Coffee Reggiegram: How careful are you when deciding to go to surgery?
What do you rely on to make your decision?
Why not take out your (pesky) appendix? As a kid growing up in sophisticated Hong Kong, I was destined to be a doctor and likely a surgeon, so I read a lot of books that were medically or surgically related. Especially exciting things like acute appendicitis! It’s a common joke that any medical student, when he enters medical school, seems to develop features of diseases that he reads about. Similarly, I began to feel that I had symptoms and signs of appendicitis in the right lower belly, just like the medical textbooks reported. Often pains would come after meals, just like the folklore stories.
This was really bothering me, and also was bothering my surgeon father, especially when I pestered him about it. So one day my action-oriented dad said, “Let’s just get it out and be done with this problem.” Which is what he did, since that’s what surgeons do. It was also apparently a pretty common thing to do, a fine idea that made everybody happy.
I even saw the pathologist’s report on my removed appendix, that it was something like “chronic appendicitis”. Which today sounds like a “fishy” diagnosis to me, and is not really much believed in. Hopefully, contemporary doctors are much more careful about removing a quite normal appendix for likely childish reasons!
Surgery is done for many strange reasons.
Why not take out your (misbehaving) tonsils? This was a common question by doctors in days past. Tonsils were readily taken out if there was repeated tonsillitis (infection of the tonsils). My wife’s brother, a teenager then living in Thailand, visited a surgeon in Bangkok who thought it would be a good idea to do that. Indeed, a pretty common procedure done all over the world.
However, shockingly, he died of bleeding from the surgery, which turns out to be not that rare, in any part of the world. “The surgery was successful but the patient died,” as they like to say.
After large clinical trials showed that this surgery was mostly unnecessary (1), and at times life-threatening, thankfully it’s done much less nowadays.
Our fine surgeons can take out your (hyperactive) thyroid. As part of our medical mission to poverty areas, we were working in a small town in Southwest China. We consulted on a patient with an overactive thyroid that was enlarged. The common treatment in America or China then would be to take out the thyroid.
We had one of the best thyroid surgeons in Ohio with us, who helped the local surgeons to do just that. Again, the surgery was excellent but the patient died. Because of a nonsurgical overactive thyroid hormone storm that basically got out of hand. Presumably if the patient had been in a major hospital, the involved medical care team would have included expert internists helping to control the overactive thyroid storm, but we weren’t back home!
The hospital had a fund to “compensate” the family, which they did. The young man who died left behind a young wife and child, with whom our team grieved, cried, and even prayed together when we realized our common faith.
Wasn’t it just a (“simple”) hernia operation? Yes, indeed our friend had just a common hernia operation. The kind of operation even I had performed in half a dozen instances while in surgical training.
I was in the waiting room of the leading hospital of Cincinnati with his wife, when the operating room staff reported that he was continuing to lose lots of blood, ultimately requiring 38 pints of blood transfusion on the operating table. Meaning the doctors essentially “changed his blood” four times.
我和他的妻子在辛辛那提一家大医院的候诊室等着，手术房间工作人员报告说他继续大出血，最终需要 在手术台上输血38 品脱， 相当于医生基本上给他换了四次血。
Likely it was related to his innocently taking Chinese herbs that commonly have anticoagulant properties (Photo 3). Again, the surgery was successful, the patient nearly died, but thankfully did not!
“Our top-ranked hospital can fix his prostate cancer.” My dad had prostate surgery in one of the best hospitals in Asia. It “should not” have been much of an issue. A surgical approach done quite routinely, worldwide!
But after the surgery, my dad suddenly turned senile. He had always been a highly active and energetic doctor who seemed tireless. After the surgery, his total demeanor changed. I had never seen him so dull and inactive. The anesthesia had, most likely, altered his brain function and changed him, as it might to a senior person! However, the surgery was successful.
Don’t people say there’s “only a one in” a thousand, or even ten thousand, chance of serious surgical problems? When we face surgery, we often hear that the serious complication rate is only one in a thousand, or something like that. Which means that the average practicing doctor, say your personal family doctor, may have never seen any real problem in his practice, since he may not have actually seen a thousand patients with that same surgery. So in his mind, it might not even seem like a real practical problem, even if the problem is mentioned in the medical textbooks.
When your average doctor doesn’t seem to emphasize any major bad results, or say much about it to you, it could simply reflect the common tension in his mind between medical book theory versus clinical practice. Also, he couldn’t really tell you about the hundreds of possible side effects of every treatment. Just like reading the fine print of any drug side effects, which most people just “glaze over”.
So your doctor might mention only a few problems that he considers are key ones, or problems he’s directly familiar with, or those that commonly occur in many surgeries, like pain or bleeding.
In today’s lawsuit-conscious societies, surgeons indeed will often list nearly all the possible complications including death. But the strange perverse effect could be that this “overkill” of long lists of lots of possible complications indeed generates the “glaze over” effect, essentially triggering a general denial mechanism that, “It can’t really be true, it’s just a legal ploy.”
Isn’t your medical doctor always supposed to figure out what the “real” statistical risks are? Statistics on paper are not the same as statistics in real life. To a doctor or patient, a statistical calculation of “one accident” or even “one death”, in “a thousand or more” situations might seem to be just a theoretical statistic, depending on the type of surgery. When faced with a decision to have serious surgery or not, this calculation might even seem like a pretty low statistic. But if it really happens to you as the patient, it becomes the reality of 100%!
你的医生难道不总是应该弄清楚“真正的”统计风险是什么吗？纸上的统计数据与现实生活中的统计数据不同。对医生或病人来说，统计在“一千或更多”的情况下，计算“一次事故”甚至“一次死亡”可能似乎只是一个理论上的统计，取决于手术的类型。当要决定是否进行大手术时，这个概率可能看起来很低。但如果它真的发生在你身上，那对你而言，它就会是 100% 的现实！
Meaning if you were to go to surgery you run all the risk; nobody else runs your risk. Others might assume professional or pride risk, your family might suffer financial or emotional risk, but for you, it’s your life! So statistics played out in reality mean quite different things to hospital staff, family, or you the patient!
So how do you decide when facing a decision on surgery?
Not a good idea: to base it on children’s fantasies, cosmetic appearances (even when camouflaged as “needed”), or your neighbors’ chatter, which can be surprisingly influential!
Best to ask whether the surgery is really necessary and what the options are. Even ask if there are any “randomized” clinical trials (treatment versus no treatment) regarding the procedure (like the large studies showing no real benefit from taking out the tonsils of children with repeated tonsillitis). Ask directly about the actual statistical dangers of the operation. And ask about studies of other potentially safer options.
Find the best surgeon and institution if you can. Depending on complexity, I prefer surgeons with over 10 years of practice, for their wisdom and real-life experiences! And, even top surgeons need a good mix of other experts and staff working together to make the surgery work really well. So a solidly reputable institution should help.
It might be “just a hernia”, but there are lots of secondary decisions that could drastically affect the operation… definitely don’t take “innocent-looking” traditional herbs for weeks before or after surgery! You don’t know what’s in them that could affect your surgery. Remember, there was no serious surgery in days past, times we poetically call “traditional”. So no one would even know about “modern” problems like herbal use causing severe bleeding during surgery!
And don’t forget that there is anesthesia, and other complex support disciplines are also needed in surgery, like respiration and nutrition support. Which means that especially if patients are very old or very young, they will need experienced and complex multidisciplinary expertise teams directly caring for them. Be wary of hospitals that provide only bare necessities. For example, I would always suggest a children’s hospital for surgery in the young.
Remember that there are always exceptions to rules and guidelines. So make a prayerful decision for guidance and wisdom. And there’s additional wisdom “in the multitude of counselors”. I might be biased, but it’s ideal to talk with friends who are hospital doctors or surgical nurses; after all, they work with surgeons and operating rooms so are likely to know better what “the inside scoop” is. Very ideally they’ve even worked in the same hospital where the surgery will be performed! The truly inside scoop.
In summary, it’s your life, and it’s one of your most serious decisions in life, so don’t ever take it lightly! I’ve seen too many disasters or near disasters! And if you are going to surgery, certainly pray also for wisdom, skill and patience for your entire surgical team …they always need that.