the healing muse

Volume 11, 2011

I Killed a Man with My Own Two Hands

Amy L. Friedman

            I killed a man with my two hands. I didn’t mean to. It was an error—an error made by a human being. I am the human who made that error. This error—my error, cost him his life. When his life ended, mine changed forever. I am trying to survive.

            I had given this man my oath to honor his trust in me and in my judgment, in my ability to make the system work on his behalf, in my guarantee to be transparent about the known and unknown as it transpired in his care, and in my promise to skillfully repair his broken anatomy. We had peered into each other’s unclothed souls while he held the hand I purposefully offered in confident closure of my pledge. Today, I still desperately need to believe my long ago promise was offered out of conviction, not arrogance. But this only matters to me, since nothing can change the outcome. I had been wrong. My hands were not good enough on that day. My promise was broken because I broke it.

            The moment his vein slipped from my fingers I knew he had died, though we worked for another sixty-eight minutes. The problem I had created simply had no solution. Even now, so many years later, as I once again feel the diaphanous, blue tissue escape, my heart is suddenly racing, my breaths are rapid and shallow, and I can only clearly see these words on the page while everything else has become blurred and sounds have become far away, much like those first seconds when his blood began welling up. Flashbacks don’t come as often these days, but are no less awful when they do. We have probably all wondered how horrible it must have been for the Titanic victims to have foreseen their own drowning deaths in the freezing ocean waters, or for the Challenger astronauts to have known they were falling impossible miles to earth within their intact, yet doomed, capsule. At least the pain and suffering did end for those poor souls. When my fingers failed to control this man’s vessel, I knew instantly that death would happen with that same certainty. And it did. But it was his death, not my own. Fortunately, he did not suffer or have pain because he was appropriately prepared. But others did. And I am one of them. How might one measure whether it is more awful to bear the knowledge of imminent death if it is your own, or it is a death you have caused and must continue trying to personally survive, or why? Regrettably, this was such a moment of inevitability, and it was terrible. But for me it did not stop with his death, because I replay it over and over again. Can I ever give it back? Please? Such knowledge simply escapes description. For a long time, perishing with this man was very inviting. Continued existence did not seem possible.

            When time slowed, the faces and voices around me blurred and my team watched every move as I reached deep into the virtual bag of tricks that I already knew to be empty, in contrast to Mary Poppins’ magic carpetbag. Would my colleagues immediately accept that there was no answer in my bag and that we could simply stop our efforts right then? Such a judgment would have seemed so brash, and inappropriate, and ultimately have led to such severe consequences from those unable to grasp the key surgical issues that I chose to continue what I knew to be a charade, even though expensive and valuable resources were expended in doing so. To save face and to avoid answering difficult questions, I stood there hopelessly prolonging the bloodbath. Was my choice wrong or weak or simply practical? To this day, it still seems like the best one to have made, because it allowed my teammates to feel as if they had personally tried desperately to save his life. I cared about them, and do not regret having done so. If I was cowardly in choosing the more traveled road, and being self-protective, forgive me. On this charge, just this one, I have fully forgiven myself.

            After thanking everyone for their help, I dragged myself to the scrub sink outside the bloody operating room and saw the stool and clean scrubs my circulating nurse had prepared for me. She knew just how drained I was, how much paperwork and other responsibilities still awaited my attention, and how hard it would be for me to face his family. She gifted me with those two simple acts of kindness and caring at a very tough time. To this day they remain the only words or actions acknowledging that death’s impact on me that I have ever received from any member of a healthcare system. I will always be grateful for her thoughtfulness.

            I had to tell his wife. She was devastated, as one would expect. I had to tell my husband. He was supportive, as one would hope. I continue to find solace from my spouse. The man’s spouse cannot say the same. On that night I was inconsolable. I remember the warm bath water my husband used to soothe my shaking limbs, the calming words he spoke, the softness of the cloth on my face, and the way he cradled me to his chest. I could never bear to think about how she made it through that night.

            But at work no one ever said a personal word about his death. Most would not look directly at me—or maybe that was just my perception. Without pause, I resumed operating. The case was reviewed through the usual processes. In today’s terminology, it resulted from a human error, not a system error. No checklist or timeout could have prevented the death. At the time, I could not speak about the details of the case with anyone else, because our conversation would have been discoverable. No grief counselor was offered. I could not share my grief. I worried about being sued yet no legal advice was offered. Ultimately, I survived the statute of limitations. That provided a certain type of relief.

            His death was shocking, though I am very comfortable with deaths from patient disease, even those occurring intra-operatively. But, this was death caused by me making a technical error that another surgeon might not have made. On that day, I was not a good enough surgeon—a mighty big thorn. Had I been wrong in believing I could safely perform such a procedure? Before his case, I had done so for other patients. After his death, I always feared that very step in each of the cases that unfolded exactly as planned, even with subsequent patients doing well. I always thought of him as my fingers held their tissues tight. But in his case, it was an irretrievable error. I can never forgive myself for that error. Somehow, completely on my own, I needed to understand how to tolerate being imperfect.

            We surgeons do not offer each other much comfort or compassion. No department, or hospital or legal group has ever openly arranged for team support that has been apparent to me. Neither have I have ever known another surgeon to candidly seek such solace. Perhaps they do, and I don’t know it. But, why should I not know? Is that appropriate? If I have suffered so greatly in carrying this load, can I truly be alone in such personal sorrow? Surely I am not the only imperfect surgeon, or the only human one. Am I unusually sensitive or insufficiently inured to my own shortcomings? At last, now, I find relief in sharing with you that I still care about a man whom I killed so long ago. It has been an awful secret. Not his death, because that was never hidden. But my response and grief that were so tightly contained, and the disappointment I have in myself. I was provided no outlet for my tears. Surgeons are expected to appear strong and poised. The reality is that I still cry for him. I am crying now.

            I killed a man with my two hands. I am only a human being. Part of me died on that day too.

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