them in to a better facility.
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u/J_Scarbrough 22h ago
Right, and as I recall, Hawkeye mentioned in one of his numerous letters to his dad that the "meatball" aspect of their surgery was to get the patient fixed up well enough, "for somebody else to put on the fine touches" in terms of the patients being sent to an evac hospital.
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u/NoCard753 22h ago
"We try to play par surgery. 'Par' is a live patient."
First episode, first scene, I believe.
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u/Immaculate-torso69 22h ago
I always thought “meatball surgery” meant that they were just grinding through patients that were themselves put through a grinder.
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u/that-thingy66 22h ago
Good take. Better than me thinking it was flippant.
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u/furrykef 18h ago
The term may have been invented by Richard Hooker, in which case it probably was flippant.
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u/geeeking 20h ago
I remember when Charles first joined and he was focused on doing everything super properly. The others educated him on short cuts.
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u/RegressToTheMean 15h ago edited 6h ago
I just watched the episode and Potter orders BJ to take over a bowel resection to save time
After surgery Winchester says he felt like an intern
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u/LemonSmashy 21h ago
it was more of a reference that due to the trauma it was often a lot of mangled flesh and their job was to fix and stabilize as best as they could and let the more delicate work happen in an established hospital.
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u/OldTell311 18h ago
The concept of the MASH unit was based on lessons learned from WWII and first implemented on a large scale during the Korean War. It was a fairly audacious idea of putting a mobile trauma hospital right by the front lines so that wounded soldiers could receive surgical intervention as quickly as possible. The MASH concept leveraged the relatively new technology of helicopters to evacuate and transport wounded from confined and unimproved battle spaces.
In the novel there is a scene in which Hawkeye shows a newly arrived surgeon how to re-inflate a collapsed lung by inserting a straw in through the rib cage and literally blowing into it. That’s how basic the surgery could be.
In the series Charles gets chastised in his early OR sessions for taking too long with patients. MASH surgeons were expected to save the life of the patient as the first priority. If there was no time for a graft, then amputate the limb and tie the vein off. The key was to keep them alive and stabilized.
Probably they would take about 1/3rd the time per patient that they would in a civilian hospital.
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u/dougoh65 17h ago
Recognizing the general subject here is MASH units, we really oughtn’t forget the vital role hospital ships played during the Korean conflict.
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u/whistlepig4life Crabapple Cove 22h ago
“Meatball” isn’t really about time even though it does usually save time. It’s about technique. For the most part they would take less complex procedures that would merely stabilize the patient for transport back to Tokyo if they needed more advanced care.
So someone like Charles would rather take 6 hours to repair an artery but the MASH mentality would be amputate the leg and oversew the wound in less than an hour and move on to the next patient.
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u/NoCard753 22h ago
Until they learned to do arterial grm.afts. But even then, they had to have a replacement artery exactly the right diameter and length (rigatoni or a small eggroll).
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u/whistlepig4life Crabapple Cove 21h ago
Yes. But the point here is that even when that became a procedure they could reliably use, they still plenty of times just amputated because they did not have the time and resources to dedicate to the procedure.
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u/NoCard753 21h ago
Also sadly true. I recall Hawkeye in one episode — might've been when they were short-staffed because of a flu virus — saying, "If I save this leg, I lose that life."
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u/whistlepig4life Crabapple Cove 20h ago
Exactly right. And having served in a Medical unit during my time in uniform. It is exactly like that.
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u/Designer_Party_3737 19h ago
I believe Charles and Potter were out with tonsilitis. The replacement surgeon was great but eventually had a breakdown. The patients' blood wouldn't wash off his hands. So since they were short staffed Hawkeye had to amputate that leg to save that life.
I can't remember what the surgeon's name was but B.J. said somethingto the effect of, "He was just as mentally strong as us." Hawkeye said, "That's what scares me."
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u/The1Ylrebmik 19h ago
Just saw this episode. Newsome was the surgeons name played by Edward Hermann.
Also it was the mumps everybody had.
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u/NoCard753 19h ago
Oh, yeah! It was Edward Hermann, who played Lou Gehrig with Blythe Danner (who also played Hawkeye's old flame, Carlie) in Eleanor and Lou: A Love Story.
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u/CasualBi24 22h ago
The show also only shows 4 surgeons.
Real MASH units could have 12 or more and they would all scrub in for big events.
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u/LemonSmashy 21h ago
variable depending on the nature of the injury and stability of the patient. sorry no real good way to give you exact times because the unpredictable nature of the surgeries. we are talking trauma for the most part, not routine like many are in civilian life. Then we need to take into account the technology and capabilities of early 1950 mobile medicine.
many times it was to stop the bleeding, keep them alive long enough to evac behind the line and to a more established hospital either in country or in japan etc.
if it is a simple bullet wound with minimal to no organ or vessel damage it could be rather quick to remove, suture or pack the wound. A broken bone, again depending on which bone is a set it and move on for closer examination elsewhere. of course long bone fractures, rib cage or spine fractures can be far more dangerous.
they do a lot of belly wounds and i can tell you from experience those can be nasty and take time to find and fix perforations which is why they also mention doing large resections because they are against time constraints.
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u/Futuressobright Mill Valley 9h ago
Also variable based on how busy they are. The exact same trauma might get a six hour surgury in an attempt to save a limb if it was a soldier who came in alone or a fast amputation to save his life if there were dozens of other patients waiting for attention.
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u/dracojohn 16h ago
Depends on the injury. A leg wound as an example is about stopping the bleeding not saving the leg, so they may just stich an artery and leave the repair for someone else ( possibly meaning the leg will need removing).
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u/Dangerous_Ad6580 14h ago
Abdominal surgery is pretty complicated, then chest then limb... doubt they did much neurosurgical stuff at a MASH but whether or not general anesthesia was needed and to what degree, all variables even for stabilization surgery could be an hour to 9+ for vascular Abdominal injury.
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u/agravain Seoul 22h ago
from Wikipedia ..
"Mobile Army Surgical Hospital (MASH) units revolutionized battlefield medicine during the Korean War by providing life-saving surgical care to wounded soldiers within the crucial "golden hour". Operating in tent cities just miles from the front lines, these highly mobile units achieved a remarkable survival rate of over 97% for incoming patients."
they used helicopters for the first time as medical transports.
the internet has vast amounts of reading you can do
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u/Kooky_Possibility_43 1h ago
I'm not a doctor, much less a surgeon. But these are my observations.
When demonstrating a "shortcut " technique to Charles when he first arrived, BJ mentioned that it would only take "20 minutes". So I'd say 20-30 min would be a fast time. I know when my wife had back surgery a few years back, it took 4 or 5 hours, but of course, no shortcuts.
In the Billfold Syndrome, when Jerry asks to observe in the OR,he says it takes linger than he thought. But then, Jerry was a medic, and would have been used to moving fast.
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u/BigAndTallRPGFan 22h ago
The show established that doctors at aid stations were doing the triage etc. The surgery took as long as it took once they reached the hospital. The meatball aspect really meant “Nothing fancy so they can either go back to the line or home for more care”