Tuesday 4 June 2013
It never ceases to amaze me what patients will allow me to do to them under the influence of anaesthesia. I have to take you apart, fix you, and put you back together again, Humpty-Dumpty style. That's nerve-wracking stuff, as I'm sure you can imagine. There are countless things that can go awry, and one wrong move can literally mean the difference between life and death.
So why aren't more people deathly nervous before surgery?
It's a question I can answer from personal experience. When I had appendicitis (over 20 years ago), I wasn't nervous at all before going under the knife. All I knew was that this pain was excruciating, I felt like dying, and I just wanted to get this goddamned thing out of me RIGHT NOW. It wasn't until years later during my training, assisting with my very first appendectomy, that I actually got scared. Is the incision in the right place? Is the skin bleeding? Did I cut the fascia in the right plane? Is the muscle bleeding? Did I poke a hole in the bowel on my way in? Did I tie off the appendix tightly enough? Is it too tight? Did I irrigate enough? Too much? Did that suture fall off? Is there an abscess I missed? Did I forget something? Will there be a skin infection?
You get the idea. Interestingly, even though most of my patients don't seem particularly nervous, I've had a few of them ask me if I'm nervous before operating on them. My standard answer:
A look of combined panic, terror, and "GET ME THE HELL OUT OF HERE!" universally ensues. As the patients are probably locating the nearest exit and simultaneously mentally reviewing their lawyer's phone number, I give them a warm, reassuring smile and explain my response.
I always get nervous before every operation, no matter how simple or routine it may seem, from a mole removal to an appendectomy to a pancreas excision. I'm constantly reviewing the steps in my head, even if I've done it 1000 times (which I have), and I'm constantly thinking what could go wrong at every stage of the procedure. Being nervous keeps me on my toes. When a surgeon loses that edge, he gets complacent. And complacence is what causes mistakes to happen.
As I go carefully through my explanation, their look goes quickly from "SHIT I'M GOING TO DIE!" to "I think this guy might know what he's doing" and then finally to "Ok, I'm in good hands". Only when I see that look do I allow the anesthesiologist to proceed.
If your surgeon isn't nervous, you should be.
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