Anger in the Operating Room

Anyone can become angry – that is easy, but to be angry with the right person at the right time, and for the right purpose and in the right way – that is not in everybody’s power and that is not easy.

Aristotle

We have four children. I’ve spanked my firstborn son; infrequently, but I did. The second one only occasionally. The youngest twin girls weren’t disciplined physically at all. Maybe because they were girls? Or perhaps because I was older? During all these years, I detected a pattern. For one reason or another, I became frustrated and in the end, spanking followed. This gave me initial relief, but it didn’t last long. When it was all over, I felt guilty and in effect I was worse than before the child’s mischievous act. The most important fact was that spanking very rarely changed a child’s behavior. As for me – I was miserable.

Granted, the environment in the operating room is sometimes more dramatic and more is at stake. The responsibility of a surgeon as a Captain of the Ship is enormous, and the potential consequences of any mishap can be far-reaching. Anger in the operating room is a frequent response to a bad result and raises the temperature in the operating room several notches. OR is a closed space, where a group of people is locked up for hours and emotions are amplified like music in a bare wall restaurant.

Showing anger is a usually a sign of frustration. But sometimes it’s just a way to shift responsibility away from the surgeon, who is the one responsible for final results. But OR nurses and techs have pretty good judgement who is at fault. And they are professionals, too.

This is uncontrolled anger.

However anger can also be used as a tool to achieve your goals. It’s been used to force the OR crew to behave your way and punish them if they don’t. This is calculated, purposeful and controlled anger. Big name guys, true leaders, use it a lot. For good and bad. It’s being used as a strategy to show how passionate they are and how much do they care about a particular event. Those guys wield a real power and are telling you that if you will not change your behavior – next time it will get worse.

This is calculated, premeditated anger.

The surgeon in the operating room has a significant, albeit limited, power. Sometimes he thinks he has more. Probably at the least, he can make your life miserable, at the worst can have you fired. But how can one work for hours in an environment like this?

I heard the story during my residency about the neurosurgeon, who at the tense moment in OR walked to the wall and banged his head on it. When he started the very next case, he found a pillow taped to the wall at the very same spot he was abusing before. The OR crew didn’t want him to suffer a concussion. At least not while his patient was still on the operating table.

So, is it a necessary and justified reaction to a bad outcome, a physiological response to unload or just a power grab by a person seen to be in charge in a sequestered area which the operating room is? And do we do better by hiding it or exploding and sharing our anger with the rest of the team?

That’s a common question, and there are people justifying each type of reaction. Unfortunately, some feel, that a particular response is the proper one, and they get angry, or not because that’s the way they should feel because it just looks good.

More to come.