When Fear Strikes: A Surgeon's Reflection on Growth and the Future

"Doctor, we have a major problem. There's a hole in the vena cava!"

Despite my junior colleague's desperate cry, everyone else in the operating room remained calm, as if nothing had happened. A 3mm hole had formed in the vena cava of a patient awaiting liver surgery. To my junior colleague's eyes, that small gap must have looked like a breach in a massive dam about to burst. The blood seeping from it must have felt as overwhelming as water cascading over Niagara Falls. Yet everyone except him had confirmed that the patient's vital signs were very stable and the blood loss was only about 150cc. After clamping the bleeding site with vascular forceps and calmly suturing it, the surgery concluded without incident.

About a year later, when I met the junior colleague again, his memory of that day had fermented like aging skate fish. The 3mm hole had transformed into 3cm, and the blood loss had somehow become 1,000cc. He even spun a heroic tale of having to press his finger against the hole for 30 minutes because the patient's blood pressure had plummeted. While this might have made for an interesting story to those unfamiliar with operating rooms, we were busy anticipating when the predictable clichés would appear. Sure enough, years later, this same colleague regaled us with a new heroic tale of personally stepping in to handle a situation when another junior made a similar mistake. To his own juniors, he would say with bravado, "We only grew to where we are now after experiencing that spine-chilling feeling countless times, just like you first-time surgeons."

We commonly describe the chilling sensation from unexpected or startling events as feeling "spine-chilling" or like "your heart dropping to your stomach." Anatomically and physiologically speaking, these expressions aren't quite accurate. The abdominal cavity maintains positive pressure, so the liver cannot literally drop, and as warm-blooded creatures, the liver and gallbladder area cannot become selectively cold. However, excessive muscle tension and temporary spikes in stress hormones can reduce peripheral blood flow, and combined with psychological fear, create a sensation of chilliness. When blood flow temporarily decreases to the skin and intestinal mucosa, blood concentrates in the core muscles of the back, relatively reducing flow to surrounding skin and creating the sensation of dropping body temperature. This spine-chilling feeling is essentially a defense mechanism to protect our bodies, not a sign of liver problems.

Surgeons are always tense because our actions can occasionally cause great harm to others. Sometimes we obsess over minor changes. But our ultimate goal is to make patients healthier. As experience accumulates, our perspective broadens; we learn to objectively assess whether a situation truly poses significant risk to the patient and reduce the probability of ruining outcomes by fixating on trivial matters. Of course, it's also important to anticipate various variables that can arise during surgery and develop the ability to prepare for such situations.

At the start of the new year, Tesla CEO Elon Musk's statement that "robots will replace surgeons within three years" became a hot topic among doctors. Since the future is unknowable, I don't particularly want to argue against it, but at the very least, wouldn't a robot superior to humans never experience that spine-chilling feeling? It makes me somewhat wistful to think that my small pleasure of listening to junior colleagues' tales of valor might also disappear. Surgery performed by human hands has continued to advance over the past century. Whether the next method involves robots or something else entirely, I only hope that safer and more advanced surgeries than we have today will become possible.