By Owolabi Adebayo Shonuga, MD

As surgeons, we are tasked with fixing anatomic conditions. The capacity to fix a tangible problem can be an extremely rewarding experience, yet it can also serve as a driving force behind sleepless nights when complications arise or results fall short of desired outcomes.

It is said that surgeons are inherently meticulous, if not obsessive, by nature. We like order and process. We like to do things “the same way every time.” Consequently, when things do not go according to plan, especially in the post-operative period, this can be a great source of anxiety and concern. 

Orthopedics is very much an outcome-driven field and hand surgery is arguably at the forefront of these matters when you consider the scale of impact imparted by a disabled hand. Moreover, we practice in a result-driven world where patients have come to expect excellent outcomes regardless of injury severity or their initial condition. While excellent surgical technique sets the foundation for good results, there are many variables that ultimately determine whether a patient has a favorable outcome. Unfortunately, as surgeons, we are not in control of many of these variables upon leaving the controlled setting of an operating room. These includes post-operative complications that may be due to comorbidities or lack of compliance with wound care, therapy, and protocols. Whether fair or foul, the end product, at least on the surface, is always perceived to be the result of your work.   

Not to be discouraged by these circumstances, it is important to be mindful that any distress one has over a particular complication or outcome is ultimately a function of the genuine care that we have for our patients. The altruist within simply wants to see another human being get better. The significance of our work as hand surgeons is underscored in the Hippocratic Oath where we are reminded that we “treat, not a chart, but a human being, whose illness may affect the person’s family and economic stability.” Despite all the technological advances known to date, most occupations are still highly dependent on good hand function. Without this function a person may be unable to take care of themself, maintain employment, or provide for their family. The gravity of this statement is not meant to provoke anxiety, rather it serves as a personal reminder to respect even the simplest procedures in the hand as it carries far-reaching implications.   

With this perspective, the question simply becomes, “What doesn’t keep me up at night?”