Roses, thorns, and buds: Coping with failure in surgery

In 1848, poet Anne Bronte, in the poem The Narrow Way, wrote that “He that dares not grasp the thorn should never crave the rose.” Such a sentiment will be clear to many, but it is likely there are few so well positioned to understand the depth of Bronte's sentiment as surgeons. Surgeons train for most of their lives to adeptly wield roses that can be uniform or unique in nature, but there is no surgeon who has not felt the blight of a thorn. However, just as a skilled gardener can prune around the thorns it seems that surgical researchers have been engaging in discourse as close as possible to our most fundamental thorn without clearly considering all aspects of it – how should we react when we fail in the operating room? Failure for surgeons can take on many forms, but at its basic level it encompasses failing to perform the expected action, the planned upon operation without error, as this is the standard we hold ourselves to and, despite discussions of risks, the expectation patients bring with them. Hence, we ask: do surgeons exist within an anti-failure culture?