Talk it out, and slow it down

We don’t like to think about the fact that surgeons make mistakes. Yet, a significant proportion of our patients suffer complications either on the wards or in the operating room, and some of these problems are direct consequences of our mistakes.

The emotional reactions of surgeons to adverse events can be categorized into different phases:

  1. The kick, during which feelings of failure emerge
  2. The fall, in which a sense of chaos prevails
  3. The recovery, when we try to learn from our mistakes
  4. The long-term impact, which involves integrating what we have learned into our practice*

But how do we integrate these lessons into our everyday lives?

I remember it as if it happened yesterday. It was the first week of my fellowship, and I was assigned a noncomplex case with a resident. I was nervous because it was one of my first few independent cases, but, at the same time, I was excited to be able to prove to others that, “I can do it.”

We planned to resect a pancreatic cyst that had previously been internally drained to a Roux-en-Y. At some point in the case, I felt the complex portion was over. We had identified the anatomy of the Roux limb, and we simply had to take it down. I thought this step was the routine part of the operation and resorted to “automatic mode.” Little did I know, but I was actually taking down and resecting the normal duodenum of the patient and not the Roux-en-Y. As a result, we had to perform a much larger operation with an end-to-end anastomosis to the second portion of the duodenum, which led to several postoperative complications.

Many thoughts were going through my mind. A couple of these bothered me tremendously: one was that my patient had just suffered a major complication that was avoidable, and the other was that my credibility and identity as a good surgeon-in-training were in jeopardy.

This error marked the beginning of my training as a fellow, and I was unsettled for a long time. Talking about and discussing this operative complication with residents, fellows, and junior and senior staff helped me to deal with these emotions—not only talking about the technical aspects of the operation, but also how to prevent something like this from happening again.

Through this experience, I learned the concept of “slowing down when you should.” My mistake was definitely attributable to a failure to slow down and be mindful at a crucial moment during the operation. By talking about this surgical error, I was able to dig into this problem—to look at it head-on and not shy away from it.

Talking about our reactions to cases involving surgical complications should not leave us feeling embarrassed or denigrated. Rather, expressing our feelings regarding these situations should allow us to achieve an understanding of two crucial and conflicting realities—our desire for perfection as we strive for our best and our imperfection on this real, lifelong journey.

*Luu S, Patel P, St-Martin L, Leung AS, Regehr G, Murnaghan ML, Gallinger S, Moulton CA. Waking up the next morning: Surgeons’ emotional reactions to adverse events. Med Educ. 2012;46(12):1179-1188.

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