Surgical Self-Compassion, For The Mistakes We All Make.
Surgeons are humans. All humans make mistakes. And all surgeons, like all physicians, make mistakes, no matter how well trained, no matter how well intentioned, no matter how diligent and meticulous. Every operation is a unique moment in time where there is a convergence of three things in the micro universe of the operating room: 1) the patient’s anatomy, physiology, and disease process 2) the surgeon’s knowledge, technical skills, and experience, and 3) the surgeon’s mental clarity and focus. A surgeon’s responsibility to the patient demands that they do their best to show up at their best.
And yet, even when a surgeon does their best to show up at their best, mistakes happen. Generally, mistakes fall into one of three categories, and all will likely happen to the majority (if not every physician) over a life-time of practice. The mistake categories correlate with the potential impact on the physician’s subsequent emotional and cognitive suffering.
The first type of mistake is a small judgement or technical error that is recognized and corrected with little or no impact on the patient — an example is injuring a blood vessel during an operation with significant bleeding that is controlled without incident. This feels like a fender bender or a “phew, thank god nothing big happened”.
The second mistake is a small judgement or technical error that has a delayed but major impact on the patient. An example would be an error in sewing two pieces of intestine together that leads to a leak and severe infection after surgery. This feels like severely injuring someone in a car accident.
The third mistake is a major judgement or technical error that leads to a catastrophic outcome, like the death of the patient. This feels like running over a pedestrian.
To picture how self-compassion can be a physician’s superpower, imagine that you are a physician who has made a second or third type of mistake, and suddenly you find yourself stepping out onto an emotional and cognitive high-wire act, and the audience is your patient’s relatives and all of your colleagues. Now picture self-compassion as being the long balancing pole that will help guide you forward to safety, and that without it you are at high risk of falling.
Falling to one side of the high-wire leads to self-flagellation and rumination. Your inner rightous voice takes great pleasure in harshly criticizing and yelling at you since, after all, you deserve it. Your response? The same as if someone else were yelling at and criticising you — escalation of an internal physiologic stress response that is constricting, and with the constriction comes fear, anxiety, and shame, and with these emotions comes the desire to hide the mistake and to avoid both the patient and their family, colleagues, and future patients with similar problems.
Falling to the other side of this high-wire act leads to the dark world of excessive emotional labor. On this side you rationalize, make excuses, or blame the patient, saying things like “the tissues were weak”, “the anatomy wasn’t normal”, or whatever small tale (even if true) that you can tell yourself or others, all in an effort to avoid the difficult work of dealing with the emotions and taking responsibility. The problem is, you know you are pretending, and pretending like this is emotional labor. And pretending leads to a pernicious decline in internal and external authenticity, and ultimately, trust of yourself and of others in you.
The third option is to mindfully hold the pole of self-compassion and stay balanced, keeping yourself from falling into either emotional pit. Now each step forward is a step in the direction of your common humanity with others and towards the compassionate care you need to reach the end of the high-wire act, all while nurturing acceptance of the stark realities of the mistake you made. Once on the other side, the hot ember of the mistake will have cooled allowing you to hold it without further injury and, now that you own your mistake with clarity and determination, you can make the necessary changes to prevent it from happening in the future, and move on.
