I am an experienced general surgeon, and I have performed over one thousand successful hernia operations. My complication rate was very low, and I can almost remember every one of them. The one complication I have never had was acute nerve pain.
A skilled and competent surgeon not only knows how to operate and have good results but should also be able to spot complications early on and treat them promptly and adequately. Following an operation, and more importantly, if a complication happens, the surgeon must monitor the patient’s condition regularly and provide all the treatment and support required. Honesty, transparency and timely communication are vital. A decent surgeon would not hesitate to say sorry when it is due.
Surgeons who perfect their management and operative skills face a particular challenge. When confronted with a complication that they had never seen before they might not know how to deal with it in the best possible way. They might have theoretical knowledge but lack the practical skills of how to deal with such a complication. In such an unusual situation, a caring surgeon will surely consult with and seek help from other surgical colleagues.
In my case, I fully trusted my surgeon – this was my biggest mistake!
Back to my story
Following my unproductive and humiliating visit to the pain management specialist, I became even more desperate.
27th of April 2012: work colleague B sent me a text message asking if I could do some clinics. I replied, reminding her that I was in severe pain.
30th of April 2012: I contacted my surgical colleague A for advice. I wanted him to check for me if my work colleague C would be willing to operate on me privately to release the trapped nerve. Colleague A advised me against having an operation by a work colleague except in an emergency. On the same day, I sent a text message to surgical colleague C asking if he could suggest a name for a surgeon outside our area. He did not reply.
No one could or would suggest a surgeon’s name for me, not even my GP. I realised that I would have to go it alone! I started my search for a specialist in hernia surgery complications. Simultaneously, I also started my fact gathering and extensive medical literature research. I wanted to have a deep understanding of my condition.
Without insider knowledge and/or reliable and up-to-date surgical league tables, I would say good luck for you if you are trying to identify the best surgeon who can deal with your condition. I am here not only talking about being an experienced surgeon, but also the one who ticks most of the boxes of the good attributes described earlier.
The following quotes from the book, Unaccountable: What Hospitals Won't Tell You and How Transparency Can Revolutionize Health Care, provide some guidance:
In my case I intuitively followed the above advice and went for someone whom I worked for as a junior surgeon, and whom I admired and trusted. But sadly, it did not work for me!
I contacted the British Hernia Society for some guidance and advice. This I did on the 2nd of May 2012. Two days later, I received an email reply with the contact details of a surgeon at the British Hernia Centre. I called the number and booked an appointment for the 15th May 2012.
Meanwhile, I saw my occupational health consultant and reported to him the followings:
- Whenever I sit upright, I soon develop severe pain in my left groin. I would only be able to sit for longer if I sat slouched.
- I would not be able to cope with the drive to work as my pain starts soon after driving and becomes extremely uncomfortable after 20 minutes driving.
- Once my pain becomes severe and hits 8 out of 10 on the pain scale, it would last for a few days.
- Because of my severe pain, I was finding it a struggle to do things that involve significant cognitive function.
My occupational health consultant conclusion was that I was not fit enough to be able to sustain a regular outpatient appointment nor to carry out any operative procedures due to the intermittent but severe nature of the pains I was getting.
15th of May 2012: my wife drove me to the British Hernia Centre. While waiting, I was made to fill in a questionnaire. When my turn came, the surgeon went to the waiting area to welcome me. He was outstanding in his manners, very gentle and very kind, too. Once the consultation ended, he walked me to the reception desk and asked the receptionist not to charge me for the consultation fee! I am more than happy for any patient to write to me privately for his contact details.
His written communication was prompt and kind in nature. Very soon after I saw him, I received this letter from him:
“Dear Mr Rateme,
It was a pleasure meeting you and your wife today and I want to say first of all that I do empathise with your problem and would like to do anything I can to help.
I am enclosing a letter I have sent to your GP. I will email my colleagues who are experts in this field, and let you know their views.
With best wishes.”
This is some of what he wrote in his letter to my GP:
“Mr Rateme is a general surgeon and consulted me today regarding…
The symptoms do suggest ilioinguinal nerve entrapment or damage…
There are a number of surgeons who specialise in post inguinal pain in Europe and the USA and I told Mr Rateme that I would get in touch with them and ask their advice in the first instance.”
He mentioned to me about various forms of treatment, including triple neurectomy (surgical removal of the trapped nerve along with two other groin nerves). He added that this highly specialised form of surgery can only be performed by a handful of surgeons outside the UK.
Four days after my clinic appointment, one of my work colleagues contacted me. The caller informed me that other work colleagues were asking why I was still off work, and they were saying that I should turn up for work to show how much pain I was in. The caller added, if I did not do that, I would then be at risk of losing my job! My work colleague did this in good faith. I received this advice/warning at a time when I was experiencing severe (8/10) pain. This was the last thing I wanted to hear. I was deeply hurt and very angry too. I immediately complained to the lead of the Breast Unit and the Business Unit Director of the Surgical Department. Both responded promptly, and they were very supportive. Colleague C’s reply via text message was, “Your job cannot be “at risk” as you have a contract and have been through the correct occupational health channels.”
This stressful experience left an unpleasant taste in my mouth.
24th May 2012: I received a “Get Well Wishes” and “We all miss you at the Breast Unit” text messages from the nursing staff in my Breast Unit. They followed this with a box of chocolate. It was a deeply touching act of kindness.
I sent an email with an update about my condition to the Business Unit Director of my Surgical Department.
It is now Fifty-seven days since I last contacted my surgeon and I have not heard from him since!
In my next blog, I shall give you a very brief account of the type and intensity of the neuropathic pain I endured before I travelled to Denmark for surgical treatment.
Makary, M. (2012). Unaccountable: What Hospitals Won’t Tell You and How Transparency Can Revolutionize Health Care (1st ed.). USA: Bloomsbury Press.