When you do surgery, complications are inevitable even in the best of surgeons hands. Sometimes its harder to tell the stories of your failures than your successes. Not all of them have happy endings. As a surgeon, I actually never forget the patients that have poor outcomes. The good ones, they come and go, but the less than desirable outcomes, or the ones that resulted in complications, are the ones that haunt me in my sleep. As a perfectionist, I always try to recount everything I did, and ask myself what I could do better to have potentially avoided the outcome. Was there anything I could have done different to produce a more predictable outcome? Sometimes there’s not always is an answer.
From the patients perspective, complications can be life changing. Therefore it is an even greater honor when a patient entrusts me a second time around to try and get them a better outcome. In this example, a gentleman came to see me with an acute massive rotator cuff tear. After failing management with physical therapy, we elected to proceed with a rotator cuff repair. The case was tough and although I was very pleased with the repair of the muscle, as time would tell, the outcome was less than desirable. Six months after surgery the patient was on narcotic pain medications, could not sleep, could not lift their shoulder and was worse off than when they first saw me. The patient’s confidence in me was shaken. I discussed with the patient the repeat MRI that ultimately confirmed the muscles re-tore and failure of the repair. I would not have blamed the patient if they sought care elsewhere at this point. I encouraged him to seek a second opinion. After much deliberation, the patient and his family entrusted me once more to repair the shoulder.
Fast forward 6 months later, after a massive reconstruction with a reverse shoulder arthroplasty, I am ecstatic to report we have recovered his shoulder functionality and quality of life. He worked hard with physical therapy to re-establish his shoulder functioning. Much credit to him and his family for not giving up through our 1.5 year saga to fix his shoulder.
I wish all my complications had a happy ending like this. No matter how trivial the surgery maybe, risks and complications always exist. Cases like this are humbling and remind me that while we like to think we know everything, and we try to always do everything we can, not always are the outcomes perfect or exactly the way we predicted. I am blessed patients have confidence in the work that I do.