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Editor’s Corner: Are There Safe Spaces in Surgery?
Thomas J. Miner, MD
I notice that debate over “safe spaces” and “trigger warnings” on college campuses intensified this fall. Initially, the term “trigger warning” was used on blog posts to warn survivors of horrific experiences, such as sexual violence, crime, or torture, of content that might upset or "trigger" them and give the option to read the material when they were better prepared to deal with it. The concept has changed over time from its intent as a warning to trauma survivors to a notion that people may need to be shielded from disturbing ideas. “Safe spaces” emerged with a similar intent to provide refuges for like-minded people, where they don't have to explain or defend their politics, beliefs or practices. Rather than being obliged to discuss potentially offensive material at a time which an outside group unilaterally decides upon, it allows for members to have a say when these “uncomfortable” discussions with outside groups happen. Like many I suspect, I often find this topic frustrating as valid points on both sides of the argument get twisted and become irrationally extreme. This discussion makes me think of my profession, though, and wonder if “safe spaces” and “trigger warnings” do, or should, exist in surgery?
My initial response is an unqualified “no!” As surgeons, we pride ourselves in the ability to manage uncertainty, anxiety, and often danger. What is comfortable about managing a dying patient, an unresectable cancer, a difficult M and M conference, or a hole you accidentally made in a major vessel? We take on difficult problems; we manage complications; and, we break bad news. As a profession we excel at being uncomfortable. Every Department of Surgery, Residency Training Program, and Practice abounds with stories of its surgeons going into the unknown and helping patients. In my program, applicants and interns are told the tale of the junior resident who raced to place a chest tube to relieve a tension pneumothorax caused by a pulmonary fellow who was too “uncomfortable” to place an angiocath in the second intercostal space despite multiple subclavian sticks performed during an unsuccessful central line placement. Despite only have done a handful of chest tubes early in his training, he stepped into the personal unknown to help his patient. Graduates of our program can recite this legend, and many more, with unwavering clarity. Stories such as these serve as reminders of our professional expectations and, in a small way, may serve as guideposts in times of doubt.
But I don’t think that the answer to my question is as simple as extoling our collective resilience and grit. Whether discussing a difficult patient with a trusted peer, debating local problems in the lounge with partners, or getting out of town to present data at a meeting, most successful surgeons have places where problems and issues can be shared. In order to manage the uncertainty associated with being a surgeon, especially in the current political and economic landscape, perhaps we need to be able to reach out to like-minded individuals in order to work through the challenges we face. By seeking these opportunities, are we not in a way, making “safe spaces” that allows us learn, grow and, at times, even heal? There are probably many “safe spaces” in surgery that each of us benefits from. What I have learned from being a member of NESS, a lesson that I suspect is being lost on college students and administrators in the current debate on higher education, is that the intent of my surgical “safe space” is not to make me instantly feel better or shield me from unpleasant things, but to help me overcome the circumstances that have caused the current predicaments. It is predicated on service to the surgical patient and not to simply to me as an individual. It challenges, teaches, and inspires through the support of friends and colleagues to move beyond the status quo and reach for excellence. Colleges and Universities can only dream of reproducing what we have.
Thomas J. Miner MD