Sunday, May 20, 2007
Every surgeon is going to lose someone during his/her career. It's inevitable. Especially in this era of an aging population. I can't even count how many times in the past nine months Ive been called upon to see an 80-85 year old lady/man with free air and laundry list of co-morbidities. Sometimes it works out. I even reversed a colostomy on a wonderful 88 year old fire plug a few weeks ago after she presented with perforated diverticulitis three months prior. But the odds aren't stacked in your favor. COPD/CHF/AFib/SIRS vex even the most vigilant of intensivists. Even if they survive the surgery, you never feel safe until you actually seem them wheeled off to home or rehab. I had one lady, arrived on deaths door with fulminant colitis secondary to C. Difficile; she underwent a near total proctocolectomy with end ileostomy. Amazingly, she did well over the first three days. I had started her on clear lquids and transferred her to a step down floor on post op day four when she suddenly fell over in her chair and died. Autopsy demonstrated massive myocardial infarction. It's frustrating. As a new surgeon, I tend to get a lot of the so called "disaster" cases. There's no room for error. Everything has to be perfect. You can't afford anastomotic leaks. You can't forget the IV beta blocker. You change your central lines. You look at the daily CXR's. You know all the cultures and susceptibilities. But sometimes, it doesn't matter what you do. You can't always make a Picasso out of crayons and cardboard. This doesn't absolve me of any guilt, however. When a patient dies, I feel responsible, regardless of the circumstances. You lose a little bit of yourself if you don't. There's always something else you could have done, another test, visited her a little more often, watched her potassium a little more closely. Something. You have to beat yourself over the head. You dont want it to happen again. You want to be better, more prepared for the next time.