Becoming a better surgeon involves knowing what to do after making a mistake l Expert Opinion

The first time I was placing a chest tube, I made the incision far too low.

A chest tube is a small device that is tunneled between the ribs to drain any air, blood, or other fluid that builds up around the lungs because of an injury or a disease. Without drainage, the lungs may not be able to expand fully.

The procedure comes with some risk, however, and you have to pay attention to which rib space you are entering. Too high, you can potentially injure the nerves that run under the armpit. Too low, you can accidentally enter the abdomen or the heart.

I realized the cut was too low as soon as I made it. When I felt around for the rib space I wanted to enter, it was almost two inches away. Ideally, it should have been much closer so it would be easy to tunnel the tube.

But in that moment, I felt I could overcome this challenge. The incision had been made, and I had committed to a path. I thought of an image of a surgeon who never looked back.

I dug deeper. When it became harder to see the path I was dissecting, I made the incision larger. When the patient began to wince in pain because one vial of lidocaine was not enough to numb the whole area, I asked the nurse for extra vials.

Eventually, I asked a senior resident for help. When he came into the room, he took one look at my setup, then asked me, “Instead of struggling and risking complications, why don’t you just close this incision and start over?”

He was right. With the incision in the right place, I safely placed the tube within minutes.

I still look back on that experience and think about why it was so hard to simply start again when faced with an initial error. I did not want to admit to the patient and to myself that I had made the incision in the wrong place for fear I would seem unsure of my abilities. I wanted to save time and really believed that I could still make it work without much difficulty. Of course, the further along I got, the more difficult it became for me to turn back.

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As I gain more experience treating patients, I realize that becoming a better surgeon does not mean never making mistakes. Rather, it is about recognizing errors more readily. It is about finding the grace to forgive your own mistakes and the humility to take a step back, even if it is tempting to just press forward.

It can be hard to recognize these moments during a procedure when pride, fear, and ego stand in the way. However, in my experience, it is always worth it to own up to an error early on.

Nowadays when I teach others how to do a procedure and see someone digging deeper and deeper into an error, I urge them to accept they made a mistake and start again.

Jason Han is a cardiac surgery resident at a Philadelphia hospital and contributor to The Inquirer’s Health section.