Editor’s note: For two consecutive years, the Young Fellows Association of the American College of Surgeons has presented an annual essay contest for young Fellows who are interested in voicing their thoughts on an issue of importance to the profession. The running theme for these compositions is “The Promise of the Profession.” In the following essay, Ellen Thomason, a vascular surgeon in Seattle, WA, describes her experience as a patient and how it changed her outlook as a surgeon.
Before last fall, I am not sure I was always a “human” when I took care of patients. As a vascular surgeon, I had outstanding patient satisfaction scores and considered myself a compassionate physician. I listened to my patients in clinic and made sure to meet with them and start procedures at the scheduled time both in clinic and in the operating room so I wouldn’t keep them waiting. After surgery, my hand would pat their hand or leg and my words would encourage them to look at the “bright side of things.” As they lay still in their gurney, I would extol the word “patience.” While wearing my white coat, I would explain to each patient that as my partner in their health care, patience is the very definition of what they must bring to recovery. To heal, they must be patient.
The surgeon becomes the patient
Then life taught me a lesson. This past fall, while five months pregnant, I lost my healthy son and had to have an urgent hysterectomy. Unfortunately, there were surgical complications. One of the retractors in my pelvis left me with a crush injury to one of the nerves of my leg, and I woke up from the operation unable to move or to feel my right hip and knee. Suddenly, I transitioned from the vascular surgeon in the white coat with all of the answers to the patient in the snap-gown full of questions. As my surgeon cried, disclosing the full extent of my retractor injury, I found myself thinking, “Who cares about your shame or guilt? I am the one that cannot walk. What if I can never run or perform an operation again?”
Just after having recovered enough to go back to work, I developed a wound complication, accompanied by peritonitis, which required an emergency operation. I would be out of work for an additional number of months. Sweating and in pain from the peritonitis, in the morning prior to going to work, I called my surgeon about my wound complication. This was several weeks after the original procedure—and his response was that I must be imagining things. He advised me to go ahead and do my first case of the day, which was a carotid endarterectomy. As I operated on the carotid, I wondered why my surgeon hadn’t listened to me. Afterward, with my scrubs drenched in peritoneal fluid, I drove myself to his hospital. Later that day, I had an exploratory laparoscopy and repair for the peritonitis. Postoperatively—lying awake with only the ceiling to keep me company—I questioned whether I would have the courage to press on and get back into life. Being a patient required that I work, and so I worked hard. Being a patient meant that I had to fight to reclaim my life. Being a patient meant that I had to shed my tears and learn to laugh again. Being a patient revealed my humanity to myself, and I listened. Tears fell silently as I began to understand patience.
As my health recovered, I began to look at my profession through a different lens. I recognized the anguish on my patient’s face as they grappled with the reality of their illness, and I stayed silent and still as they spoke, providing an ear to their concern. I noticed their pain as they lay still in bed, and I sat down and held their hand instead of standing at their side and patting it. I saw the fear in their eyes that they would never be the same again, and I witnessed their withdrawal from life as they fought to live and move forward. My patients were the same as they had been prior to my illness; I was the one who was different. I no longer stayed by their side and offered words of wisdom. Instead, I sat down with them, I listened to them, and I cried with them. I was able to share their journey—the journey of healing.
As I drove home the other day, I reflected on this story and realized that both my literal and figurative scars were fading. As my memory of these events fade, I had to ask myself if I was still “human,” or if I had returned to the focused, hard-charging, but emotionally remote surgeon that I had been before this experience. The answer is yes and no. Some days are easier to be human than others as maintaining the balance is a constant but worthwhile effort.
Yesterday in clinic, one of my patients—a man with an aortic dissection and iliac aneurysm that I repaired—came in for follow-up. His was an interesting case that was operationally challenging, and fortunately, he and I had a very satisfying outcome. While an inpatient, he always wore camouflage slippers. I asked him about them one day on rounds and he revealed his love of hunting and shooting. He bought these slippers to wear during his recovery to remind him of what he was walking toward. Hunting is a big part of his life, and he promised himself that he would recover by hunting season. I enjoyed his stories and I took the time to understand his camouflage slippers. Returning to yesterday’s clinic, he gave me a wrapped present. I was so flattered when I opened the bag and found—to my delight—a pair of camouflage slippers. I wore them tonight and they remind me that his journey is the same as my own. Being human has made all of the difference.