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I am not a ‘proper surgeon’. I know what a ‘proper surgeon’ is because some of my friends are ‘proper surgeons’ and I was on the training pathway to become a ‘proper surgeon’.

Being a ‘proper surgeon’ is where you carry out surgery that saves people’s lives or appropriately heals serious diseases.

I jumped off the treadmill to become a ‘proper surgeon’ because I wasn’t emotionally equipped to be able to deal with the fall out when inevitably things go wrong and, as a result of that people die.

I could write blogs upon blogs about the experiences I had that convinced me that I was not fit material to be a ‘proper surgeon’ but one case in particular springs to mind when, as a young man, I was face-to-face with a woman in her early 30’s who was terminally ill as she cried and told me how I would never understand what it was like to know that I would never see my children grow up.

‘Proper surgeons’ doing ‘proper surgery’ have to be either utter bast**ds or be able to treat the patients they are operating on as ‘technical procedures’. This is not to say that they’re cold, it is the only way to survive when you have to continue to operate after someone has died on the table in the morning and you have a case to do in the afternoon.

Taking an example from an earlier blog, if Stephen Westaby (the paediatric cardiac surgeon) operates on a Monday and a Tuesday there is a chance that one of his patients will die on the Monday. If he attaches himself emotionally to those patients on the Monday and one of them dies how does that leave the patients on Tuesday that require his attention, is he fully focused and emotionally stable?  

I am not a ‘proper surgeon’ but I can empathise and sympathise with the way that ‘proper surgeons’ feel. Here is a short story that you may wish to pass on to members of the public or members of your family who are not in healthcare to help them understand.

On Monday, I was tasked with assisting a surgical procedure in the practice. The patient was to undergo implant surgery in the lower jaw carried out by one of my colleagues, I was asked to perform a sinus graft in the upper right and also place an implant in this area.

This is a procedure I have carried out hundreds and hundreds of times and also a procedure for which we are about to publish my 10 year results for. Initially the procedure went extremely well and all the diagnostics looked like it would be easy, I felt I had done everything I was required to do to ensure a smooth surgical procedure and outcome for the patient.

During the procedure, I noticed that the sinus membrane was torn as I tried to elevate it out of the way to make space for an implant to be placed.

This happens in my practice in less than 20% of sinus graft procedures but it still proposes a significant challenge during surgery. I was able to enlarge the access cavity and work around the site in order to isolate the tear and put myself into a position where I would be able to patch the tear and proceed with the procedure, all be it with a  slightly higher theoretical  risk of complications.

As this was occurring though I was considering the conversation I had had with the patient immediately prior to surgery where they (once again) expressed their concern as to how long after the procedure they would have to wait to re-start the pursuit of their hobby playing a wind instrument. During that conversation, it was absolutely clear that the playing of the wind instrument was fundamental and significantly important to the patient and this should be taken into consideration at all times when treatment decisions where being made.

This was going through my mind as I was trying to isolate the tear in the membrane and considering what the sort of risks were when patching that tear and proceeding. I was aware that if the patient suffered a significant sinus complication as a result of this surgery it would set them back considerably in terms of their wind instrument hobby, and cause some considerable upset and stress.

I assessed the situation and analysed things during the procedure and elected to take a different approach. I placed an angled implant into the site which is significantly stable and measured extremely high on our stability measurement too. I elected not to graft or patch the sinus and to do a small graft behind the implant and close the area.

In essence, I changed the patient’s treatment plan part way through the treatment based on the circumstances I found.

Why do I feel that is a failure?

Why did I berate myself after surgery and reflect back to the event far on into the evening and question my ability to carry out these procedures?

Why do I find it unacceptable that my plan should change during surgery regardless of the biological situation or considerations?

The story continues. The following day I was booked to carry out bilateral (two sided) sinus surgery and implant placement on a particularly complicated case.

Does my experience with the patient the day before enhance the chances of the patient the following day or effect the chances negatively?

So here lies the deeper and more important question for the public and the society as a whole.

If I try my best, am appropriately trained and worked within my scope of practice and still things go a miss as they will and as they must in biological situations why should I get the fear?

I get the fear because I do not live or work in a just culture and I will be held to blame for any negative outcome that that patient receives, particularly when they’re paying for treatment.

It is important for the public to remember the damage that they cause by blaming empathic, enthusiastic and committed clinicians, it damages other patients who are also other people’s relatives and friends.

I was anxious treating the patient the next day. More anxious than I usually am in surgical procedures like this. In the end, the surgery passed off uneventfully and in fact beautifully. I was very proud of the outcome as I finished off 3 and a half hours after starting.

The irony of the story is that as these patients recover over time it will perhaps be the patient whose surgery proceeded beautifully who will have a complication and the one whose plan that part changed half way through with an altered approach may well be fine; this is the nature of the work that we do.

A small tale from an insignificant ‘improper surgeon’.

Imagine what it must be like for the proper guys.

Blog post number: 1557