It has been a busy few weeks – I have moved to my own house now, and I would definitely say all the hassle was worth it! Good time to put pen to paper !!
All throughout my career as a surgeon, I have been pretty lucky not to have had a major complication until very recently. I must emphasize the word ” have had”. But as one of my mentors put it, rather bluntly, ” If you have not broken a plate, you have not washed enough” !!
Complications are an inevitable part of surgery or for that matter any invasive procedure. There is no way out of it. However we as surgeons like to avoid complications they are indeed part and parcel of the business, and there is no way around it.
We as surgeons take utmost care to avoid complications. We take all the precautions before and during the surgery. The training and accreditation process is long and arduous. The stakes are high …..things do not often go wrong they do go wrong!
Once again most complications do not need further surgery or procedures and can be managed conservatively. Unfortunately, this is not true for some, and sometimes despite the best intentions, surgery does cause a significant amount of harm, rarely causing even permanent disability and/or death.
Understandably the first victims the patients get angry and frustrated. ” Why me ” is the first question that most patients have – after all there are complications that happen one in a million and patients naturally want to know ” Why me”. It is difficult to give a straightforward answer …often there is none. The only way forward is to accept it and acknowledge it and Move on.
A significant source of anxiety and stress for the ” first victims” is “what happens next”. Most do not know what will happen next and what the future holds for them. Most feel that they have been ditched and abandoned. Therefore it is important to involve the patients in the discussion about their future care and plans. At the very least it will give them a sense of security and will allay a significant source of anxiety.
Now we come to the Gist of this story……Who is a ” second victim”?
For every story there are 2 sides, Simillarly every coin has 2 sides. In literature it is well described about the ” First Victim” but very little about the ” Second Victim”.
In every major complication that happens as a direct or an indirect result of surgery ,there is always a man or a woman behind the scalpel, who is usually suffering silently despite his or her best intentions. This entity was ignored till quite recently. Thanks to a few surgeons from the US who had brought this to light, the term ” Second victim” has appeared in the medical literature.
Second victims are often unseen and unheard. They are invisible but let me tell you that the suffering is real. As surgeons, it is incredibly hard when one of your own patients suffer a complication as a result of our actions. More so if this is a major complication which are often life-changing for the patients.
The matter is even more complicated in that there is always the additional worry of litigation . inquiries in the background for the second victim after a complication. These add on to the stress during an incredibly difficult period following a major complication. Atleast the first victims have a good support network provided for them but unfortunately the second victims often have none !!
So it is important to recognize the “second victim” of surgical complications and adequately support them. It may be useful to refer the second victim to more experienced mentor who can discuss and debrief the case with them. It is also important to help them get back on track and often there is an incredible feeling helplessness following a major complication. As with most things in life, first step is to acknowledge and recognise the issue , rest will follow !!
So next time you read the news or hear from one of your colleagues , it is important to realize that there are two victims – One is visible and obvious , the other is invisible and hidden in the shrouds………We should support both of them, as no surgeon ever takes a scalpel to intentionally harm his or her patients!!
Have a great week ahead and I wish you safe surgery as always !!
LBS
Surgery-the good bad and ugly 