surgical principle number 2: fear nothing but fear itself

the gist of this principle i have already covered. it has to do with the patient's best chance. if it's you then it really doesn't help to cower away.

i have seen patients suffering because there is some or other doctor just too scared to have a go at it. twice i have been forced to stand down with thyroid surgeries because the anaesthetist was afraid, even though it meant the one patient would remain intubated for a week and the other would disappear into the system, probably to die of asphixiation somewhere down the line.

yes you need to know your limits, but somehow in surgery you also need to back yourself and go where few dare. it is the nature of the beast.

when i joined the surgery department there had just been an acute shortage of registrars in general surgery. therefore, although i was just a medical officer, i was placed in a registrar position as the head of a firm. i was pathetically ill equipped. my consultant, although he was usually available to come out and help, was not quite so willing. there would also be nights when a private surgeon would be the consultant on call. then there was little chance of getting him to come out. our consultant gave myself and my colleague a crash course in what we were likely to encounter on a call and what to do. i called it the how-to-handle-pretty-much-anything-so-i-don't-have-to-come-out-and-work-once-the-sun-has-set course.
in his opening address he told us about an incident that had happened to him during his registrarship when he called his consultant in the middle of the night to help him with a gunshot tail of pancreas. the consultant irritatedly told him to remove the damaged tail. he had never even seen it being done before. he asked how he was supposed to do that.
"use prolene!" shouted the consultant and hung up the phone in his ear.
"so what did you do?" i asked.
"i used prolene." he replied. i remember thinking i should probably find out what prolene is.

some time ago the state asked me to operate a gunshot chest and abdomen. i naturally responded. the abdominal part went quite well, but it soon became apparent the main source of bleeding was the chest. i phoned the thorax surgeon. he told me a bit about how nice it was to be on holiday and that the sun was shining and he was working on his tan. i considered warning him about the dangers of skin cancer but at that moment it didn't seem to be too pressing an issue. he then helpfully suggested i transfer the patient to pretoria, a good three hour drive. i had a better idea. i opened his chest.

now thoracotomies are not really my thing and i haven't done all that many of them. it is not a general surgeon's usual stomping ground, but that didn't matter at that exact moment. i was not only the patient's best chance, i was his only chance. i swallowed hard and got to work.

so, in surgery it is important to fear nothing but fear itself.