By Dan A. Zlotolow, MD

We all know the feeling of a case that has gone well. High-fives all around and the proud moment talking to family and telling them that everything went great. At the first post-op visit, you see the patient’s name on your schedule and you smile. You look forward to going in the room. Then you get beamed. You didn’t hit the home run you had thought. The patient is suffering, the family has lost trust. What happened? I am in my mid-career, and I’ve had my share of triumphs and failures. I don’t lose sleep anymore over the disasters that I can’t fix. But the presumed home runs that become pop flies still consume me. It’s the not knowing what went wrong. Not knowing what you could do next time to avoid the same ends. It’s the emotional distance travelled between euphoria and misery. I will replay the surgery in my head over and over again looking for some hint of a misstep, some thread of explanation. Perhaps I will reach a point in my career when these cases no longer haunt me, just like I now no longer worry about the longshots that didn’t work out. But perhaps staying up at night examining where we could improve is good for our patients, and maybe I’d rather lose a few nights of sleep than live an unexamined practice.