Originally published by our sister publication General Surgery News
‘Every surgeon carries about him a little cemetery, in which from time to time he goes to pray, a cemetery of bitterness and regret, of which he seeks the reason for certain of his failures.’—RenÉ Leriche, MD
Recently, I suffered what I consider to be a major intraoperative complication while operating on a young patient. This event occurred during a very difficult cancer operation and, in the opinion of my colleagues, was likely a consequence of the nature of the disease and perhaps unavoidable. Since then, I have done equally difficult cases without any negative sequelae. The patient is alive and likely cured. She has suffered substantial morbidity, however, and I have had a very difficult time dealing with this. I have found myself having difficulty sleeping, I am constantly replaying the operation in my mind, my mood has been depressed, I have been tearful at times, and frankly I think I have just been difficult to be around.
One of the things that has made this more bearable is the support of my respected colleagues. When the complication occurred, I presented the case to a surgeon in my particular specialty who I greatly respect. He acknowledged that he had similar occurrences in his long career and provided me reassurance and community. Although this did not completely kill the pain, it did remind me that I am not alone. I also reached out to Dr. Sunil Geevarghese, a Vanderbilt University transplant surgeon, who has made the concept of “second victim syndrome and moral injury” a more frequent topic of discussion among surgeons through his work with the American Society of Transplant Surgeons and its peer support group. His efforts have greatly increased awareness of this problem.
Throughout this experience, I have learned two things. First of all, we should not suffer alone and in silence. When you suffer a complication, reach out to those you trust and who are knowledgeable in your area of expertise. Doing so will allow you to learn from the experience while receiving much-needed moral support. Whether this is done formally through support groups like those developed by Dr. Geevarghese, or whether it is done informally by reaching out to respected colleagues, the result will be the same. You will not suffer in silence.
And finally, some advice to those who are approached by a colleague for support: Recognize that what they need, more than anything, is your ear to listen in a nonjudgmental manner. What they do not need is expert analysis of the event, nor do they need a comparison of their particular complication with those that the colleague being approached might perceive as more severe. Statements like “hey, your patient is still alive,” or “at least she is cancer-free,” do little to support a colleague who is struggling with pain and self-doubt. Minimizing their lived experience through statements like these will not serve to support those who are suffering. As surgeons, we have a responsibility to our colleagues that is no less significant than our responsibility to our patients. That responsibility is to let no one suffer in silence.
By Bryan K. Richmond, MD, MBA, in Charleston, WV
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I teach a course called Human Factors and Patient Safety and we include a discussion on just what you are talking about. Our students who have been in practice for some time have much to say regarding this as few have not experienced something that left it’s mark. In medical error there are almost always two victims and both can suffer. It is important that we recognize this and can talk about it. Thank you for sharing.