Trust Your Supervisor, Trust Your Surgeon

When I first started doctoral study in the UK, a fellow research student with the same supervisor, but who was slightly ahead of me, gave me the piece of advice that has helped me survive my PhD so far. His advice was simple, ‘Trust your supervisor!’. This advice was not given to me in a context where I was expressing doubt about my supervisor. I was expressing doubt about myself and whether I had what it takes to write my PhD. His point to me was that I could trust my supervisor because of his track record. My supervisor is a man of sincerity and earnestness, who has a heart for his students. Starting a PhD with my supervisor was unnerving at the beginning, and not for the reason of his reputation. He gave me task after task to complete and I had no idea where it was going. I had to trust him and his process. Until one day, he posed a question to me, a challenge really, and that was the day I knew where I was going. I still didn’t have the confidence that I was capable to pursue the particular thesis idea that he suggested. Other scholars had tried and given up, so what hope did I have? But I knew I could trust my supervisor because of his track record, not only with his previous students, but with me as well, from the short time we had been working together. The fellow research student who gave me this advice did clarify his statement, ‘You can’t say this of all supervisors, but you can say it of this one’. The sad reality is that not all doctoral students have supervisors they can trust and who they should trust. But this was not my situation. And he was right. Going through my PhD, my general approach has been that if my supervisor is happy with my work, then I’m happy; if he’s concerned, then I’m concerned. There have been times when I have been unhappy with my work, but my supervisor has been okay with it and has asked me to move on. I want to rewrite another draft of a chapter I’ve been working on, he wants the next chapter written. At that juncture, I need to follow my fellow student’s advice; leave the chapter I want to rewrite and trust my supervisor.

When I first met my surgeon on that ‘in-between’ day, I can’t say that my natural instinct was to trust him from the beginning. My lack of trust had nothing to do with him personally, I hadn’t met him before; I don’t tend to give people my trust without a reason to trust them. Being a surgeon doesn’t automatically mean that he has my trust. I guess you could say this is one of my weaknesses. If so, then a second is that it’s easy to lose my trust. This particular surgeon, however, gave me a reason to trust him by the end of that first meeting, and it’s something I have already written about, his honesty and frankness. Admitting to me that if my situation was a bad case of sciatica, then he wouldn’t operate; the situation was though that I could barely walk and there was the risk of permanently losing function in my right foot. His sincerity and openness commended him to me as a surgeon perhaps I could trust. By the end of Thursday evening, he had given me a second reason. A simple phone call. After an initial look at the MRI done that day, he phoned to say that the diagnosis has changed slightly and so the surgery plan needed to also change. He then listed the risks involved. He was a surgeon that communicates. I know from past experience that not all surgeons are relational, but this one was. And he continued to communicate. The next morning, which was the morning of the surgery, he didn’t assume that I was sold on having the surgery until I had put pen to paper and signed my consent. He was also very careful to make sure that I understood the surgery and why it was needed, before I had signed my consent. His willingness to be real with me meant that by the time I was going into surgery, I knew I could trust him.

After the surgery, hearing from the surgeon that he was happy with how the surgery went, even though what they found was a bit surprising, I was happy. And I think that I had unconsciously started applying the logic I had learnt from my supervisory relationship to the surgeon. If he’s happy with how the surgery went, then I’m happy. So when he said, ‘please go to the rehabilitation hospital’, I went to rehab. It’s not by any stretch of the imagination that I’m a ‘yes sir, three bags full sir’ type of personality. I have a very active rebellious streak, which my research supervisor has learnt to sometimes enjoy. I complied because in a short space of time, I had grasped that this particular surgeon seeks the good of his patients, which I know is not true of every surgeon.

So, what happened? As I sat on the hospital bed that Monday afternoon when I was readmitted, being admonished like a child by the surgeon, had the surgeon stopped listening? When I wrote that I wouldn’t ask for help again from the medical team at the hospital, was that a telltale sign that I no longer trusted my surgeon? After our conversation that Monday afternoon, I asked myself both of these questions. And the answer for both questions is, ‘no’. The surgeon sat and listened, he asked whether there was anything else I wanted him to hear. He was listening. And he took the time between surgeries to sit and listen. He spoke to me with the same sincerity as he had before and after surgery. That’s what made his words hard to hear. He was seeking my good and he sincerely wishes to see me get back into life. I don’t think he meant to imply that I wasn’t getting back into life, but was voicing his desire to see this issue resolved so that I can get on with life without hindrance. Unfortunately, his words just did not come across this way in that meeting. Did I stop trusting my surgeon? No. Just because I resolved not to seek the help of the medical team again for the problem I was experiencing, doesn’t mean I stopped trusting. In fact, my willingness to trust was the reason why I was willing to give their point of view a go – again. I was so over questioning and pointing out patterns that were dismissed. I gave up.

Why then was the surgeon persistent in his point of view that medication from the surgery was the cause of the problem that led to my readmission into hospital? Because there was one piece of data that didn’t fit the rest of the picture. A particular test was performed pre-op and then twice post-op and each time the results were acceptable. This ‘acceptable’ was a deviation from what the surgeon would expect if the problem I was experiencing was a result of nerve damage. Hindsight though is a wonderful gift. I wish I could say that the hope the surgeon offered that Monday turned out to be true. I wish I could write to you that the complication is now resolved. But it’s not. Within 36 hours, the old patterns that point to nerve damage being the cause started to emerge again. I wish this was not the reality, but it is. Now I just have to move forward with this reality as part of my present normal.

I wrote the above over four days, from the Monday afternoon during my second stay in hospital to the Thursday when I knew for certain that complications were not resolved, and is only part of what I originally planned to post. This post was due to be made public two weeks after the event and the day after the previous post. Quite a few days have lapsed since my last post went public. I was uncomfortable with a paragraph. Two friends, who are doctors, have read the paragraph in context of the original post. Both had different responses and each was useful. I have written and rewritten the paragraph too many times. The explanation I offer below is reworked. I attempt to give a reason for why I have found the whole process infuriating. I also try to take you through the process of what I originally thought and the understanding I have now come to. This change would not have happened without the feedback of the two friends who, both as doctors, have a great heart for their patients. So here goes.

Thinking through the past ten weeks, two weeks on from my readmission into hospital, I have finally pieced together why the process was frustrating and, at points, disheartening. The problem is not with my surgeon, or with my medical team, but with me and how I’m trained to think and reason. I was perplexed as to why one piece of data dismisses a possible explanation for other pieces of information. First, I thought the difference between the surgeon and I was due to the fact that we are trained in two very different disciplines with two very different methodologies and ways of thinking. We deal with two very different types of information. What I originally wrote pointed out the differences between what I have observed to be true of the surgeon’s methodology and the methodology that characterises how I work as a scholar. My point was not to show the flaws in the surgeon’s methodology because I don’t actually think it is flawed. My original point was that I needed humility within his process. My discipline is not his discipline. And I’m the one needing to rely upon his expertise. I know from his track record, which the second MRI shows so well, that he is good at what he does. Also, as a friend so kindly reminded me, we can all be wrong, even with the right methodology. And even in my discipline, there are as many conflicting methodologies as there are ways of thinking. So the point I originally made was that I need to trust my surgeon. When he says move on, just like my supervisor tells me with my habit of continuously rewriting, I need to listen, heed his advice, and move forward. I have to trust his process, just as I trust the process of my research supervisor. That was my original point. But I was wrong.

I was wrong with an assumption I had unconsciously made. I was wrong to begin even suggesting that the way the surgeon made a decision on one small part of my case was representative of how he approached the whole. I was also wrong to give the impression that how he worked in this one instance was true of how he works with his other patients. I didn’t write any of these assumptions explicitly and I don’t think they are right. I have a high regard for the rigour that the surgeon has shown every step of the way. But that was the impression the original paragraph left. But I was partially right about one thing. Part of my frustration is that what happened seemed contrary to my own training as a scholar. Here is what I originally wrote about how I’m trained as a scholar and, I should note, senior scholars in my own discipline would dispute the underlying convictions.

I’m trained to see detail in the context of the whole picture, with the irregularities. If something does not fit, I’m encouraged to ask why, to probe further, not to disregard the explanation if a detail is not behaving. I then go over the data again, asking whether there are other irregularities I passed over before, other patterns that can be observed, maybe even patterns that I missed, without trying to force data into patterns that were not intended to be there. Often that piece of misbehaving data is the key to understanding the whole.

As one friend pointed out to me in her feedback, my method is similar to how a doctor might work. So then, what did happen and why was I frustrated? Because it seemed like, from my perspective, that this one problem was not treated consistently with the rest of the complications from the spinal injury. I was perplexed as to why, in this instance only, when one piece of information did not behave as he would expect it to behave, that he then seemed to dismantle the evidence, assigning one symptom to one diagnosis and the symptom that doesn’t quite fit the picture to another explanation. But as I said earlier, hindsight is a wonderful gift. But hindsight can also make us too critical. The surgeon’s explanation for the complication was reasonable. So, where does this leave me? It leaves me back at the beginning of the post. Just as I had to learn to trust the process of my research supervisor, so I need to learn how to trust the process that my surgeon uses. Trust your supervisor, trust your surgeon. Advice I need to relearn.