"If you want to have a sound sleep at night......"

      "If you want to have a good sleep at night......" This is a very common idiom used by surgeons when they advice a colleague or teach juniors. Usually this is completed by something like "...you have to doubly ligate the vessel" or "....you have to over sew the staple line."

       So what is this that is going to impair the sleep at night? The fear. Surgeons' sleep is crippled by many things other than just fear of medico-legal issues. My Senior consultant often says that he could not sleep well before the day of a complicated surgery planning and thinking on how to tackle it most effectively. Since I haven't started doing any major surgery under my own responsibility I never had gone through such situation.

       When some big shots get admitted, sleep is deprived for all the persons on duty irrespective of hierarchy. Because big shots come big responsibility and every five minutes some one will call either to know about progress or some trivial things. Another stressful situation is when some relatives or people from our own regional area get admitted. We are influenced by so many things and we want to make them feel contend.


         But the one I have felt is when we operate a patient and his or recovery gets deviated from the normal course. This is the most difficult situation. It get worse when the recovery depends on time and the clinical findings are such a way that everything is inconclusive and you don't know whether to operate and over treat or watchfully wait. This is time where one wish there was a  person to advice. I have got my senior consultants now and I feel protected. But when they get similar problems, they get their equally experienced colleagues to involve and help them. This is the time when a surgeon ask for opinion from every one, including the juniors, residents on some input that could be useful. The time for some one to support. Sleepless nights become a common story then.

        I know that this is a risk associated with surgical field. A plastic surgeon may be worried of the flap viability,  A vascular surgeon may be worried of the leak, A thoracic surgeon may be worried of a broncho-pleural fistula, A gastro surgeon may be worried of a anastomotic leak. But as a part of training, the surgeons will acquire the acuity to ensure things that has to be done are done during surgery, so that they don't have a problem sleeping at night.