Rule No. 2: Never underestimate the role of luck.

It’s the same approach that I recommend to patients. Physicians have an awkward relationship with luck. There’s a general feeling that a good physician should never count on luck. Why? I suspect many would like to think that intellectual mastery puts our medical practices beyond the realm of coincidental, haphazard events. But since so many of the important discoveries in Science and Medicine have come about through serendipity, it strikes me that not relying on chance events smacks of a certain hypocrisy. We accept that Alexander Fleming “stumbled” on the discovery of natural “antibiotics”--penicillin excreted by moulds that accidentally grew on some unwashed culture dishes he left behind in his laboratory as he rushed off to vacation. So why not accept that luck may have a hand in the course many of our patients lives as well?

Woody Allen’s movie Match Point opens with an insightful narrator saying:
“The man who said: “I’d rather be lucky than good,” saw deeply into life. People are afraid to face how great a part of life is dependent on luck. It’s scary to think so much is out of one’s control. There are moments in a [tennis] match when the ball hits the top of the net, and for a split second it can either go forward or fall back. With a little luck, it goes forward and you win. Or maybe it doesn’t, and you lose.”

During a surgical case, there are a thousand, minute decisions where a surgeon must stop, consider, and hope. But then he or she has to take the plunge, to cut or dissect deeper. The breath is held. A tight lump of dread sinks into the chest. There’s the mad hope it was the correct guess about where an artery or nerve might lie. Then there’s that inaudible sigh when the guess proved correct. Nothing’s damaged. You win.

In such a situation it seems to me untenable that luck does not play a role. I think that’s why surgeons use the saying: “Better lucky than smart.” I’ve had cases where a brain tumor had perfect planes of dissection. I seemed to be able to see every blood vessel, to staunch any bleeding, and leave the adjacent tissues pristinely intact. To the casual observer, it may look like the operation’s a reflection of my transcendent skill. It is not. Those planes, those vessels, are all matters of just getting lucky with that particular tumor. My major concern about physicians who cannot recognize the inherent value of luck is that they substitute a false sense of their own power in its place. That puts them in the category of a physician who’s smart and dangerous--a potentially lethal combination.

Patients need to seek out surgeons who have done the same procedure so many times it becomes routine, like an assembly line. A surgeon needs to practice, just like a virtuoso musician does, endlessly playing the same piece of music until every subtlety can be appreciated. By the same token, serendipity may suddenly present a better sound to the musician’s ear on a particular repetition of a musical piece. Then the instrumentalist incorporates that sound into his or her personal interpretation of the music. It is the appreciation, the watchful anticipation for surprises, coincidences, and chance that distinguish the masterful performance from one that’s merely competent. It’s the same in surgery. The best surgeons are also the luckiest and that’s more than coincidental.