Early in my career I had a complication that still haunts me. As far as complications go, it wasn’t a big one, but it was still a lesson. What I didn’t know at the time was that the lesson would save me many times over: the lesson of when to bail on a case for the sake of the patient.
Back then, it was a lipoma. I was in a rush that day, so I didn’t mark the area. I remember it was easy to feel. I had my notes that described the location. While the patient was being prepped and draped in the OR, I realized that I actually wasn’t so sure where the lipoma was. I asked for the ultrasound. I perseverated. The time ticking away seemed like forever, and I felt all eyes on me. I wondered what my colleagues were thinking, and what the upcoming Morbidity and Mortality Conference would be like when I presented on why I couldn’t find a simple lipoma. So I took out what I thought was the lipoma.
When I saw the patient in tears in the recovery room, I knew I blew it. For her and for me. Good judgment escaped me that day, but I did the only thing I could do: I vowed that I would learn from my mistake. Marking any surgical site with the participation of the patient is something I do now without question, because I know how important it is. No matter how certain I am at the time that I will find the lipoma, we work together. It is a lesson that I have taught others so they don’t make mistakes either. I am a better surgeon and teacher now because of that case. But the guilt, shame, and embarrassment are still readily accessible.
This week I started a straightforward case. I placed the port for a hernia and checked the entry site. But something didn’t look right. Could I have injured something at the site? It’s described in the literature. It happens to smart people. I still told myself: “It doesn’t happen to ME.”
Well, apparently it does. The confident “it doesn’t happen to me” line of thinking evaporated in an instant.
I paused again like I did all those years ago. I explored the area. OK, I told myself, Maybe nothing was injured. I could still do the case. It would probably be OK. But then I remembered that first case. And what I wished I’d done differently. Do no harm. Wake up the patient. Explain. Reschedule.
So that’s what I did this time.
As surgeons, we aim for precision. This can look like packing our emotions away into a deep dark corner and moving on with the task. But my work as a surgeon coach has taught me that we can — and must — do better than that. For our patients, for ourselves, and for everyone coming after us.
With so many years removed from my initial mistake, I’ve been able to engage in some self-compassion and healing. When I start to feel the pain coming up, I remember a lesson from the book “What Happened to You?: Conversations on Trauma, Resilience, and Healing” by Dr. Bruce Perry and Oprah Winfrey. The authors explain that when you experience a trauma, you start to heal by approaching the trauma in ways you can control. I take this to mean engaging in small bouts of venting and processing.
I also reflect on the researcher Brené Brown’s lessons on shame resilience from her book Daring Greatly. She provides three steps: Talk to a trusted source about what happened. Speak kindly to yourself. Own the story, so you can own the ending.
After the incident with the hernia patient this past week, I decided to face my shame head-on by sharing the story with my team. I brought it up in little parts throughout the day, and healed a bit. I also told the patient’s family member the full and honest truth.
After all my cases were done for the day, I sat in my car before leaving, and remembered that I didn’t see the patient while she was awake, and that she likely didn’t know what had happened. So I got back out of my car and went upstairs and owned it. And told her that her well-being was first in my mind. And that there was a plan to complete her surgery when it was safe. That she could trust me (because I can trust me). And I owned the shame I felt, so I could work through it. This wouldn’t be a festering wound that would haunt me for years.
When I got back in my car, I thought about how when you have a complication, the best course of action is to just wait. You don’t need to move ahead in order to avoid feeling shame. Your future self will be there to comfort you.
As I drove away from the hospital, I revisited the complication from many years before and talked to the person I was back then. Yes, I learned something from you, I said. Thank you for the lesson. I did better today.
Have you ever experienced a complication in your work as a clinician? How did you handle it, and what did you learn from it?
Amy Vertrees, MD, FACS is a board-certified general surgeon and certified life coach. She is the founder of “It’s complicated” surgeon coaching and “Time for your success” life coaching. You can find her at www.amyvertreesmd.com, Instagram @amyvertreesmd.
Illustration by Jennifer Bogartz