Dr. Aparna Govil Bhasker

©Dr. Aparna Govil Bhasker

It was the last case on the list on that day. A very routine laparoscopic fundoplication that took an unexpected turn. In a fateful moment, a short gastric vessel ruptured, with torrential bleeding across the surgical field. Suddenly, all I could see on the screen was a bright red splash of colour obscuring everything else. A surge of panic coursed through me, and I could distinctly feel the rapid, intense pounding of my heart. My mind raced faster than my heartbeat – what if the bleeding couldn’t be stemmed, if the procedure needed conversion to an open surgery, if a splenectomy was necessary or worse, if things went south? And even though potential complications are always explained prior to surgery and consents are duly signed, in that intense moment, I felt intensely weighed down by the prospects of having to justify something like this to the patient and the family later.

Within a heartbeat, I regained composure, drawing strength from years of rigorous training and experience, and perhaps a touch of divine intervention. It felt like a battle I couldn’t afford to lose—a target that could not be missed. Complete focus became paramount, as every passing moment would reduce my chances of winning. In that fleeting instant, with unwavering determination, I seized control over the bleeding, witnessing the haemorrhage stop as abruptly as it had started. The field was clear once again. I heaved a big sigh of relief, went on to complete the surgery with my team and later everything was fine. The patient, unaware of the precarious precipice they skirted, recovered and was discharged, the episode fading into a memory of a successful surgery.

HOWEVER, BEHIND THE SCENES, WAS EVERYTHING REALLY FINE? 

A surgeon’s silent struggle with the aftermath of such high-stress surgical moments is not much talked about. There exists an unspoken burden, an emotional fallout, that surgeons carry post-operation, which is unacknowledged by most.

As surgeons, we undergo rigorous training, assuming that alongside our surgical skills, we are equipped mentally to navigate these critical junctures. Yet, reality often diverges from this assumption. 

The weight of a patient’s life rests squarely on our shoulders, and when confronted with such intense scenarios, the physical, mental and emotional turmoil can be overwhelming.

Despite effectively managing the crisis, the haunting realization of what might have transpired, lingered for days in my mind. Although the entire episode during the surgery had lasted for just about 15 seconds or so, for many days, I experienced physical manifestations of stress – low energy levels, mild anxiety, throbbing headaches, neck spasms, and debilitating fatigue. It is not uncommon for doctors/surgeons to experience symptoms of acute gastritis, insomnia, spondylitis, diarrhoea and sometimes even menstrual irregularities as an aftermath of stress. 

As surgeons, we routinely navigate through high-intensity stress scenarios. The serene and composed atmosphere of the surgical field can transform into a battleground at any given moment. While our profession doesn’t grant medals for bravery, failure is simply not an acceptable option. This consistent and prolonged exposure to high-pressure scenarios spanning through a long surgical career, fosters chronic stress, which can further manifest physically as hypertension, cardiovascular disease, diabetes, and other health issues. Additionally, it can exact an emotional and mental toll, potentially leading to various forms of depression. Higher suicide rates amongst doctors have remained a concern for quite some time now.

Reflecting on my own experience, this particular incident wasn’t the first of its kind in my clinical practice. Like many surgeons, such moments have become a familiar part of my daily life, too. We often internalize these experiences, deliberately understating their significance, avoiding extensive discussions or acknowledgment. What transpires within the operation theatre typically stays confined within those sterile walls. Over time, it’s almost as if we build walls around ourselves, inhibiting our willingness to share and communicate. 

Many of us in the surgical field, myself included, pride ourselves on our ability to swiftly forge ahead. The rationale being that immersing ourselves quickly back into work, aids in overcoming these thoughts and emotions, contributing to our resilience. However, this culture of resilience prevalent within the medical community, though admirable, often comes at a price. Surgeons are left to grapple with their emotions in solitary introspection, navigating uncharted emotional territories without the necessary guidance or support systems in place.

THE NEED FOR SOLUTIONS IS URGENT.

Firstly, acknowledging the impact of professional stress and the emotional burden that surgeons carry is essential. It involves recognizing that these experiences can have significant effects on mental and physical health, as well as on overall well-being.

Acceptance comes in understanding that it’s okay to take a step back and prioritize self-care. Many healthcare professionals often push themselves relentlessly, believing that taking a break or seeking support is a sign of weakness or may negatively impact their ability to care for their patients. However, this mindset needs to shift.

Being kinder to oneself means recognizing personal limits and the importance of self-compassion. Allowing time for rest, recuperation, and seeking support isn’t a sign of inadequacy but rather a necessary step towards maintaining mental health. A rested and emotionally balanced healthcare provider can potentially offer better care to their patients.

Taking breaks, seeking support networks, and practicing self-care can potentially enhance a surgeon’s mental clarity, emotional resilience, and overall effectiveness in their profession. It’s vital to understand that caring for oneself doesn’t compromise the quality of care provided to patients; in fact, it can enhance it.

A systemic shift in the medical culture is imperative. Encouraging a healthy work-life balance, emphasizing the importance of self-care, and destigmatizing seeking help for mental health challenges should be prioritized.

As surgeons, we are entrusted with the profound responsibility of preserving lives, a duty we hold with utmost reverence. However, it’s equally vital to recognize that safeguarding our mental and physical well-being is pivotal for providing optimal patient care. It’s time to acknowledge the unspoken toll on surgeons and pave the way for a healthier, more supportive environment within the medical community.