This is a love letter to all my friends who work in surgery. But even if you’ve never stepped foot in an operating room, keep reading. You may be able to apply this to other events in your own life.
Dealing with the emotions that follow a surgical complication on your watch can be incapacitating. It is one of the most intense things we go through as surgeons or surgical support staff. One of my mentors at Mayo used to say when surgery was going well, he couldn’t believe he got paid to do it. And when it wasn’t going well, he’d think ‘they can’t pay me enough to keep doing this.’ It is brutal.
We could compare surgical complications to any work complications. A contractor’s incorrect measurement, a chef’s soggy entrée. Except the ramifications of a surgical complication are more significant. Some not reparable. It affects a person’s vision, body, health. We constantly worry about that person.
The stew of emotions that occur following a surgical complication include guilt, grief, sadness, frustration, embarrassment, regret, and anxiety. But I think the most poignant emotion is shame. My husband is also a surgeon. We hold each other up when this occurs. He said to me several years ago – “the best way I can describe this is shame.” Always the wiser one, he is correct. And it helps to name it and say it. As Brené Brown says, “Shame cannot survive being spoken. It cannot tolerate having words wrapped around it. What it craves is secrecy, silence, and judgment. If you stay quiet, you stay in a lot of self-judgment.”
Let’s work through shame.
What. Name it: Shame
Where. Locate the emotion. Abdomen -- nausea. Throat and chest – tightness. Shoulders – hunched and tight. Head – fatigue.
Why? What are the thoughts running through your mind that are causing this feeling? You’ll have to peel the layers of the onion to get to the subconscious thoughts. But usually they are something like this:
“I caused it.”
“I’m not a good surgeon/nurse/scrub/anesthesiologist.”
“I did something really wrong.”
“I’m a terrible doctor.”
“Others are way more qualified.”
“I’m incompetent.”
“I’m an imposter. I’m a fraud.”
“I’m worthless.”
The underlying fear beneath these thoughts is the big one: “I’m not worthy, valuable, lovable.”
Note the why is NOT because of the circumstance. This may take a minute to wrap your head around. But let me give you an example. In cataract surgery, our most common complication is an unstable or broken capsule which holds the cataract. In this setting, we perform a vitrectomy – cleaning up any vitreous gel coming forward from the back of the eye through the compromised capsule. Sometimes we anticipate needing a vitrectomy in advance – in cases of trauma or certain congenital cataracts. In these cases, when the vitrectomy is anticipated and then needed, thoughts arise like:
· “I did the best I could with the situation.”
· “I took it one step at a time to maximize the outcome.”
· “I knew what I needed to do and stayed calm.”
· “The patient should do really well.”
When the capsule breaks or shifts during what we anticipated was going to be a routine case, the surgical steps are all identical to what we would do in an anticipated case. The only thing that is different is our thought about the circumstance. Instead of “I did the best I could with what was handed to me,” we immediately think “It was all my fault and I’m a terrible surgeon.” Now at this point, you could argue “but it was my fault! I went too deep, I placed the instrument in the wrong place” etc. Then I would quote Russ Harris from the book “The Happiness Trap”: “The important question here is not whether your thoughts are true or not, but whether they are helpful. If I use this thought for guidance, will it help me to be the sort of person I want to be; do the things I really want to do, and in the long run build a better life?” Simply by recognizing the thought you are having, and by recognizing that it is unhelpful, you can start move forward.
4. How long? The physiologic waves of emotion will last about 90 seconds each time. Allow yourself to breathe and feel into and around these waves of shame. Imagine you have a lead ball in your stomach that is occupying the whole area. Breathe in and around it. Imagine getting a little air around the whole lead ball. Focus on this with each wave. The waves will come and go. In my experience, they’ll be your companion for several days. You’ll be very tempted to eat a whole cake, say 'budget be damned-mama’s shopping', or drink too much wine in front of a Disney movie. But if you recognize, name, feel and process the emotion instead of buffering, it will leave you much sooner.
5. What’s the lesson? As you process through, ask yourself this question. For example, when I’ve had a complication at a very specific step of the procedure, I’ll watch surgical videos involving that step, look up papers written about that complication, and reach out to colleagues to discuss what happened. I have a couple buddies from residency I really trust and can speed-text when needing advice. After all of that, I can come up with a good game plan for how I’ll handle that situation moving forward.
6. Live according to your values. What are your values as a surgeon, nurse, etc? Quality, compassion, excellence, innovation. Pick a couple and use those as your big-picture north star. Put this into context within your larger mission. Remember a quote by another of my Mayo mentors “the only way to not have surgical complications is to not operate.” Remember this is an inevitable storm during your career as a pilot. A downswing in the market during your career as a financial planner. We only become great by going through the storms, learning the lessons, and clarifying our guiding values moving forward.
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