Coffee Reggiegram: How careful are you when deciding to go to surgery?

Coffee Reggiegram：你在决定做手术时有多小心？

What do you rely on to make your decision?

你依据什么来做决定？

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.

为什么不切除你那（讨厌的）阑尾呢？孩提时代，我在香港长大，知道我注定要成为一名医生，而且很可能是一名外科医生，所以我阅读了很多医学或手术相关的书籍，尤其是关于急性阑尾炎这类令我兴奋的疾病！有个常见的笑话，说任何医学生进入医学院时，似乎会发展出他所读到的疾病的特征。这在我身上得到了应验，我开始觉得自己右下腹有阑尾炎的症状和迹象。就像医学教科书上写的一样。饭后经常会痛，跟传说的一模一样。

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.

这真的很困扰我，也困扰着我那当外科医生的父亲，尤其是因为我老缠着他。所以有一天，我那行动力很强的父亲说，“就把它割掉吧，一次性了结。” 于是外科医生的他就这样做了。这显然是一件很平常的事，割掉了阑尾皆大欢喜。

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!

我甚至看到了我那被切除的阑尾的病理报告，说是“慢性阑尾炎”。在今天这样的诊断听起来像有点“可疑”，实际上很多人不相信这样的诊断。希望当今的医生不会因为很可能是孩子气的原因而去切除相当正常的阑尾！

Surgery is done for many strange reasons.

有时许多奇怪的原因导致了手术。

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.

为什么不切除你（捣蛋）的扁桃体呢？这是过去医生们常问的问题。那会儿如果反复出现扁桃体炎（扁桃体感染），医生就会摘除病人的扁桃体。我太太的哥哥就是这样，当时他才十几岁，住在泰国，在曼谷看一位外科医生，他认为应该切除扁桃体。事实上，这是在世界各地很常见的做法。

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.

然而，令人震惊的是，他死于手术出血，事实证明这种情况在世界各地并不罕见，正如有人总结的那样，“手术成功了，但病人死了”。

After large clinical trials showed that this surgery was mostly unnecessary (1), and at times life-threatening, thankfully it’s done much less nowadays.

大型临床试验表明，这种手术大多是不必要的（1），有时甚至会出人命。感恩的是，现在很少这样做了。

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.

我们优秀的外科医生可以切除您的（过度活跃的）甲状腺。我们在贫困地区从事医疗事工，曾到中国西南的一个小镇工作。我们看了一位患者， 他的甲状腺过度活跃，肿大。当时美国或中国的普遍治疗方案是切除甲状腺。

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!

我们同行的有俄亥俄州最好的甲状腺手术医生，他帮助当地的外科医生做手术。再一次，手术非常好，但病人死了。因为非手术过度活跃的甲状腺激素风暴基本上一发不可收拾。如果患者当时是在一家大医院，其医疗团队将包括内科医生， 他会帮助控制过度活跃的甲状腺风暴，但当时我们没有在我们自己的医院！

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.

医院有一笔基金来“赔偿”这个家庭，他们照做了。那个死去的年轻人留下了一个年轻的妻子和孩子，我们的团队和他们一起悲伤、哭泣，当我们意识到我们有共同信仰的时侯，我们在一起祈祷。

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.

这不就是一个（“简单”）的疝气手术吗？是的，确实我们的朋友只是做普通的疝气手术。这种手术我在外科实习的时候就做过六次！

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!

很可能与他无意中服用了通常含有抗凝血剂的中草药有关（照片 3）。再一次，手术成功了，病人却几乎死了，但非常感恩，他没有死！

“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!

“我们一流的医院可以治好他的前列腺癌。” 我爸爸在亚洲最好的医院做过前列腺手术。它“不应该”有什么问题。这种手术在全世界都很常见！

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.

但手术后，我爸突然老了。他本来一直是一个非常活跃，精力充沛，不知疲倦的医生。手术后，他整个人变了。我从未见过他如此沉闷，窝着不动。麻醉很可能改变了他的大脑功能并改变了他这个老人！不过，手术很成功。

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.

人们不是常说“只有千分之一”，甚至万分之一，的概率会发生重大手术事故吗？当我们面对手术时，经常会听到严重的并发症发生率是只有千分之一左右。这意味着普通的执业医生，比如说你的私人家庭医生，可能从未在他行医中遇到过任何真正这类的问题，因为他可能实际上没有看过一千名接受同样手术的患者。所以在他看来，这可能甚至看起来都不是一个真正实际可能发生的问题，尽管这个问题在医学教科书上提到过。

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”.

当一名普通医生似乎没有强调任何重大的不良后果或跟你说不出说太多来时，这只是反映他心目中的医学书和临床实践之间的张力。此外，他无法真正告诉你任何治疗的数百种可能的副作用。就像阅读任何药物副作用的细则一样，大多数人只是“扫一眼”。

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.

所以你的医生可能只提到几个他认为是关键的或他直接熟悉问题，或者在许多手术中常见的那些副作用，比如疼痛或出血。

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.”

在当今注重诉讼的社会中，外科医生确实经常会列出包括死亡在内的几乎所有可能的并发症。但奇怪的反常效应可能是：这种“矫枉过正”式地列出一长串可能的并发症确实会产生“扫一眼”效应，基本上触发了一个普遍的否认机制，即认为“这不可能是真的，医生这么说只是为了避免承担法律责任。”

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!

这意味着如果您要进行手术，您将承担所有风险；没有其他人能替你承担。其他人可能会承担职业或名声的风险，您的家人可能会遭受财务或情感风险，但对你来说，这是你的生命！所以现实中的统计数据对医护人员，对病人或家属来说意味着完全不同的事情！

So how do you decide when facing a decision on surgery?

那么，当您面临手术决定时，您如何决定呢？

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!

不可取的是：将手术决定基于孩子式的幻想、美容外观（即使伪装成“必需”），或者你邻居的闲话，这些有时可能会对你产生惊人的影响！

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.

最好询问手术是否真的有必要以及有哪些选择。甚至问有没有任何相关的“随机”临床试验（治疗或不治疗），（比如大型研究表明切除反复得扁桃体炎的儿童的扁桃体并没有真正的好处）。直接询问手术的实际统计风险。并问有没有关于其他可能更安全的方案的研究。

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.

如果可以的话，找到最好的外科医生和医疗机构。复杂的手术，我更喜欢找有十多年临床经验的外科医生，因为他们有智慧和实际上手的经验！而且，即使是顶级外科医生也需要其他专家和工作人员的良好配合才能把手术做好。因此，应该找信誉良好的医疗机构。

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!

这可能只是“疝气”，但你做的许多其他决定可能会严重影响手术……绝对不要在手术前后几周服用“看起来没事”的传统草药！你不知道里面有什么会影响手术效果。记住在那些我们诗意地称为“传统”的时代，是没什么大的外科手术的，所以没有人真正知道传统中草药会带来什么样的现代问题，比如引起手术过程中的大出血！

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.

而且别忘了还有麻醉，其他复杂的辅助学科也是手术中需要的，如呼吸和营养支持。这意味着，尤其是如果患者年龄很大或很年幼，他们将需要经验丰富且复杂的多学科的专业团队直接照顾他们。小心那些只能提供最基本需求的医院。例如，我总是建议儿童的手术到儿童医院去做。

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.

请记住，规则和准则总是有例外。所以做决定的时候，带着祈祷的心祈求引导和智慧。还有多方咨询寻求更多的智慧。我可能有偏见，但最好与在医院做医生或外科护士的朋友聊聊，毕竟，他们与外科医生在手术室一起工作，所以很可能知道更多的“内幕消息”。如果他们甚至在你要手术的那家医院工作过， 那是最好不过了，因为他们有真正的内幕消息。

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.

总之，这是你的生命，是你一生中最重大的决定之一，所以永远不要轻忽这个决定！我见过太多灾难或几近灾难！如果你要去手术，当然也为你的整个手术团队祈祷智慧、技能和耐心……拥有这些总是不会错。

1. https://pubmed.ncbi.nlm.nih.gov/12093941/