Each year, the Communications Committee of the RAS-ACS selects a topic of broad interest to young surgeons and solicits brief essays from interested members on the subject. This year’s topic — How Surgeons Deal with Complications – generated a robust response from RAS-ACS membership. This year’s winning essay by Elisha G. Brownson, MD, details lessons learned from a case involving a lucid patient and a snapped catheter.
Accepting accountability and moving forward
by ELISHA G. BROWNSON, MD
PUBLISHED JANUARY 3, 2014 in Jan 2014 /Volume 99 Number 1/Bulletin of the American College of Surgeons
In an instant, the whole procedure changed. I had been called to assist another co-resident in removing a port-a-cath at the bedside. It had been difficult, and despite retrieving the port, the tunneled line was proving to be more of a struggle to remove. It was my hands that came to assist, that applied stronger tension, and that snapped the catheter. It was my complication.
My thoughts flashed back to the consent form that the patient had signed. The risks of the procedure include: bleeding (not expected to be more than a tablespoon), infection (we are removing the port due to suspected infection), damage to nearby structures…
Did we even mention retained foreign body?
In a calm voice, I asked my co-resident to get our chief resident to the bedside and get the nurse to put the patient on telemetry. There we were, with an awake patient and a catheter that I could not retrieve.
Surgeons must often face complications in a much more overt way than our medical colleagues. And, unlike a hospital-acquired pneumonia, which often can be attributed to several factors with shared responsibility among numerous providers, surgical complications can often fall into the operator’s hands. Our hands, which we have trained to heal, are also held accountable for their actions.
I returned to our workroom feeling a mixture of embarrassment, regret, and disappointment in myself. My chief’s response surprised me. She said that this problem was a sign that I was operating because, in the end, we cannot operate without encountering complications. We must reconcile this fact within ourselves to move forward, while at the same time proceeding with great care and detail so that we do not advance recklessly to the operating room. It is this awareness that our colleagues and attendings attempt to reproduce at the podium of our morbidity and mortality conferences, but often we are our own greatest critic in this process.
The sterile field was taken down. My gown, gloves, and mask were removed. Are you all done now? We invited the patient’s wife back to the room so the attending surgeon and I could explain our findings and the plan going forward. It is a challenge, in a field wrought with pride and confidence, to expose our failures to patients and their families. But this humility carries forward with us and shapes us. Every surgeon has those poignant faces or names engraved in their memory, and they stay with us for the duration of our career.
The patient was wheeled off to interventional radiology. Thankfully, retrieval of his catheter was resolved promptly and without further complications. The next day, I apprehensively walked into the patient’s room to round. Deep breath. Move forward. Another day in residency. These were the thoughts that were running through my head that morning.
I am a surgeon in training and as my responsibilities grow, I understand more intimately the unique challenges of our field. I have learned from this patient and have found that our complications spur us on to strive for better care in the future.