Pretty regularly, medical students ask me if they can “shadow.” They want to follow me around, to get an idea what my day is like. They hope to see how it might feel to lead the life of a surgeon.
I try to say yes to these requests. The students are accomplished, earnest people. They’re trying to preview the career choices in front of them. Why would I be opposed to that?
Still, I’m skeptical of shadowing in surgery. I’m not sure that a day spent with a surgeon can capture what it feels like to actually be one. Sure the students have a chance to eyeball the inner O.R. sanctum. They can be dazzled and awed, as I am each day, by the instruments and technology and teamwork. And they can certainly get a sense of how tiring it is, how much your legs ache after standing in the O.R. all day. I can guarantee that shadowers will learn the value of a good set of support hose.
What shadowers are unlikely to see are complications, which are uncommon but inevitable. Uncommon as they are, though, complications play a significant part in the emotional life of surgeons, and because shadowers are unlikely to see one – and even less likely to see the long-term sequelae, the physical and emotional cost to the patient and the surgeon – the shadowers are missing a fundamental aspect of what it means to be us.
Surgeons do everything in our power to avoid complications. We train for years in technique and decision-making. We use antibiotics to minimize the risk of infection. We’ve developed safety checklists to tick off at the beginning of cases. We discuss complications in surgical meetings that are specifically designed to review and learn from them. Still, we can’t make the risk of anything be zero. That’s the tough truth of our work, which means that each one of us will have patients who do poorly. Each one of us will live with that.
So here’s a complication story.
Years ago, I operated on a patient with ulcer disease. He could no longer eat because of his ulcers. At the time, his operation seemed unremarkable. I talked to his wife and daughter afterward and let them know it had gone well. The patient’s daughter was also my patient; I took care of her breast lumps.
The patient didn’t recover as quickly as I’d anticipated. A week after his operation, he bled internally. Then he developed an infection in his abdomen, and then pneumonia and then kidney failure. His post-operative course went on for a while, but ultimately, he died, despite attempts to treat each one of his setbacks.
He was my first death as young surgeon. I was devastated.
I reviewed his operation over and over in my mind. I discussed it with colleagues. I thought about what I might have done differently. I examined each of his complications and whether I’d treated them appropriately. And, of course, I thought all the time about his wife and daughter, ruminating on their loss.
A couple of months after his death, his wife and daughter showed up in my office. It was time for the daughter’s regular breast appointment, and she and her mother always came to it together.
I couldn’t believe they had come. I’d assumed they would find another surgeon for the breast lumps, that they wouldn’t want to be reminded of the ulcer surgery and death. But that wasn’t the case. They kept coming back to me; I saw them for years.
In truth, I was the one that didn’t want to be reminded, and early on, I found myself dreading their appointments. Seeing them reopened my wounds. Eventually, though, I started thinking about why they’d chosen to come back to me.
I suspected then that it was because we were a good doctor-patient mix. I’m a talky doctor, and they were talky people. I’d spoken with all of them a lot before the ulcer surgery. We’d discussed risks and benefits of surgery, complications with their percentages. I’d listened to their questions and tried to answer all of them. As complications developed, I’d been honest with them, which I think they valued. Truly, I think the family accepted risk and imperfection, probably more than I did.
Unintentionally, this family taught me what it meant to be a doctor. Not every day is a dramatic victory over life-threatening disease. Some days are full of wrenching losses, and making your peace with that is a critical part of what it feels like to be a surgeon. It’s the part that shadowing will never be able to capture.