Complications, redux and understanding for people

 I have read the book - Complications by Atul Gawande, but despite this and my now quite long medical career, complications in vascular surgery still hurt and astound.

As one of my friends and fellow vascular surgeons put it - vascular surgery is a contact sport.

We are lucky in many respects - life and limb saving surgery at high risk, and quality of life surgery at relatively low risk are our stock in trade.  Unfortunately, two of our common operations (carotid endarterectomy and aortic aneurysm repair) are in fact prophylactic operations, with the potential stroke or rupture not a guarantee - most probably don’t benefit from a carotid, and possibly most do from an aneurysm repair.  Problem is we just don’t know which person will benefit, we just know on a population scale.

When a bad thing happens, even though you have warned everyone and we know bad things happen, it is still a shock and still hurts.  Then you feel your colleagues eyes on you in case this isn’t a blip, in case it isn’t just chance…

Go back to square one, check the plans, check the technique, check everything.  Then start again with support.

Then the cycle begins again…