us, who often provided ICU care as we were unable to operate, and saw death on a scale that was highly unusual. For some doctors, there were tragic consequences, and more than a few sui­cides in doctors have been reported as an after­math of the chaotic breakdown of our medical systems during that time.

The challenge of continuing to perform at one’s best for each new consult or subsequent operation cannot be understated, and although surgeons are proud of their “grit,” we must be mindful of our own vulnerabilities and respond appropriately for the safety of all our patients [1]. In another quote from his book “Complications” Dr. Gawande writes about a colleague who had made an error: “Afterward, he could barely bring himself to operate. When he did operate, he became tentative and indecisive. The case affected his performance for months.” Seeking guidance from a senior colleague may be helpful in these circumstances to help the surgeon nd their equilibrium anew [4]. This may be particu­larly important if the surgeon has to operate on another patient with a similar condition, where fear of the outcome can impact the surgeons’ per­formance—asking for assistance may help the physician overcome this hurdle.

Although surgeons have by tradition always had some form of oversight of their performance in our weekly mortality and morbidity confer­ences, most hospital organizations have a paral­lel but different process known as peer review. In the case of the hospital peer review commit­tee, the peers are usually NOT surgeons, and the process unfolds very differently and can be a source of additional stress and concern for the surgeon. Having experience on these commit­tees, and having experienced how surgeons respond to them, it is clear that this kind of over­sight, while well- intended and necessary to identify issues, is not well liked by the average physician, who nearly always regards the review as punitive in nature.

While many surgeons are their “own worst enemy” in terms of how they review their own cases in terms of the patient’s death, fear of retri­bution from the patient’s family, the hospital or even the State medical board may compound the stress from the event and contribute to the “sec­ond victim syndrome.”

The support of our peers is another avenue from which we can draw assistance. This includes our partners, senior colleagues, mentors, or oth­ers in positions of authority. This may be more

How we deal with a patient’s death can dene us; whether we wall ourselves off, become emotion­ally over attached and vulnerable, or in those cases where it leads to consequences in terms of anger, depression, or even substance abuse. The pressures of modern surgical practice and the increasing expectations of patients can make what is a highly rewarding career increasingly fraught with difculties. Surgeon burnout is real, and we need to come up with ways to openly discuss it, and provide support to those surgeons in their time of need. The individual physician needs to have insight into their own feelings and either have robust coping strategies of their own, or seek appropriate help when it is needed. Although the notion of “second victim syndrome” may not be fashionable amongst our profession, where we pride ourselves on our resilience, we must not fool ourselves that our junior colleagues and trainees wish to continue to suffer in silence, and we must remove the stigma. Personally we would rather be cared for by a surgeon who is affected by a patient’s death, than one who has become stone­hearted to the suffering of his patients. This is what we entered the sacred profession of surgery for, to alleviate suffering, and we should keep that foremost in our minds.