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carelessly cut into a healthy organ, who is also obligated to go into
exile. This is perhaps one way of explaining the words of Tashbetz.
However, the Minchas Yitzchak (Part 3 #104) explains the words
of Tashbetz in a different way, and that is that the difference between
a surgeon and a physician who heals with medications and laxatives is
that the surgeon causes the patient’s death with his hands, but the in- A PHYSICIAN LEFT AN
ternal medicine doctor causes the patient’s death indirectly (gerama). INSTRUMENT IN THE
Thus the surgeon is exiled, while the ordinary physician is exempt 35 PATIENT’S ABDOMEN
from exile. In our case, then, the surgeon who mistakenly operated
for appendicitis would have to be exiled because he cut the patient
with his hands.

However, the Tur and the Shulchan Aruch (Yoreh Deah #336:1)
write: “If he caused the patient’s death and he became aware that he 1 Question
caused the death, [though] unintentionally, he is exiled for what he I would like to hear the Torah view on the following case:
did.” And the Perishah explains the words “he became aware” as im-
plying that only if the patient died immediately after the treatment A patient underwent abdominal surgery. During the course of the
is the physician exiled. If he died later, one can argue that the patient surgery, a hemostat was mistakenly left inside the abdomen. (This
caused his own death by eating and drinking or by moving around. is an instrument used to stop bleeding, 8 to 10 centimeters long,
According to this, in our case, if the child did not die immediately resembling a pair of scissors.) The instrument was discovered sev-
after the surgery, the surgeon may be exempt from exile. eral months later when the patient sought treatment for pain he had
endured since the surgery. It was removed by additional surgery. The
It says in the Shulchan Aruch (Yoreh Deah #336:1): “One should not hospital administration blames the surgeon and wants to fire him.
practice medicine unless one is an expert, and there is no greater phy- Are they justified in doing so?
sician than he there, for if it is not so, he is shedding blood.” According
We sent this question to Dr. Devir, an expert physician and sur-
to this, if the physician on duty who operated on the child could have geon in Jerusalem, and asked him: Who is to blame in this case? Here
consulted with a physician greater than he but did not do so, then is his answer:
although his error was one of judgment, his mistake is considered
“close to intentional,” and we can only hope that exile will serve as To the honorable Rav… shlit”a,
an atonement for him, for if a physician was able to consult with a During the surgery, the surgeon is handed dozens of instruments
greater physician but did not do so, he is viewed as having shed blood. and swabs. Before he closes the abdomen, he checks with the nurse
that the instrument count is correct, examines the site of the surgery
One should not, Heaven forbid, avoid consulting with a greater
physician because it is not pleasant, is a bother or is embarrassing. As and certifies that there is no bleeding. Only then does he close the
it says in maseches Berachos (4a): abdomen.
If there is an apparent discrepancy in the number of instruments
King David said… My hands are soiled by the blood of that were in the operating room at the beginning of the surgery and
menstruation and fetal membranes, in order to declare a the number of instruments at its conclusion, or between the instru-

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