By Lilah Morris-Wiseman, MD
This is a story about leadership in surgery.
I was in my third year of post-training, independent private practice and had been dealing with a disastrous complication. We know that the first two years post-training are those in which we are more cautious and we may defer more challenging cases. Then our confidence grows with positive outcomes. I had taken on a complex elective case in a younger patient. The case went well but the second day out it was clear the patient was having a known but serious operative complication. I called a senior partner to help me and we took the patient back to the operating room (OR) together and repaired the problem. Several days later, it was clear the repair didn’t work; the complication had recurred.
The situation went from controlled to uncontrolled. I was in a state of mixed dread and fear – I worried I had harmed this patient and had run out of options to fix the problem – but I knew I had to do something different, and quickly.
I called a colleague at a local academic center who I had met before but did not know well. She is in a position of leadership in academic surgery and had much more experience and expertise in this area than I did. After listening to the story, her first question was “how can I help you?” She offered me every option – from accepting the patient that day for transfer to her ICU and her service at the university hospital, to coming with me to see the patient and give advice, to trying to obtain emergency privileges at my hospital and coming with me to the OR. Training in large academic medical centers, I didn’t realize that one could obtain emergency privileges if a hospital did not have a specialist in that area. Ultimately, we decided on the latter. That afternoon, she came to a hospital she’d never entered – one to which she needed directions – and scrubbed in with me. She came with me to talk to the family. In the OR, she lent her vast experience in a calm, reasoned, empathetic manner, withholding any criticism. “This happens,” she told me, “It will heal.”
Everything changed that day for the patient and for me. We didn’t solve the problem, but we took the first steps necessary to achieve success. She was in contact with me daily to discuss ongoing management and give suggestions that were helpful and unassuming. By coming to my hospital and giving of herself in this way, she allowed me to continue to care for the patient, to fix the problem, to see this through and learn the most from this. Fortunately, the patient made a full recovery.
I’ve seen many different types of leaders in surgery. In training I was on both sides of this picture, with an attending surgeon asking for help and with those being asked to give it. From this experience I learned that true surgical leadership is less about the number of papers you publish and the awards on your wall than how you react and behave in a situation in which you are called to help. It is about your willingness to support your colleagues (even those with whom you have no professional ties), and, most important, it is about doing whatever it takes to achieve the best outcome for the patient.
Lilah Morris-Wiseman, MD, FACS, is an Assistant Professor of Endocrine and General Surgery at the University of Arizona, Tucson where she is the Associate Program Director for the General Surgery residency. After graduating from Tulane University School of Medicine, she completed General Surgery Residency at University of California, Los Angeles and fellowship in Surgical Endocrinology at MD Anderson Cancer Center in Houston, Texas. She worked in private practice in the Tucson community before returning to academics. You can find her on twitter at @lilahfran.
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