Surgeons, Surgery, and Luck

From a review of the memoirs of British neurosurgeon Henry Marsh:

When he was younger, Dr. Marsh recalls, he used to feel an “intense exhilaration” after a successful operation — he felt, he says, “like a conquering general,” having averted disaster and safely delivered his patient: “It was a deep and profound feeling which I suspect few people other than surgeons ever get to experience.” But while he’s made many patients very happy with successful operations, he says that there have also been “many terrible failures and most neurosurgeons’ lives are punctuated by periods of deep despair.”

Dr. Marsh candidly runs through a list of his “disasters” in this book — headstones in “that cemetery which the French surgeon Leriche once said all surgeons carry within themselves.” A woman left almost completely paralyzed because Dr. Marsh dismissed early signs of a postsurgical infection. A patient who came through surgery on his pituitary gland just fine but suffered a debilitating stroke days later that left him “utterly without language.” An 11-year-old Ukrainian girl with a huge tumor at the base of her brain, who suffered a severe stroke after a second operation, returned home more disabled than when she had left it, and died 18 months later.

Such stories underscore the role that bad luck and terrible mistakes can play in medicine, resulting in the dreaded word “complications”: A piece of surgical equipment can malfunction; a tumor can turn out to be stickily attached to the brain and impossible to completely remove; a poor decision (even whether to operate or not) can be made; a vein can tear and flood the brain with blood, hiding everything and leaving the surgeon to operate by “blind reckoning, like a pilot lost in a cloud.” A trainee doctor, supervised by a veteran like Dr. Marsh, can also botch a routine procedure: “It’s one of the painful truths about neurosurgery that you only get good at doing the really difficult cases if you get lots of practice, but that means making lots of mistakes at first and leaving a trail of injured patients behind you.”

If you were only looking after your own interests, you would always refuse to be operated on by an inexperienced surgeon. But if everybody did that, surgeons could never get experience -- for medicine to continue new surgeons must operate on somebody, and those people face longer odds.

These stories also bring home the hardness needed to be a surgeon. In general, empathy is one of the most important things in the world, but if surgeons had too much of it they could not do their jobs, and we would all suffer for it.