Chasing Life: How Surgeons Balance Hope with Honesty

Episode Overview

In the July 4, 2025 episode of Chasing Life, CNN’s Chief Medical Correspondent, Dr. Sanjay Gupta, delves into the intricate balance surgeons must maintain between hope and honesty. Featuring a profound conversation with Dr. David Sandberg, a retired pediatric neurosurgeon and author of Brain and the Triumphs and Struggles of a Pediatric Neurosurgeon, the episode explores the emotional and ethical challenges faced by medical professionals in high-stakes situations.

Personal Reflections and Introduction

Dr. Sanjay Gupta opens the episode with a deeply personal story from his early days as a surgical intern. On Christmas Eve 1993 in Ann Arbor, Michigan, Gupta recounts a failed thoracentesis procedure that resulted in the death of an elderly patient. Reflecting on this experience, he shares, “I believe that that reminder makes me a better physician” (00:01). This story sets the stage for the episode's exploration of the emotional burdens carried by surgeons.

Gupta introduces Dr. David Sandberg, highlighting his new memoir, which provides a glimpse into the life of a pediatric neurosurgeon. He poses critical questions: How do surgeons make life-and-death decisions? How do they navigate hope amidst the harsh realities of their profession?

Garrett’s Story: A Case Study in Decision-Making

Dr. Sandberg shares a pivotal case from his career involving a 15-year-old boy named Garrett. Garrett suffered a severe head injury after an ATV accident while not wearing a helmet. Dr. Sandberg explains the initial grim prognosis: “His pupils were large and unreactive, a terrible sign” (05:15). Despite the bleak outlook, slight neurological signs led him to opt for surgery, ultimately saving Garrett’s life without lasting neurological deficits.

Reflecting on this decision, Sandberg admits the emotional toll it took: “His case haunts me, and I wonder, I can't think of examples, but have I made mistakes like that, that I could have saved a life and didn't?” (06:55). This introspection underscores the perpetual uncertainty and the heavy responsibility surgeons bear in their decision-making processes.

Balancing Hope and Honesty

The core of the conversation revolves around the delicate balance between maintaining hope and delivering honest assessments to families. Dr. Sandberg emphasizes the necessity of transparency, stating, “You gotta have the honest conversation and convey the uncertainty” (08:46). He illustrates how, in gray areas where outcomes are uncertain, physicians must communicate the potential risks and benefits without swaying towards false optimism or undue pessimism.

Dr. Gupta adds depth to this discussion by highlighting the intrinsic value of hope, suggesting that it may even contribute to better patient outcomes: “I think there's something there” (10:14). Together, they explore how hope can coexist with honesty, providing families with the strength to face difficult medical decisions while being fully informed of the possible outcomes.

The Role of Morbidity and Mortality Conferences

A significant portion of the episode is dedicated to the concept of Morbidity and Mortality (M&M) conferences. Dr. Sandberg explains their importance in medical training and continuous improvement: “It's very hard. Imagine yourself, you have the worst day of your life, and then that worst day of your life is presented with a room of 50 to 100 people” (23:15). These conferences serve as critical learning opportunities, allowing surgeons to analyze adverse outcomes openly and constructively.

Dr. Gupta shares his own early experience presenting a surgical complication, highlighting how mentorship in these settings can provide solace and guidance: “He had thrown me a lifeline in many ways” (26:42). This mutual support system is essential in helping medical professionals cope with the emotional fallout of surgical errors or complications.

Prevention and Societal Responsibility

Transitioning from personal and professional experiences, the conversation shifts to the broader topic of prevention. Dr. Sandberg passionately advocates for societal measures to protect children, such as helmet use, gun safety, and regulations in contact sports. “We should be doing more and we're not doing enough” (19:15), he asserts, underscoring the preventable nature of many traumatic injuries he encounters in his practice.

Dr. Gupta echoes this sentiment, expressing frustration over preventable accidents and advocating for proactive measures to safeguard children’s health and lives. This segment highlights the intersection of medical practice with public health and policy, emphasizing the role of physicians in advocating for safer environments.

Coping with Surgical Outcomes

Addressing the personal struggles surgeons face when outcomes do not meet expectations, Dr. Sandberg discusses the emotional burden of patients experiencing worsened conditions post-surgery. He shares, “I've lost a lot of sleep on nights that follow when a patient wakes up worse after surgery” (21:15), revealing the profound psychological impact of surgical complications.

He advocates for a balanced approach: acknowledging mistakes without internalizing undue blame, and continuously seeking improvement through reflective practices and peer discussions. This honest portrayal sheds light on the human side of medicine, demonstrating that even highly skilled professionals grapple with self-doubt and guilt.

Hope in the Face of Incurable Diseases

The dialogue culminates with a discussion on hope amidst daunting medical challenges, particularly in cases of incurable diseases like diffuse midline glioma. Dr. Sandberg contemplates the role of hope when outcomes are bleak: “Is hope useful in that circumstance? I don’t know” (28:36). He recognizes the delicate balance between fostering hope and maintaining realistic expectations, especially when clinical trials offer limited prospects.

Dr. Gupta adds a critical perspective on maintaining integrity in hope, cautioning against the exploitation of vulnerable families by dubious treatments. He emphasizes the physician's role in guiding families through these emotional landscapes with empathy and honesty.

Conclusion and Reflections

As the episode draws to a close, Dr. Sandberg reflects on the significance of his memoir’s title, encapsulating both the triumphs and struggles inherent in pediatric neurosurgery. “There are situations that make us question ourselves, even the most confident among us” (31:15), he muses, highlighting the profound emotional and ethical dimensions of surgical practice.

Dr. Gupta commends Dr. Sandberg’s contributions and the candid portrayal of a surgeon’s life, reinforcing the episode’s central theme: the essential interplay between hope and honesty in the pursuit of preserving life while acknowledging its fragility.

Notable Quotes:

• Dr. Sanjay Gupta [00:01]: “I believe that that reminder makes me a better physician.”

• Dr. David Sandberg [05:15]: “His case haunts me, and I wonder, I can't think of examples, but have I made mistakes like that, that I could have saved a life and didn't?”

• Dr. David Sandberg [08:46]: “You gotta have the honest conversation and convey the uncertainty.”

• Dr. Sanjay Gupta [10:14]: “I think there's something there.”

• Dr. David Sandberg [19:15]: “We should be doing more and we're not doing enough.”

• Dr. David Sandberg [21:15]: “I've lost a lot of sleep on nights that follow when a patient wakes up worse after surgery.”

• Dr. David Sandberg [28:36]: “Is hope useful in that circumstance? I don’t know.”

This episode of Chasing Life offers a compelling exploration of the ethical and emotional complexities faced by surgeons. Through heartfelt storytelling and insightful dialogue, Dr. Sanjay Gupta and Dr. David Sandberg illuminate the human side of medicine, emphasizing the vital balance between maintaining hope and delivering honest, compassionate care.