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