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I listen to Stephen Westerby’s book Fragile Lives but in truth I haven’t finished it yet; I’ve started to do something else.

You can find the Steven Westerby’s book here. 

It’s another book in the line of ‘the surgeon tells people what it’s like to be a surgeon’, only this time it’s to do with cardiac surgery not brain surgery.

Aspects of it I liked and aspects of it I didn’t and I found his character sometimes hard to stomach but then wondered what character I would need to be to do the job that he did.

Imagine the situation where you have back to back days of operating on cardiac patients knowing that the likelihood is you lose a patient on one of those days.

How do you go to work on the Tuesday to operate on more children with congenital heart diseases when one of them has died on the operating table the day before?

If you’re a police officer, part of the armed response unit, if you shoot a criminal they send you home from work, but you were only doing your job.

What do the surgeons do who have complications and who are emotionally unhinged about the situations that have arisen through (probably) no fault of their own?

This is where the characters, the arrogance and the sociopaths come in.

I remember vividly the larger than life neurosurgeons and orthopaedic surgeons I met when I was a senior house officer. They were bullish, over confident and seemed to be lacking in empathy. They were able to compartmentalise mistakes and apply the extroidinary amount of cognitive dissonance as they ascribed patient’s post-operative symptoms to something else.

The sad part is though that this might be the only way to survive in modern healthcare.

If you re-examine yourself and blame yourself every time something goes wrong you’ll spend a considerable amount of your time wallowing in self-pity and grief unable to function the next day as you remember what happened the day before.

The healthcare pioneers and the surgeons who create opportunities for other people and other patients going forwards are the ones who come in and put this aside. This is a fine balance that we’re still exploring and haven’t got any closer to answers yet but there is an important lesson for the public to learn here.

You can self-select out the arrogant surgeons who are able to abstract patients to pieces of meat on an operating table undergoing technical procedures but you’ll need more surgeons because many more of them will break due to the distress and psychological damage that comes from complications for patients who they’re trying to help.

This is a paradox indeed, is it true that you can have empathic surgeons who care as much as they can but won’t break over time due to the damage that’s caused from being a surgeon or you can have long lasting surgeons who see patients in the abstract, but empathy has to come from somewhere else? I’m not sure it’s possible to have both, the ones who sit in the middle ground, have excellent surgical skills, the ability to compartmentalise and the ability to live normal lives outside of their ‘job’ are rare animals indeed.

The public and the authorities attitude to healthcare has also made it all the more difficult for these people to survive.

These are the discussions that have to be had and these are the stories we have to tell to the young people wishing to progress into surgery in the future.

Blog post number: 1548