Aside from the joke being not funny, the joke really should finish like this:
"The third surgeon said, "You guys are amateurs. Several years ago
a fellow who was high on pot and alcohol rode a horse head-on into a train
traveling 80 miles an hour. All I had left to work with was the horse's ass and
a large nose. Now George W. Bush is running the United States into the ground."

And that's not even funny.

Frank