By Victoria R. Masear, MD

It was a routine clinic at the University, ending at about 6 pm. There was a new hand fellow on my service. He had been with us 3 months, but this was his first day with me. I also had a new PA who had only previously done spine.

I briefly told the fellow about the next day’s surgeries and told him to go by the office and read the clinic notes of the patients having surgery the next day. I then went and read the notes myself, as I always did prior to surgery, and went home to get some much needed sleep. The next morning we did a trapezium arthroplasty, harvesting a palmaris for interposition. I taught the PA how to harvest the tendon. The next surgery in that room was another trapezium arthroplasty combined with MP arthroplasties on a 33 yo rheumatoid. At the scrub sink I told the fellow to go in with the PA and get started, making the surgical approaches, while I scrubbed in for a few minutes with the residents in an adjacent room. I reminded him that this patient did not have a palmaris and that when I came in we would find another tendon for the interposition.

When I came back into the room with the hand fellow and PA, there was an incision over the palmar wrist. I asked him what it was for, and he responded that they had harvested the PL. I said that she didn’t have a palmaris, and he assured me that she did. I was concerned that he apparently never heard my instructions at the scrub sink and did not read the charts as I had instructed the night before. Her chart clearly stated that she had no palmaris. I sat down to explore the wound to see which finger flexor tendon they might have accidentally harvested. I cannot describe the sickening, sinking feeling I experienced when I saw the fascicles of the cut end of the median nerve staring at me from the distal wound.

I told her family that day, and the patient the next day, how very, very sorry I was. I also told them that it was my fault, that I should have been there for her. Fast forward 30 years, and I still see this patient’s family members and friends as my patients. They all say they have genuine respect for me as to how I dealt with the entire situation, how I was very truthful as to exactly what happened, and how I never tried to minimize her poor outcome. That doesn’t help my sense of guilt over this disastrous high median nerve palsy in a young lady, and I still wake up sometimes in the middle of the night seeing those fully transected, healthy fascicles.

So, where do we learn trust? We learn it as children from our parents. Young children all trust their parents to shelter and feed them and to make the bad things better. As we grow up, we continue to trust those who have always been truthful with us. We treat with caution and disrespect those who have not been truthful with us. We should always be truthful with our peers, residents and fellows, co-workers, children and patients. If you do this, you will make some enemies along the way. If I am going to write a less than glowing recommendation for someone, I tell them they may want to read it before mailing it. Others do not always like what I have to say, but they always know where I am coming from. I have gotten a few compliments over the years from people who say it’s nice to always know where I stand. I learned this from my father who taught us to always be honest. Even if it hurts.

Trust comes from truthfulness. Once that trust is broken, it is extremely difficult to ever repair.