On folding

December 12, 2012 by MassDevice

By Westby G. Fisher, MD, FACC

Westby Fisher

Every surgeon has been there at some time in their career.

It's a horrible, exhausting feeling.

Yet one we all must come to grips with: knowing when to stop.

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There you are, six hours into a case, legs rubbery, mind racing, and barely conscious of the world outside the narrow view of the operative field. A life, literally in your hands, asleep now, but hoping (with you) for the best of outcomes on this last try.

"Maybe if I just..." you think, and a new idea is tried to no avail.

"Now, let's look at that again," you ask your techs. "Which electrogram's earlier? That one is CLEARLY earlier...right?" as you try to convince yourself that another choice is better. "What about here?" You go back and recheck once more, just to be sure...

So you do.

And it's still a dangerous spot to burn.

"Maybe it's on the left side?" So you cross to the left side and repeat the process. Everything maps back to the spot your dreaded before.

"Maybe if I give just a little energy here...." You hold your breath.

No effect.

"But if I burn here, I risk giving the patient a pacemaker. We never talked about a pacemaker," you think.

Yet the tachycardia persists, as if laughing at you and your inability to locate its origin.

* Bruuuuhaaaahhaaaahhaaaa... *

"Bastard!" you think. "I can get this!"

So you map above, below, left and right, forward and back...

* Bruuuuhaaaahhaaaahhaaaa... *

Like stubborn mule, you fail to give in. Again.

And again...

Until finally...

... you quit. A white flag raised. It beat you. Yes, you lost.