Dr. Bob's Ego

Dr. Bob completed a Cardiovascular Residency at a well-known and respected University Hospital. He performed very well during his training period.  At the completion of his training, Bob surprised everyone and did not seek an academic position, or locate in a large, high profile metropolitan area. Instead, Bob decided to practice surgery in a small town of about 10,000 people and resign himself to simple cases.

 The hospital in which he practiced had about 30 beds and was located 200 miles from the University Hospital in which he had trained. Burned out by his years of training, Bob wanted to make his living in a relatively quiet manner. The small community had invested a lot of money in their new hospital and Bob was well known and well liked in the town. He knew the Mayor and other various fund raisers who were responsible for the new hospital being built. Everyone knew he had been superbly trained at the nearby University Hospital and they assumed this ensured superb medical care.

A prominent member of the community presented at the new hospital’s Emergency Room with what appeared to be a near rupturing abdominal aneurysm. The patient did not want to leave the town, and thought Bob could do the necessary operation.  Because the patient and the entire community knew of Dr. Bob’s excellent training, Bob was pressured to do the operation.  At abdominal exploration, Bob found a near-ruptured aortic aneurysm, which he began to repair. “What the hell?” he thought. “I did many such cases in my training. The necessary steps will all come back.”

An abdominal Aneurysm is a weak spot in the aorta, in the abdomen, which develops over many years. It is much like a weak spot in a hose which enlarges from a normal diameter of 2 centimeters to 6-9 centimeters. The continued enlargement carries the risk of sudden rupture and death. The repair consists of removing the enlarged portion of the aorta and replacing it with a synthetic cloth tube. The operation is not intrinsically difficult, but because of the size of the blood vessel and its many branches, the first few operations a surgeon does can be a little tricky. In a Cardiovascular Residency the cases are turned over from the Chief Resident to the more junior members of the training staff after their first few months. A typical large University program would be performing 2-3 repairs of such problems in a week. The “trickiness” of the repair could easily return after the five year layoff Bob experienced.

In attempting the repair, Bob tore a branch of the Aorta, which created uncontrollable bleeding.  Fortunately for Bob, he was able to control the bleeding with a massive amount of packing, close the abdomen, and reinforce the closure with an abdominal binder. Dr. Bob put the patient in an ambulance, and sent him to the University Hospital where he had trained.

Fortunately, the Chief Resident remembered Bob and liked him. He accepted the patient and went on to repair the patient’s aorta rather easily and the patient went on to recover nicely.

What went wrong?

Bob did not pay heed to his limitations. He should not have attempted such a case after a 5 year layoff from such operations.  He should have explained that fact to the patient and the community representatives. The patient should not have resisted being sent by ambulance to the University Hospital, 200 miles away. Bob’s ego and community pressure caused the patient to have a near catastrophic attempted repair of the aneurysm. Believe it or not, this is not an uncommon problem. Doctors in small communities often get into situations over their heads. Despite superior training, Doctors in small communities face the disadvantage of not seeing certain cases for years. The doctor’s location and recent experience are very important – just as important as the initial training period.


*Real names have not been used and all facts and dates have been changed to avoid identification.*