Expectations of surgery: She's grateful, But

Alina Tugend's story

My father recently had his second knee operation in a year.  The first time, things went poorly.  His rehabilitation was difficult and months later, he still could not walk well or, even more important to him, play tennis.

He had the operation a few weeks ago, and he's already doing much better.  Different doctor, different outcome.  And perhaps, most significantly, different expectations.

"The first surgeon just raised my expectations unrealistically," my father said.  "He told me that in a few weeks I would be out on the tennis court."

I started thinking about how we manage expectations after my father's operation and after a friend, Amy, told me she recently had her cancerous thyroid removed.  The cancer was contained, but one of her vocal cords was paralyzed.  

She wasn't warned about this, but has since learned it is a common side effect of such an operation and can last up to a year.  It makes talking, eating and drinking difficult.

"It's not what I bargained for," Amy said.  "I'm grateful to be alive, but if I had just known, I would have been more prepared before and afterwards."

Advice to people considering surgery:  Consult a professional patient advocate, or read about the experiences of older and wiser patients on the Internet, before consenting to surgery.

Read a story about a man's ill-informed consent for surgery.  Thanks to Alina for her article, "What Did You Expect?  It Makes a Difference," excerpted here from the NY Times of Jan. 14.

In a peculiar position: Patients' expectations of surgeons

I’m re-reading Dr. Oliver Sacks' memoir of his own severe leg injury as a young athletic hiker, A Leg to Stand On. This excerpt comes after a surgeon has performed technically successful surgery on the broken leg, but leaving the young Dr. Sacks with no feeling whatsoever in his leg, nor any ability to move it. Dr. Sacks has explained the story to his beloved feisty elderly aunt, who advises him:

"You're going to have to be very clear and strong and bold. You're also going to have to bow your head, and be humble, and acknowledge that there are many things that pass the understanding. You mustn't be arrogant – and you mustn't be abject.

"And you mustn't expect too much from the surgeon. I'm sure he's a good man, and a first-rate surgeon, but this goes far beyond the province of surgery. You mustn't get angry if he doesn't understand completely. You mustn't expect the impossible of him. You must expect, and respect, limits. He'll have all sorts of limits – we all do. Professional limits, mental limits and emotional limits, most especially…." She stopped, arrested by some recollection or reflection.

"Surgeons are in a peculiar position. They face special conflicts. Your mother was a dedicated surgeon, and a very gentle sensitive soul, and it was sometimes difficult for her to reconcile her human feelings with her surgery. Her patients were very dear to her, but as a surgeon she had to see them as anatomical and surgical problems. Sometimes, when she was younger, she seemed almost ruthless, but this was because her feelings were intense: she would have been overwhelmed by them, if she hadn't maintained a rigorous distance. It was only later that she achieved a balance – that essential balance of the technical and the personal.

"Be gentle, Bol! Don't react to Dr. Swan. Don't call him 'the surgeon.' It doesn't sound human! Remember he’s human – as human as you are. All too human, probably, and even shyer than you are. All the trouble starts when people forget they're human."

Read another story about patients’ expectations.