The Most Useful Thing I’ve Learned

Nicholas Sasson, MD
4 min readFeb 3, 2020

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There are many experiences I’ve had throughout my life, and throughout my medical training, that have helped make me the doctor and person that I am today. I’ve tried to learn from the good and bad experiences, and from the smart and poor life choices I’ve made along the way. I’d like to share the single most impactful advice that I’ve ever received as a physician. It is a story that I’ve retold many times with residents that I’ve trained, and is something that profoundly changed the way I think of what it means to be a doctor.

One night during my 2nd year of Family Medicine residency training, I was on “Night Float” covering labor & delivery, and a baby was born prematurely via an emergency cesarean section after showing signs of severe distress. Despite our best efforts, tragically the baby died several days after delivery. There were a series of internal reviews that followed, looking at how things were handled — how closely and appropriately was the fetal monitoring, how quickly was the code called and how was it communicated and run, who showed up and when, and how well the Attending was supervising and monitoring both the patient and myself. When this process finished, it was determined that overall the care was appropriate, and my actions had met the standard of care expected. In other words, I hadn’t made any serious errors.

This process was extremely stressful, and while of course I was relieved with the outcome of the review, instead of feeling relief, what I felt was sadness, depression, self-doubt, and fear. I was afraid that I wasn’t cut out for this type of work, that I’d picked the wrong profession. If I felt that bad when I hadn’t made a mistake, I couldn’t possibly imagine how I would handle a situation where I was at fault. Everybody makes mistakes, we are all human and it is to be expected. Unlike most other professions, when physicians make mistakes, sometimes people are hurt, and sometimes they die. The enormous amount of pressure that could go along with that realization hit me full force.

I went to one of my most respected mentors, an Attending at my hospital by the name of Dr. Alan Santell. He was a dedicated, smart, wise and kind physician who had been at my training program for decades. He passed away a few years ago, and is sorely missed by all those whose lives he has touched. I took him aside and opened up about my feelings. What he shared with me in just a few sentences truly changed who I am as a person and who I strive to be as a physician.

He told me that we, as medical providers, were very fortunate to be in our positions. We are able to provide the care we provide, only thanks to the hard work, trial and error, and wisdom of those that came before us. An enormous amount of resources went into giving us the collective knowledge that we have available to us. All we can do is do our best based on the information we have. Sometimes good things will result, sometimes bad. When you’ve tried your best, you cannot “own” the bad outcomes, and in fact it is egotistical to think you have that much power, and you cannot allow tragedies to deform your being and self-worth. He went on though to say that this was the easier part, and that it only can work if you take it a step further. If we aren’t going to own the defeats, then we certainly can’t own the victories. When we have “good” outcomes, when we are praised for “saving a life”, we can’t take that credit either, and we can’t allow it to distort and fuel our egos.

I’m almost 50 years old now, and the longer I practice, the more I’ve come to appreciate what Dr. Santell taught me that day. I’ve had this philosophy tested many times throughout my career, and I’ve caught myself erring on both sides — sometimes taking on too much of both good and bad results. It is a constant struggle, and takes humility, vigilance, and the time and space for self-reflection to avoid the pitfalls of “owning” patient outcomes.

Recently I treated a young woman in her 20’s who presented with a mild cough most consistent with allergies, but also with dyspnea on exertion that seemed disproportionate to that diagnosis. After checking her O2 saturation with a walk test and seeing it go down to 82%, I sent her to the ER to be worked up for a pulmonary embolism. I found out that this was indeed what she had when she came back to the clinic later that week wanting to “thank that brilliant doctor who saved my life”. Of course that felt good, who doesn’t like being told they are smart, and who doesn’t like to be right? As much as I want to own that “victory”, I know deep inside that I can’t. If I let that one in, then I’m opening up myself for the bad ones to enter too.

I can still feel in the pit of my stomach how awful it felt when that baby died, and I’ll always question if there was something that I could have done better. But I know I’ll have a better chance at keeping my ego in check and nurturing humbleness, and being a better physician and human being, if I can maintain a healthy work-life balance, and if I always keep in mind what Dr. Santell told me.

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Nicholas Sasson, MD

Dr. Nicholas Sasson is a family practice physician from Monterey, CA who is the current Medical Director at an outpatient clinic for the VA.