This job is unique because every decision, every action, seems to have a moral quality. If I make a mistake, it’s not merely an error, it’s wrong. I feel it to be so – a sin against my patients – and my superiors act similarly horrified. Not only major failures: misjudging the need for an operation; choosing the wrong course intra-operatively; failing to recognize an important change in the patient’s condition – but the small ones: tying a knot wrong; not cutting exactly in the plane between tissues; forgetting to order morning labs; one liter too much or too little in resuscitation; imperfect phrasing in a note.

I don’t think this is just in surgery. It seems to be across the board in medicine, part of the nature of professional responsibility. Perhaps the rigidity of surgical training means it’s voiced more clearly, but I think my friends the medicine residents feel just as badly about errors small and large.

That’s the problem, of course – there are no small errors in medicine. Every single mis-step could have disastrous consequences, even if most of the time things work out ok. Getting morning labs a few hours late, to take one example, could mean missing a significant acidosis or hemorrhage for a length of time that could impair our ability to respond quickly and effectively. Sure, it would be rare for a few hours to make much difference; but I can easily picture it happening.

So every decision, every action or lack there of, carries a tremendous potential for guilt, which only increases with the size of the decisions. And every night, you can go home and spend hours second-guessing yourself: was I wrong? and if wrong, how wrong?

Other jobs may have long hours, but I doubt that any have this weight of moral implication attached to every moment.

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