Editor’s Note: An existential crisis.
I trained in a large metropolitan hospital system where residents taught residents. “See one, do one, teach one” as the saying goes. This was before surgical training labs. Education occurred while operating on live patients at times with the unscrubbed attending screaming across the room while watching the fluoroscopy screen. You showed up every day, did what you were told since it was a privilege just to be there, completed the scut work, stayed awake countless hours, studied and hoped for a bright post-residency future. You trusted that the training process would work.
I naively chose my area of specialization based on the rotation where the attending was the kindest. My subsequent fellowship was poorly organized with loose OR supervision. The residents were in on every case and wanted to do the surgery themselves.
My first practice was at a site where my work could be focused on my specialty area. I trusted that this would allow me to gain surgical mastery over time with repetition of similar cases. I also took training courses right out of the gates.
I enjoyed my surgical and non-surgical work but did not exude confidence at the beginning. I was adamant that my equipment needs and the needs of the individual patients be met in the OR. I wanted my cases to run well. This undoubtedly reduced my popularity with the surgical staff.
Within the orthopedic department, I had two partners who also practiced my subspecialty. One was a great colleague and a major reason why I chose the job. The other was a narcissist and a malignant liar. I had worked with many types of people as a resident and as long as I had one positive colleague, I was satisfied that I would be okay. Within a year of my joining the practice, the positive partner left out of frustration. The narcissist had maligned his operative skills, reputation and in his own words, “drove him close to suicide”.
I stayed on alone with the narcissist as the dreams for my very special practice persisted. I was easy prey being new and lacking confidence in the political as well as the procedural sides of my chosen field. I also had a temper that reared its ugly head under stressful situations. My shortcomings were broadcast to anyone who would listen both at work & in the community. My blooming triumphs also became a threat to him.
About two years into practice, a local patient failed to achieve the expected outcome after his surgery. My partner got wind of it and may even have offered the patient a second opinion. I was soon told by the narcissist that the disgruntled patient was considering filing a malpractice suit against me. I hadn’t done anything obviously wrong, the procedure failed per testing parameters.
That weekend, I left town. Not being a competitive athlete, I had never learned to accept defeat. I was horribly distraught, disappointed in myself, ashamed and demoralized. I felt I was the failure, not the operation. I sat for many hours in a quiet hotel room contemplating the future and whether or not, I wanted to be part of it. I went equipped with a plan to end my life.
In the end, I (obviously) did not carry it out. I returned home and went back to work. And, no, the patient did not sue. He went on to a physically active teaching position and as far as I know, did not have another operation.
What did I learn from this experience? That I had value as a person, not just a surgeon. I needed to redefine myself and look more closely at my practice beyond the present environment. Change was indicated even if it meant sacrifice.
Based on these experiences, to others I say:
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Failures of procedures do happen. Look closely at the data. Be suspect of those who say they have never had an adverse outcome. Look at their patient profile. If they are not accepting all comers, they are skewing their outcomes. Maintain a critical eye.
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Your value as a person is not defined entirely by your work.
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If you are in practice with a narcissist, get out. Your self-esteem is in for a beating if you stay. This personality disorder never gets better. As you become more successful, you become a bigger threat in their perceived kingdom.
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Be very serious about achieving surgical skills during your training. Use training labs as much as possible. Don’t allow yourself to be relegated to just watching or assisting. Confidence comes from doing. Be sure the residency programs you apply to have an investment in your development as a surgeon while in the program.
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Once in practice, visit your friends to learn a new skill in a friendly environment.
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Join organizations where you can be mentored and receive constructive additional training.
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Don’t ever ever give up your dreams because of politics or adverse practice relationships. Find something better, it’s your only life.