Surgeons love surgery. It is what we train for, what we are drawn to, what we want to do.
But as the years pass and experience accumulates, something else accumulates too: reflection.
Not every surgery is a success. There are complications. There are risks. And sometimes, in the quiet after, comes the harder question: might this patient have done just as well without the operation? We use published data, clinical guidelines, our own experience. We consult each other. We are rigorous. And still, uncertainty remains.
When a patient has additional health conditions, the calculus becomes more difficult. Is putting them through surgery reasonable? How do we weigh present risk against future benefit? These questions do not always have clean answers.
And then there is the particular complexity of operating on children.
Children grow. They change. There are windows, specific ages, specific developmental moments, when intervention is most beneficial. The earliest years, infancy and the toddler stage, are often the best time to operate. Children heal with a speed and completeness that older patients cannot match. And perhaps most importantly: they do not remember. The fear, the disorientation, the hospital stay - it fades. It does not become part of their story of themselves.
Strangely, it is often the parents who find this harder. Their child will have no memory of something the parent will never forget.
There is something else, too. Young children are, in a practical sense, easier to care for in recovery. Still in nappies, not yet mobile enough to pull at catheters or disturb the operated area. When the window is missed, everything becomes more complicated medically, emotionally, logistically.
So we try to get the timing right. We try to catch the window.
And then there are the scars.
We know that even the smallest difference in appearance can be very difficult for a growing child. Bodies are a child's first map of themselves, and anything that marks that map as different can carry weight far beyond its physical size. So we do our best to minimize scarring, to place incisions in less visible areas, to think ahead about how a body will grow and change around what we leave behind. When necessary, reconstructive surgery can restore what developed differently.
We carry all of this into every decision.
The knife is the last thing. The thinking comes first and it never fully stops.