When surgeons become wise

I noticed something different about my driving habits lately. At a traffic light I used to accept the green as an open invitation to drive through unconcerned, confident that other drivers would see the red and do what they are supposed to do, ie stop.

I don’t do that anymore. I always look to see if the road is clear, and other drivers have indeed stopped. And then I go. I have come to anticipate the worst of other users of the road, and I no longer take a chance, even if I am 100% within my rights to do so.

On thinking about it, the same thing has happened to my surgical practice. I used to operate without dwelling on the negative consequences of surgery. I’ve always known that bad things happen to patients even in the hands of good surgeons, but that didn’t stop me not giving the prospect a second thought when I was newly qualified.

Maybe it was the four-year-old tonsillectomy kid who had a respiratory arrest seconds after coming off the operating table, and whom I found blue and with fixed dilated pupils? The anaesthetist and nurses were distracted with another emergency nearby at the time. (She made a complete recovery.)

Or the active, still working 80-year-old who needed septal surgery to control annoying nosebleeds? He slipped in the ward while waiting on the morning of the surgery — no one was to blame, it was a freak accident — fractured his acetabulum, and died six weeks later as a result.

I have come to see the green light of patients meeting criteria for having a surgical procedure as an opportunity to stop, look around, and think, “Why should I not be doing this operation?” For a surgical patient can be a little like the tired, asleep, distracted, drunk, drugged driver careering towards your intersection, and both of you are going to bear the consequences.

Like young drivers I used to think I was invincible, as a young surgeon that complications happen to someone else, and I was wrong. Maybe it was the so-nearly-a-facial-nerve-injury in my surfer patient having surgery for exostoses, or the so-nearly-an-optic-nerve-injury in my patient with terrible sinusitis, and whom I thought for a terrible hour as I finished the operation that I had blinded in one eye. (He wasn’t blind, but I was ten years older immediately afterwards.)

And so, in both my driving habits and my surgical practice, I look both ways before I put my foot down. That attitude does not come from a textbook, nor from talking to older surgeons or colleagues. It comes from direct experience gathered over time.

You might call it the beginning of a priceless quality for a surgeon — wisdom.