An Incompetent Surgeon
by Mike Litrel, M.D.

Thoughts about this woman's impoverished children would break my heart - if I let them.

So I tried to think analytically. After an exam I could see that my patient and her unborn twins weren't in imminent danger. So I broached the topic of prevention - why not prevent this from happening again? I asked, had she ever considered a tubal ligation?

"I WAS tubalized - last year!!!" my patient spat. She sounded as annoyed as I felt. I re-examined her abdomen and there under her belly button was a well healed incision. All my annoyance took a new direction - toward whatever fool of a surgeon had tied her tubes.

Tubal ligations, it's true, can fail. But the odds of getting pregnant with fraternal twins after a tubal are one in ten thousand. It had to be the surgeon's fault. He or she had undoubtedly mistaken the round ligament for the fallopian tube. It's pretty easy to do. But the surgeon must also have neglected to check the pathology report to discover the mistake. And THAT is bad medicine.

I had always prided myself on my surgical skills. Keen observation, calm actions, and conscientious follow-up are the hallmarks of a good surgeon. I tried to live up to those ideals. It takes a lot of doing, and there were more than a few surgeons around who just didn't live up to those standards. Hot on the trail of the unknown culprit, I looked up the operative report. I needed to know who it was.

But when I finally found the name of the idiotic, incompetent fool on the operative report, I realized it was a surgeon I had not considered.

It was me.

My hands shook as I pulled up the pathology report. Could I possibly have missed her tubes? Was this twin pregnancy my fault? Was I the reason this mother was lying in a hospital away from her other eight children? Was it I who was incompetent?

Relief washed over me like a flood when I saw the report: I had done the surgery correctly. Sometime within the next few days I confessed to my patient just exactly who her surgeon had been. She was pretty cheerful, considering. My explanations about medicine and failure rates to vindicate myself didn't make much of an impression. As far as she was concerned, it was God's will, and she would live with it.

My patient and her babies did well. Six months after their birth I operated again. Looking at the condition of her tubes, I saw that there was no way she should have conceived. But I removed the remaining segments - and offered her double protection with birth control pills.

She gladly accepted.

I still don't know how she defied the odds with her twin pregnancy. No answer, I suppose, is better than my patient's. God creates Life, His miraculous gift to us. And in the same way a tree blossoms with flowers and leaves each spring, a woman's body blossoms with the miracle of life.

No matter how much a surgeon - incompetent or not - says it won't.

Dr. Litrel is a surgeon in private practice with Cherokee Women's Health Specialists in Woodstock and Canton. He is a Clinical Professor at Emory Medical School and the Medical College of Georgia. Dr. Litrel lives in Woodstock with his wife Ann and their two sons, Tyler and Joseph. (mikelitrel@attbi.com)

I was a third year resident on a night rotation at Grady Hospital. A twenty-eight year-old woman with eight children was awaiting my evaluation. Seven months pregnant, she had been admitted to Grady's high risk obstetrical service because she was in early labor. An ultrasound had revealed twins. With lungs twelve weeks immature, one or both babies could certainly die if they arrived that day.

Before seeing the mother I reviewed her thick chart. She had been only fifteen when she'd had her first baby. She fired off the next three like a semi-automatic, and they had taken their toll on her body. Succeeding pregnancies had come with complications and early labor.

A wave of annoyance washed over me. It was an emotion I had become familiar with since my arrival at Grady. Part of the annoyance stemmed from the patient being high risk. I would definitely have to keep an eye on her. In theory, every new patient was an opportunity to learn and grow as a physician, so the more difficult the better. But in practice, after a thousand days of residency, sleep had come to feel a little more rewarding than personal growth.

But the factor that really annoyed me was how unnecessary this patient's problems were. Why not stop at four children, or six? Why NINE? Was she trying for a family baseball team?

The official goal of obstetrics is to ensure that every child is well born. "Well born" is a concept that extends beyond simply the baby's and mother's physical health. The health of the family unit is essential as well - the physical, emotional, and financial ability of the parents to care for the child.

How could a single mother on welfare take care of eight children? How could anyone, for that matter? And now she was pregnant yet again, with twins to boot. And who was taking care of the other eight while she was stuck here in the hospital?

I think the reason so many physicians become cold is in trying to protect themselves emotionally. Coldness is not a real solution. But it is difficult to bear witness to so many people enduring so much suffering - some of it so unnecessary.