What did I do wrong?- A page from a surgeon’s diary.

What did I do wrong?- A page from a surgeon’s diary.

By Dr. Aparna Govil Bhasker
Bariatric and Laparoscopic Surgeon

There are only two types of surgeons. Those who have had surgical complications and those who are going to have. The law of averages catches up with us eventually. As the old adge goes, if you have never had a complication, you’ve probably not performed enough number of surgical operations.

Surgical training is all about minimizing complications. As surgeons we are also trained to first find fault with ourselves. When a patient has a complication after a surgery, the first thought that enters our mind is – “What did I do wrong?” The second is- “Could there have been a better way to do this?”

Unfortunately, in retrospect there is always a better way to do it. And sometimes when patients go asking for second opinions, they come back confused about why their surgeon did not choose the obvious better way.

Surgery is not mathematical. Ofcourse all of us plan before a surgery. We prep and we go through the steps mentally. We anticipate certain events and keep things ready. Unfortunately, there are times during surgery when things are not straightforward and clarity may elude us. There are times when we have to choose the best possible solution from the available options. There are also times when we run out of options. There are times when saving a life becomes a priority over everything else. There are times when help may not be available and the buck stops with us. And then there are times that despite our best efforts things still go wrong.

What follows for the patient has been talked about. Ofcourse the patient is a priority and the one who suffers. But what about the surgeon? I recently read an article about the surgeon being the “second victim”. I would say that a surgeon is the “neglected second victim”. Carrying the burden of someone else’s health and life is not easy. No surgeon wants to have a complication. We feel guilty and accountable. Every inch of our existence wants the patient to get better. Every minute is spent waiting to get some good news. Every complication takes away a bit of our life because when someone is in pain because of us, we don’t feel like doing anything else. Many a nights are spent thinking what we could have done to avoid it. We go through every step of the surgery in our minds wondering how we could have done it better. Complications take their toll and forget socializing, we find it difficult to focus on our daily family lives. Our children and our spouses become the “third victims”.

People say it’s a part of growing up and eventually every surgeon gets used to it. Well, I am yet to see a surgeon who can take it in a stride. In today’s day and age, there is also a fear of litigation, of being abused and of things being dragged in the media. Many young doctors today suffer from high stress levels and depression. Today, suicide rate is amongst the highest in doctors.

One complication is equal to thousands of successful surgeries and sometimes that one complication is enough to ruin work and reputation of an entire lifetime. There are no easy answers. Artificial intelligence and robots are still eons away from the magical number of zero complication rate. At the end of the day surgeons are only human and there can never be a perfect 100% good outcome. The complexities of human bodies are sometimes beyond us. The worst patients sometimes recover unexpectedly and complications may happen when we least expect them.

We have many a workshops and conferences that focus of management of complications but I am yet to see a workshop where they talk about stress management for surgeons. Technical skillset is important but at the same time, it is also important to deal with the stresses of a surgical career. We need to retrain ourselves to not expect too much from ourselves. We need to learn to become more realistic. We need to accept that sometimes things are out of our control. We need to know that human body is too complex and 2 plus 2 is not always equal to 4. We need to understand that we are not God.

At the end of the day, the bottom line is that, we can only try our best but ultimately it is He who heals.

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