SGO Wellness: Dusting Myself Off and Getting Back on the Horse Again | Emma Rossi, MD

Emma Rossi, MD

This month I’m cheering on the Matildas in the FIFA Women’s World Cup and Simone Biles as she returns to competition. I’m reflecting on the resilience of elite athletes and marveling at their ability to recover from defeat and self-doubt by shifting their thinking towards the positive. I could use some of that.

Surgery, like sport, is a physical craft. I use this analogy a great deal with learners in (and out of) the operating room. I speak about how, just like athletes, we should use video review to plan and prepare, then reflect and review. I discuss the concepts of practice, consistency, and repetition in achieving mastery. And, just like for the athlete, mindset is important: not just in making good decisions, “reading the field,” anticipating and being flexible, but also in our ability to recover from setbacks.

For me as a surgeon, surgical complications rank as the most powerful defeats. Seeing a patient sickened by their disease can be devastating, but there is a special added psychological burden and secondary trauma from seeing a patient sickened by a complication of my surgery. It is true that all surgeons have complications. But merely acknowledging the universality of it doesn’t seem to satiate the feelings of guilt, shame and fear that fog my brain (and spirit) when complications follow surgery.

Being a cancer surgeon means walking a treacherous tightrope where the indication for surgery, not just the surgery itself, is potentially lethal. An insightful mentor of mine once mused, “as I get older, I become more risk averse because I’ve seen the complications accumulate over time. But it’s not good for a cancer surgeon to be too risk averse.” No doubt, prior experiences shape future decision making, a necessary part of growth and learning. However, experiencing the secondary trauma of complications has the potential to create avoidance behavior. As my mentor suggested, for a cancer surgeon, hyper-avoidance is, at best, not helpful, and, at worst, dangerous.

So, how do I acquire resilience and channel these “defeats” into growth rather than avoidance? While much has been written about the impact complications have on surgeons, research is lacking on what interventions are most effective for us.^1,2 What do our athlete “cousins” do? They address the loss both intellectually AND emotionally. The intellectual review focuses on analysis of technique: what was done, what experts say might have been a better approach, what we can do differently next time. This involves research, data collection and analysis. As a scientist at heart, I am good at this type of reflection.

However, emotional reflection (not to be confused with pathologic rumination) is also necessary to shift the mindset towards positive. Speaking to others is an important part of this reflection and, yes, this could come in the form of a therapist. Just as there are sports psychologists for elite athletes to work on overcoming their anxieties, doubts and negative self-talk, there are therapists who specialize in working with surgeons, and it’s definitely worth-while to explore what options are nearby. Alternatively, it might come in the form of speaking with another surgeon. I have the most incredibly supportive partners and boss, who are both empathetic and encouraging, but I’ve also had wonderful surgical confidants from other specialties. They provide me with their own “war stories,” what they learnt from them and how they moved on. I am not alone in this, with nearly 90% of surgeons reporting that they lean on other surgeons for help after complications.³

Facing the music is also an important part of shifting our negative mindset. Athletes hold press conferences. For us, one of the most productive ways to move towards healing is to talk to the patient and their family. Tell them we are sorry. Let them see that we care about what happened (without letting our own grief eclipse theirs). Showing up and being accountable shows grace and it shows courage.

I am so grateful to have the best partners in both work and in life who equate to my coaches, trainers and therapists. They really are great at dusting me off after a complication and putting me back on the horse, telling me, “we need you, our patients need you.” That’s the other really important thing to learn from athletes about loss: how to be a great team-mate and how to put someone else back on the horse again when they are in need of a hoist. Because, we’ll all be there at some point.

Emma Rossi, MD, is a gynecologic oncologist at Duke University in Durham, NC.

References:

1. Vitous CA, Byrnes ME, De Roo A, et al. Exploring Emotional Responses After Postoperative Complications: A Qualitative Study of Practicing Surgeons. Ann Surg 2022;275(1):e124-e31. doi: 10.1097/SLA.0000000000004041 [published Online First: 2021/01/15]

2. Le HD, Wolinska JM, Baertschiger RM, et al. Complication Is Inevitable, but Suffering is Optional-Psychological Aspects of Dealing with Complications in Surgery. Eur J Pediatr Surg 2023;33(3):181-90. doi: 10.1055/s-0043-1767830 [published Online First: 2023/03/23]

3. Patel AM, Ingalls NK, Mansour MA, et al. Collateral damage: the effect of patient complications on the surgeon’s psyche. Surgery 2010;148(4):824-8; discussion 28-30. doi: 10.1016/j.surg.2010.07.024 [published Online First: 2010/08/24]