Physical Limits, Enduring Calling: A Life in Surgery

Erol Kisli, MD, seated in the center, with his family, from left to right: Ahmet Meriç Kisli, MD, a pediatric resident; Halit Cemil Kisli, a lawyer; Hatice Hanne Kisli, MD, a general practitioner; and his wife, Mesude Kisli, MD, a neurologist.

Editor's note: The opinions expressed by the author do not necessarily reflect the opinions of the AAMC or its members.

I could not open my eyes. Somewhere beyond the darkness, a nurse kept calling my name. When I finally forced my eyelids apart, she told me that I had been in a traffic accident and was in an intensive care unit in Ankara, the capital of my home country, Turkey. I tried to answer, but no sound came. A tracheostomy had taken my voice, and my body below the waist gave me no reply at all. I wanted only to fall asleep again and wake from what had to be a nightmare.

What I remembered from that day in 1998 was preparing to return from Sivas, where my father had recently died from renal cancer, to Van, where I was nearing the end of my general surgery residency. My dear wife, Mesude Kisli, MD; our young son, Ahmet Meriç; and I were traveling on the Sivas-Malatya highway when our car skidded on loose gravel. I lost control of the vehicle, and it crossed into the oncoming lane and plunged down an embankment. As I would later learn, I sustained a hemopneumothorax and an L1 vertebral fracture. After surgery in Malatya, sepsis and respiratory failure led to my transfer to Ankara, where I spent months receiving intensive treatment and mechanical ventilation.

Unable to speak, I asked for paper and wrote the only question that mattered: Where were my wife and child? A nurse told me that Mesude had also fractured her spine and undergone surgery, but she was recovering with her sister. Our son was safe with my mother. Relief entered the room before hope did. Whatever had happened to my own body, my family was alive.

After my tracheostomy tube was removed, I called my wife. My voice was unfamiliar after so long in silence. "Mesude, it is Erol," I said. "Which Erol?" she asked. She had been receiving many calls from people expressing concern and wishing me well. Knowing I was in intensive care and might not survive, she had not imagined that I could be calling her myself. "Your husband. I am alive," I told her. In that brief exchange, I heard the distance between the life we had known and the life waiting for us. I also heard the beginning of our return to each other.

Rehabilitation made the truth visible. I could not sit independently, control much of my body, or imagine operating again. Around me were people living with severe neurological injuries; some remained motionless in bed. Before the accident, standing and walking had felt as ordinary as breathing. Now I understood them as forms of freedom. Over the next six months, I learned to propel a wheelchair, strengthen my arms, perform wheelchair push-ups, and transfer in and out of the wheelchair with less assistance. These modest acts became the architecture of a new independence.

One day during rehabilitation, Mesude arrived carrying narcissus flowers, her favorites. She was still having difficulty walking after her own operation. I was overjoyed to see her, yet terrified. I had watched relationships around me collapse after disability, and I believed I had to release her from a future she had not chosen. I told her that if she wished to leave, I would understand. She answered, "Never say that to me again. We will be together until death." Her words did not restore movement to my legs. But they did restore a future to my life.

Over the following several months, my recovery took nearly as many steps backward as forward. Tuberculous meningitis brought even more debilitating symptoms before it was diagnosed and properly treated. I had multiple spinal surgeries and countless hours of rehabilitation.

Gradually, with the help of advanced braces and parallel bars, I learned to stand and take steps using my upper-body strength. Deciding to return to residency was far more difficult. I was afraid, especially of how others would see me. I felt self-conscious. Mesude's support was essential. She kept reminding me that I was no less the person I had been before the accident. During rehabilitation, I also began to believe that I could still do many things. Eighteen months after the accident, I returned to my residency. Once I was back, the university leadership and my general surgery mentors consistently encouraged and supported me.

When I returned to finish residency training, my fellow residents had already become specialists. The department had changed. I had changed more. Yet the faculty members in my general surgery department did not reduce me to my injury. They asked me to complete my thesis, rotations, and surgical training.

During my specialty examination in 2000, I stood with the help of an ARGO (advanced reciprocating gait orthosis), which braces the hips, knees, and ankles, and performed an epigastric hernia repair. The operation tested more than technique. It asked whether the surgeon I had been could survive inside the body I now inhabited. I completed the procedure and the oral examination and became a general surgery specialist. But the ARGO also taught me something important: Standing was not the measure of my competence. It was merely another tool.

Later that year, after my appointment as an assistant professor, I returned to Houston, where I had previously worked in pathology and tumor genetics at Baylor College of Medicine during my residency. This time my goal was to deepen my knowledge of anorectal surgery through an observership at Houston Methodist Hospital. There I learned from the late Ernest Max, MD; H. Randolph Bailey, MD; and Michael J. Snyder, MD. Dr. Max studied not only my clinical knowledge but the practical problem before us. In my wheelchair could I get close enough to the operating table? I swung the wheelchair footrests outward and showed him how the chair could approach the table. "This is great," he said.

Then he gave me words I have carried for more than two decades: "What matters is not the thousand operations I have performed, but the one operation you will perform." I understood his words as a belief that my return to surgery could have significance beyond the operation itself - for my professional and academic future, and for others, including fellow physicians, who might draw encouragement from seeing me operate again. Near the end of my time in Houston, he asked whether I needed a job. I was deeply moved, but I felt a responsibility to return to the university that had supported me after my accident.

When we said goodbye, I kissed his hands, an expression of respect in my culture, and he kissed my eyes. A mentor can teach an operation. The rarest mentors also return possibility to the person learning it.

Back in Turkey, I began performing anorectal surgery from my wheelchair. The adaptation was simple: I moved the footrests laterally, approached the operating table, adjusted the table and patient position, and worked seated. Adjusting the patient's position gave me access to the operative field, while my team helped maintain safety and efficiency. The arrangement did not diminish surgical standards. It allowed my training, judgment, and hands to reach the patient.

At first, some patients assumed I was a patient too. A few colleagues found the sight of a surgeon operating from a wheelchair unusual. Over time, the unusual became routine. Patients saw outcomes. Residents saw technique. The operating room absorbed the adaptation and moved on. This is what genuine inclusion often looks like: not a grand gesture, but a workplace redesigned until a qualified person can do the work.

Despite this surgical success, my path to associate professorship stretched to eight years. The hardest part was not simply the delay, but the feeling that my professional accomplishments and my worth as a physician went unrecognized. When I finally became an associate professor in 2008, the emotional toll on my wife and me overshadowed the joy of that achievement. My mentors, my wife, and those close to me believed in me and supported me because they witnessed my academic enthusiasm, my determination to keep learning and working, and my dedication to patients and surgery. Yet I also encountered people within the surgical community who struggled to reconcile disability with being a surgeon - or even a physician. These prejudices became particularly evident during the process of becoming an associate professor.

After moving from Van to Cumhuriyet University in Sivas in 2010, my body tested me again. Recurrent infections, once treated as urinary infections and episodes of sepsis, were ultimately traced to severe vertebral osteomyelitis, a bone infection. In 2012, after MRSA was identified, I underwent surgery to remove my spinal hardware, followed by a second operation involving debridement, bone grafting, and renewed spinal stabilization. There were periods when I was forbidden to sit and could turn in bed only with my wife's help. The surgical treatment and recovery took approximately three months, after which I returned to work, although medical treatment continued for much longer. I continued my surgical and academic work and was promoted to full professor of general surgery in 2014.

I have now taught thousands of medical students about anorectal disease and helped train generations of surgical residents. Contributing to their education has been one of the most meaningful aspects of my professional life. When I watch a young surgeon I trained perform an operation well, I feel the same quiet satisfaction as when I complete one myself. Surgery is healing and light passed from hand to hand; in that journey, a career becomes larger than the individual who lived it.

My family has traveled this road with me. Our eldest son, Ahmet Meriç, is now a pediatrics resident. Our daughter, Hatice Hanne, one of our twins, graduated from medical school this year and is now a physician. Her twin brother, Halit Cemil, is a lawyer. Much of what others have called my determination was sustained by their presence and by Mesude's unwavering partnership. If I were to tell my story solely in terms of my own determination and struggle, I would fail to give due credit to the people who helped me get to where I am today.

Focusing solely on individual determination can also obscure the responsibilities of institutions. Disabled physicians should not have to become heroic simply to enter a workplace. Determination cannot lower an operating table, widen a passage, create space for a wheelchair, or persuade a rigid system to recognize competence. Hospitals should listen to disabled clinicians and design accommodations with them: adjustable equipment, accessible work areas, flexible positioning, and teams prepared to solve practical problems. The needs will differ from person to person, which is precisely why the person doing the work must be part of the design.

Medicine should judge us by our knowledge, judgment, technique, ethics, and the quality of care we provide - not by our physical limitations. My wheelchair changes how I work, but not my responsibility to patients or my commitment to students. The most enduring barriers I have encountered were not in my spine. They were in assumptions about what a surgeon is supposed to look like and whose future is considered worth investing in. The question should not be whether a person with a disability can conform to an unchanged system. The question should be: How can medicine change so that ability is not wasted?

Disclaimer: The writer used ChatGPT to assist with translation and language editing.