Aditya J Nanavati: How do surgeons reflect on surgical complications?

Aditya J NanavatiLosing a patient in the operating room is probably every surgeon’s worst nightmare. I recently happened to experience such an event. Not my first and probably not my last. Yet every time it happens it is accompanied by a troubling few hours or days afterwards. I know the operating surgeon of the case that day to be a very good and compassionate man. Even after years of experience he was visibly moved. How good a person he is, probably was evident by the fact that he discussed his feelings honestly with all the team members. What happened in the operating room that day made me think quite a bit. How does a death or a bad outcome in or after surgery affect a surgeon? What philosophy guides the surgeon’s response to a complication? A part of me was sad for the patient and his family. Of course it had to be, part of being human and having a good value system meant that I was wired to feel bad. But another part of me wondered, if I were the operating surgeon, would that be all it made me feel? It brought in a flood of thoughts. I reflected on all the surgeons I have worked with as well as I tried to recollect my personal experiences. In terms of reacting to complications arising from surgery I believe different surgeons react differently. In my personal opinion I believe I would be able to classify them into four types.

Firstly, we have the empathetic type. I know surgeons who have been in agony due to the complications patients have faced in their post operative periods. They are truly empathetic. These people think back and analyze what went wrong and try to correct it. Most of them will make a conscious decision to rectify their methods so that similar complications are avoided in the future.

Secondly, we have the ego-centric type. I have come across surgeons who consider a complication in the patient’s post-operative period as a personal defeat. I fear they have dissociated from the patient’s sorrow and take it more as a blot on their personal record. They usually display sympathy and good will. The personal loss may be hidden from the patient’s view but whether they genuinely feel for the patient is not known to me. In either case I believe such surgeons are driven to ensure they have good outcomes consistently. Patients are usually safe in their hands even though their safety may be only secondary to the surgeon’s personal triumph.

Thirdly, we have the believers in destiny. I am sure many others may have recognized this type. They truly believe that complications were unavoidable because it was the patient’s fate to suffer. I do not know whether this is more in tune with their personal religious beliefs or is it merely a way they find to escape blame. I have known such people to rarely introspect. They are so convinced that it was the patient’s destiny to suffer that they never scrutinize their own ways or make rectifications to minimize complications. This is a dangerous type of surgeon. I hope nobody has to suffer at their hands.

But, probably the worst types are those who just don’t care. The first time I came across such a surgeon I thought it was a defence mechanism. I believed that nobody can be that callous. Over the years I think I have been proven wrong. There definitely are such surgeons and hopefully we can all stay as far away from them as possible.

After classifying the types of surgeons that I just mentioned I must admit I have no fool proof way that one can identify the kind of surgeon you encounter. I also believe that this classification is by no means rigid. While psychologists may be better able to answer questions surrounding this topic, I believe all the types are actually fluctuating states of mind that probably every surgeon has encountered in different settings in their own life. I think if a surgeon is honest with him/herself he/she can truly think back and say they have gone through all four emotions at some point of time or the other. I believe a surgeon should strive to encourage thoughts in tune with the first type and suppress thoughts that fall in the other three. All surgeons should try to be empathetic and introspect after a complication occurs. I by no means think I have mastered it yet, but I believe we will be better surgeons if it can be done consistently.

Aditya J Nanavati is a general surgeon working in Mumbai, India.

Competing interests: None.