Complications maketh the surgeon 

Complications maketh the surgeon 

Can you recall getting into trouble as a child? A time when you had done something wrong either at school or at home? Dealing properly with post operative complications is much like that. 

Firstly, you have to own up to what you did as soon as possible. It’s no good avoiding the CT scan for the white cell count of 20 and hoping it will go away. If you think there might be a problem, you confirm it asap. You have to express your regret, ideally you say that you are sorry, in those exact words. 

You do not delegate this task to your trainee, you see the patient and their family at the earliest opportunity. 

Then you need to keep coming back, keep coming to see them. You phone about them. Worry about them. You keep on caring and explaining and communicating all the way through the third re-do laparotomies, ICU and what feels like never ending painful encounters. 

You admit you’re sorry, that you wish they hadn’t experienced this complication, that you’ll try and fix it and that you are there with them. 

And like a naughty child you take the punishment that they give you, you don’t flinch when you are hit with their death or disability, or close your eyes and shy away from the unsightly open abdomen or enterocutaneous fistula or whatever other disaster has occurred. You don’t recoil from or avoid their tears and distress. 

This is the bit that hurts, the bit that takes gritting your teeth and girding your loins against your instinct which is to hide, to run, to go and see well patients. It’s an easy joy to go and see patients with no complications. Moaning unhappy patients make for joyless ward rounds, and unlike a medical round, we are the guilty and culpable persons responsible. 

This is very hard and watching someone do it well is like watching a boxer take hard slugs and keep standing, keep fighting and keep their fists up. It’s impressive is what I’m saying and makes me hope that I’ll do it as well as they do. Because it’s the way you handle your complications that defines the kind of surgeon you are. Xx 

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Is it better to be lucky or good?

  

Some surgeons believe that it is better to be lucky rather than good. Personally I opt for both when possible but would opt for good over lucky. 

Luck comes in to surgery quite a lot. Everyone knows a colleague who is the renowned shit magnet when on call. As soon as you comment that “it’s quite quiet” you can guarantee that a person will suddenly start bleeding, perforating or infarcting some part of their GI tract and be heading in to you. 

Patients wish to be lucky, when you tell your old, elective, cancer patient that they have an 8% predicted mortality (I love this website for risk in surgery predictions it’s by Paris Tekkis) they hope that it doesn’t happen to them. Patients need all the luck they can get. 

I try to be good, I try very hard to do a nice operation. My perfectionism is occasionally a hinderance and endlessly washing until it’s crystal clear goes against any belief in the magic God of luck, who one of my Great Leaders swears will take care of anything I haven’t sucked away or a tiny bleeder I’ve failed to frazzle. 

I’m a red cell chaser, I like it all to look like an anatomy book. 

Having surgical OCD kicks in even worse when I am doing the operating alone, with nobody surgically minded assisting me. My need for just one more look, one more stitch, one more wash and then I will be happy is quite bad. I’m a mother hen fussing about, indecisive and back and forth peeking at the bit in question. I also talk to myself, which is bat shit crazy, but I imagine that I’m talking to someone who actually knows and understands surgery and is not the medical student or junior doctor hauled off the ward to assist me. 

Talking aloud and agreeing with yourself is obviously madness but quite often my opinion is the only one I have available  during an operation. I also think that my operating table chatter is a deliberate way of controlling the noise level in the room as at least if I keep talking everyone else stays quiet. An as yet unemployed tactic suggested to me by a friend is to declare “right, everyone shut the fuck up unless you are me”. 

Luck is something that you can’t control, sometimes you will have some bad luck and other times it will be good luck. You can control being a good surgeon, doing good operations and making good decisions and quite often your good decisions can compensate for any bad luck.