Enhanced recovery after emergency laparotomy
18 May 2023
28 April 2022
Rebecca Winterborn MB ChB, MD, FRCS, PGCert US, PGCert Med Ed. is a Consultant Vascular Surgeon at North Bristol NHS Trust, Bristol, UK.
Miss Winterborn is a Consultant Vascular Surgeon in Bristol, who as well as providing care to vascular patients, is training to become a certified coach with ‘One of Many’. Over the coming months Rebecca will write articles for BJS Academy inspired by her experiences, challenges, highs and lows of being a Mother, musician and vascular surgeon.
On the 19th of November 2013 I was the Vascular Surgeon on call for the Bristol Bath and Weston Vascular Network. I was sat in the theatre coffee room when I had a phone call from our Registrar to say his best friend had been knocked off his bike and had broken his pelvis. I told to him to finish what he was doing and go and support his friends and family. Three hours later I had a call from the major trauma centre asking me to come to theatre immediately. I vividly remember every part of the fifteen-minute car drive to the hospital across town, turning right out of the gates and planning in my head what I would do when I arrived. The next 12 hours would change my life forever. I have never seen so many people in one theatre. The back wall was lined with anaesthetists and the operating table was encircled with surgeons, yet there was an eery calm. It suddenly dawned on me that the patient on the operating table was the friend who had been knocked off his bike, and an Anaesthetic Consultant colleague to all of us in the room.
Despite the heroic efforts of all involved, our colleague and friend died on the intensive care unit that he had helped design, surrounded by family, friends and colleagues.
The following day I tried to work but found it incredibly difficult. I shared my experience, emotionally, with colleagues, and I received a call from one of the Anaesthetists involved in the case who wanted to check that I was OK. I talked it through with my friend and Registrar, who had just lost his best friend. I took a few days of compassionate leave but never had the opportunity to properly debrief with everyone in the room that day.
Over the coming months, every time I saw a cyclist or a truck I was transported back to that day, questioning the decisions I had made. Every time I saw an angiogram, discussed a trauma case, or performed an open aneurysm repair I was transported back to that day. Every night when I tried to sleep, I would have images running through my head reliving the hours in theatre, wondering if it was one of my colleagues, rather than me, the outcome would have been different.
Eventually in March 2014, whilst sat in a vascular clinic, I broke down in tears. I no longer had the energy to see patients, I no longer felt empathy, I no longer wanted to be a vascular surgeon, in fact I wasn’t sure I wanted to be ………. at all.
Why am I sharing this story?
Because, as surgeons we all have the cases we remember, the graveyard in our mind, but at no point during my training do I remember having a conversation with a trainer about what it feels like to lose a patient. What it feels like to carry the burden of being the last person to have the privilege to try to save someone’s life.
I have always prided myself on being me, not conforming to the surgical stereotype. Determined to show that calm considered compassion goes hand in hand with shared decision making, team working and above all kindness. I am open and honest about my experiences and share them with trainees, colleagues, and friends alike.
I was not the first and I will not be the last surgeon to experience Post Traumatic Stress Disorder and the absolute despair that comes along with it.
So next time you perform a case that makes you feel emotional, share those feelings with your colleagues and trainees. You might be surprised how people respond, and it might help you to move on knowing that we are all in this together for the benefit of patients, and one day that might be you.
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