A Surgeon’s Four Humblings.
Four lessons in humility. Four opportunities to become better at what we do, and who we are.
Hilal A Kanaan, MD
To describe someone as a “good surgeon” implies the possibility that there are “bad surgeons” out there. They do exist. But through self-selection or censure, there are actually few bad surgeons operating. With time and experience, a surgeon will become a better surgeon. Time and experience. Experience can take different forms: triumph and disaster, and everything in between. And along the way, four different experiences may stand out. Four moments when a surgeon feels humility and understands that good surgeons can always be better. Four Humblings.
The First Humbling. Surgeons study and train through many years filled with long days and nights. And when it’s all over, and a surgical resident graduates, he or she will apply for privileges to operate at a hospital. We sometimes take for granted that operating on a patient is, above all other motivations, a privilege. A patient trusts in us that our judgement is sound, and that we have the ability to meet the technical challenges of the prescribed operation. But there are times when the plan or execution is flawed. And sometimes a poor plan is executed poorly. There can be a moment when a surgeon realizes they are guiding their unconscious patient towards death or disability. This moment can be associated with denial or blame but ultimately, a surgeon on the path to becoming a good surgeon will accept that they need help. The gratitude we feel for a colleague who gets our patient out of trouble of our own doing is different than gratitude for help with a tough case. When a surgeon can’t hold the disease responsible, and has only him or herself to blame for impending doom, the rescuing surgeon is truly a hero. The hero saves two lives. And when it’s all over, and we have expressed and over-expressed our gratitude, we reflect. We re-focus ourselves to becoming better at our craft. To becoming a surgeon who doesn’t need a hero to save them. To becoming a surgeon good enough to be called upon to be a hero for someone else.
The Second Humbling. Surgeons are people too. We get sick. We have families who get sick. When our families need surgery, we know who to ask. And when we accompany our loved ones for the initial surgical consultation, we generally have heard it all before. We are prepared for every part of the experience, except one: waiting. Waiting for the surgery to start and finish is new for a surgeon when one of our family is on the operating table. And if we have chosen the surgeon well, then we are hopeful for a good outcome. As we wait, we realize that our patients trust us the way we trust the best surgeon we could find. And when we wait on “the best” to finish taking care of a spouse or parent or child, a humble surgeon will ask, “am I the surgeon who other surgeons will bring their family to?” If the answer is “no”, then we know it more acutely at that moment. Every patient deserves the best version of the surgeon operating on them. Every family in the waiting room deserves the comfort a surgeon feels when we wait.
The Third Humbling. Informed consent is the process by which a surgeon explains to a patient the nature of an operation, the alternatives, and the risks. Every surgery has risks. And many surgeries include the risk of death. Patients die. It happens all the time, unfortunately. A patient can succumb to their disease or the stress of surgery can be too much for the old or infirm. Sometimes, even relatively healthy patients can become a tragic statistic. Monsters sleep under every hospital bed. But sometimes, the surgeon makes a mistake. A little too much or too little with the hand or wrist. A misadventure into a dangerous part of anatomy. When a surgeon is solely responsible for the death of a patient, there is no energy left in the room to curse or cry. And when the fault lies in us, absolution can only come from an honest account of the error. There is no room for any word but the truth when telling a family you have taken a life from them. And then the family forgives, in an instant, without a thought. When the new widow consoles the surgeon, the room is filled with love and humility. And through their forgiveness, we can hope to become a better surgeon and a better person.
The Fourth Humbling. For years, “A Surgeon’s Three Humblings” lay unfinished and unpublished. I considered the possibility that I would face a fourth lesson in Humility. I would learn that I was right: there are Four Humblings. But the last experience isn’t unique to surgeons. It is one that can teach all physicians, and non-physicians as well. During the early days of the Fourth Humbling, when my diagnosis was still in question, I wore my white coat and scrubs to my ultrasound and CT scan. But with each subsequent test and consultation and treatment, I gradually lost my armor. When I check in for my chemotherapy infusions, my wrist band doesn’t say “MD” after my name. The Disease doesn’t care who we are. And as humbling as the role of Patient can be, I am most humbled that my diagnosis carries Hope. I have a curable Cancer. But, I have taken care of patients who cannot be cured. I have given bad news to many families and patients. I have spoken definitive, hope-ending words. Not because I don’t believe in fighting the fight or in miracles. But because some cancers or injuries cannot be cured. We can learn so much from our patients and their families, who carry on despite an unquestioned prognosis. I am humbled by my illness, but more humbled to be a patient in the presence of these people. As physicians, we can be enriched more by the patients we cannot cure. As long as we are humble enough to see that the absence of Hope sustains a vacancy for Grace and Love.
