High risk, high reward in surgery

When rounding with my two teams at the beginning of each day, I am grateful to have opportunities to visit patients and their families, and sometimes even to engage in brief conversations.  After all, everything is about them, and without these individuals, there would be no purpose to our clinical and academic endeavors.  The euphoria I feel in witnessing healing and endowing greater appreciation for life itself in others is unlike any other emotion I’ve felt and likely cannot be bested by a different experience.

At the start of the summer, I did not expect to encounter patients of such high acuity.  Heart transplant recipients are some of the sickest at the hospital, with at least mild comorbidities in several if not all other organ systems.  Moreover, the average prognosis is 12 additional years following receipt of a donation.  While promising, the fate of younger patients for re-transplants, for instance, is uncertain.  In other scenarios, patients with severe aortic aneurysms often appear completely healthy, yet they have internal ticking time bombs that require immediate surgery.  Death is imminent within a few minutes of an aortic rupture.  These and similar conditions are not to be taken lightly.

I am inspired that my mentors seek to take on the majority of these cases despite the numerous complicating factors and high risk of failure.  I have high confidence in their judgment, but I also find it valuable to contemplate the pros and cons of going through with these surgeries.  One of my mentors always cautions, “Surgery is a cure in most patients’ eyes.  But even if the surgery is successful, to what end is life expectancy extended and quality of life improved?”  The analogy in the world of finance insists that it is worthwhile to invest in riskier stocks every so often, since the gains may be huge.  High risk can incur high reward.  Yet how can physicians afford to follow this same line of thinking if every life is valuable in its own right?

Last Wednesday, my peers in the program and I presented our “swan songs” to the Department of Surgery, providing some of the highlights and takeaways of our summer.  I spoke about how surgery first captivated me because it has the power to immediately relieve suffering, to act as a cure.  Yet this summer I learned that outcomes are not necessarily this optimistic.  No surgeon, doctor, or human can play God, no matter how much we plan ahead and attempt to control for everything that could possibly go awry.  Throughout medical training, especially in surgery, we are conditioned to seek perfection, yet physicians would be out of work if perfection were a guaranteed outcome in healthcare.

Despite the uncertain results of risky procedures, I believe in calculated risk-taking in surgery, with informed consent, of course.  I think perfection should always be the desired end in any given specialty, yet never quite getting there offers unlimited potential for improvement and therein lies the beauty and humility of humans treating other humans.

 

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