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Wednesday, October 5, 2011

Rule No. 4: Let the patient die at God’s hands, not yours.

I put this rule in because it was something that Dr. Zervas, the Chairman of our Neurosurgery Department, tried to drill into me as a resident. We would look at x-rays together, and Dr. Zervas would ask what I would do for this problem or that one. Sometimes we’d come across a very extreme case and I’d start to concoct elaborate, lengthy surgical procedures to address the problem. He would chuckle and say: “Let’s pass on this one, Allan. Better to die by the hand of God than the hand of man.”

At the time, it struck me as sort of neatly packaged “old guy” wisdom. Maybe even an excuse for chickening out. But later, when I was an attending myself, I’d watch some of my younger neurosurgical colleagues attempt overly aggressive, elaborately complex surgeries in some really frail, elderly patients. They wanted to cut their teeth on what we refer to as “big, sexy, monster cases.” Most of the time, the patient succumbed quickly to a series of predictable complications. I’d find myself remembering Dr. Zervas’s sage advice. Many times it has helped stay my hand where I might have persuaded myself that I could pull a surgery off.

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