Being a surgeon is hard. But, I don’t think anyone who chooses to pursue a career as a surgeon really gains a full appreciation for the gravity of the job until you walk into the OR for first time and all the responsibility for what happens from the moment the case starts until the time the patient walks out of the hospital and is fully recovered from their surgery is on your shoulders. During training, residents and fellows are instilled with the need to view all patients they care for as their own. But, no matter how many times it’s said and how seriously they ‘own’ a patient, it is no substitute for the real thing.
Without question, the hardest thing I’ve had to deal with over my first couple of years of practice has been figuring out how to deal with situations when things don’t go exactly according to plan. I’ll be the first to admit, I spent my first year of practice terrified that the decisions I was making were the wrong ones. After the fact, I probably second-guessed the majority of the decisions I made in clinic, on the ward, and in the OR during that year. I still harbor some of that fear even now in my third year as an attending. But, in many ways, I think that’s a good thing. I firmly believe a healthy dose of fear helps to keep me honest because there is truly no such thing as ‘minor surgery’.
At the same time, it’s taken time for me to accept that no matter how careful I am, no matter how much I plan, no matter how much I second guess myself, and no matter how much I respect the gravity of what we do each day to and for patients, inevitably things will not always go according plan. In training we see patients of attending surgeons we respect have complications. As junior faculty, we have patients who experience complications that result from an operation we performed and our senior partners are there to reassure us that these things happen. But the reality is no matter how many times we’re told and how much we think we appreciate this fact, really understanding this is entirely experiential.
While we need to learn from and remember the situations in which we could have done things differently, we can’t be so paralyzed by the things that have already happened we become unable to effectively care for the patient in front of us. For those who grew up playing sports or played in high school, college, or beyond you were probably told on more than one occasion to ‘shake it off’ or ‘move onto the next’. But, do we ever really forget and move on from our failures? Doesn’t part of us always wonder what could have been?
Although there is always something to learn when things don’t happen as we want or expect, how do we effectively forget what we don’t want to remember, but at the same time remember what we shouldn’t forget? Don’t look to me for the answer because I’m bad at it and still trying to figure it out. As the saying goes, good decisions come from experience, and experience comes from bad decisions. I guess that’s just a part of the package deal we all signed on for.