The patient was kind and gentle, and looked younger than his medical record might indicate. His cardiac history was immense – heart attacks, bypass surgery, and the resulting compensatory physiology that makes for a weak heart and poor operative candidate. And now he had a bowel obstruction, and though the exact cause was unknown, it seemed that surgery was his only option. His high-risk cardiac status notwithstanding, we took him to the OR. He was nervous but upbeat, and the night before the big day looked me in the eye and told me that he had all the confidence in the world that we would do right by him.
The surgery itself went fine, but it took an unusually long time. His intestines were worse than we imagined – abdominal surgery from many years ago had caused massive scarring that pulled his distal bowel into a knot of obstruction. Painstakingly we relieved every adhesion, and resected what we needed to.
As I said, the surgery itself went fine. By that I mean that there was no excessive bleeding or injury or anything like that. But it took too long. And his heart couldn’t handle it. Later that night he had a heart attack and died.
Oftentimes in surgery we are dealt a bad hand, insofar as the patients are sick and in a pretty desperate state. This is no more true than in trauma surgery – people get shot or have an accident, and while that is tragic we are forced to do only our best with what we have to work with. But in surgery like we performed on this gentleman, we have more of an active role. And we have more options at our disposal. No, we didn’t kill him directly, but he did die as a direct result of what we did. At least for me, the hurt from losing a patient like this is the worse kind.
The next day I spoke with the attending surgery and we replayed the whole thing, and every decision we made. We second-guessed certain things, but ultimately decided that we did the best we could given a bad situation. I guess the morbidity and mortality conference at the end of the month will judge us in their own way.
Our conversation was cut short by the OR staff telling us that our patient was ready for us in room two. This patient had come into the office about a week ago and needed her gallbladder removed. Just as the gentleman had placed his confidence in us, so too was this women deciding to go under the knife with us in control of her fate. She didn’t know of the events from the night prior, nor would she learn of them. She needed surgery, and she needed a surgeon who could perform that safely.
As I scrubbed for our new patient, the events from the night before slowly faded away. With every pass of the scrub brush, the memories dissipated. When the gown and gloves were placed on me, the feeling of loss had gone. And when I was handed the scalpel, all that mattered in the whole world was her gallbladder.
What was done was done. I could second-guess, I could doubt, I could question all I wanted to – it wouldn’t have mattered. I could feel bad for myself, I could cry, I could complain, but it wouldn’t change what I had to do. Reliving the past not only would do me no good, it would potentially hurt our next patient.
This isn’t to say that I can’t learn from the past – of course I can! We all can, and all should. But when we have moved past a challenge, regardless of the outcome, the most important thing at that moment is to focus on what is up ahead.
Surgery residency teaching many things, and surgery is only one of them. How to move is another. And that gallbladder came out just fine - she is now home, safe, and moving forward with her own life.
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