Surgery has no room for errors. If they happen, there’s nowhere to hide. You cut the wrong thing in the OR, and everybody knows about it. Even if it’s something as relatively simple as getting into the hernia sac you were trying to get around, everyone knows because you have to call for a suture to repair it with. Anything bigger is even more obvious.

When your patients die, everyone knows that too. What happened to so-and-so? Where’s the patient who was in that room? What’s with the blood and paper all over the floor? Why’s your attending so gloomy today (in fact why is the entire service colored grey)?

You also can’t hide in the sense of withdrawing from the life of the hospital. Just because one person died, there are still a dozen others needing help, even others with the same problem. That’s what’s really getting to me right now. One person died, and there’s another patient with an extremely similar problem, whom we simply have to operate on. It would be irresponsible not to – and yet it feels irresponsible to go ahead. Statistics say there was a 1% mortality rate, and that patient bought it – so really the next hundred ought to do great; but I don’t want us to do that same operation again so soon. It seems like tempting fate. I can tell the attending doesn’t want to, either. For a guy who doesn’t talk much anyway, the main way he shows emotion is by talking even less, and more inaudibly than usual (which is harder to deal with than another attending cursing and swearing). But he has to take the case. There’s no one else who can do it, and the other patient can’t wait.

I guess it would be more accurate to say there’s no room for denial. Errors, and inevitable complications, occur. The big thing is not to hide from them. You can’t be so insistent that there were no technical errors that you refuse to go back to the OR for postop bleeding. You can’t ignore an enterotomy and hope it goes away without you stitching it up, and admitting to yourself and the scrub and the circulator that something slipped. You can’t pretend that the patient didn’t die, and that if you don’t even think about a patient with that disease for a month, it will somehow undo their death.

(Which is why I hate euphemisms, especially at M&M: “The patient CTB (ceased to breathe).” Come on guys, we’re surgeons. The patient died, is what they did. They’re dead. That’s why we’re discussing it.)

I hate it when my patients die. Somehow it feels worse when I wasn’t there at the time, as though in addition to generally having let them die, I also failed to be with them when it mattered. At least I didn’t have to see the family. . . I can’t even think about them. I can say to myself, the person I was talking to yesterday is dead and gone. . . but I can’t bring myself to even imagine the family, how they received the news . . .