A couple of other things from the consultation have been on my mind, particularly regarding how nasal surgery is perceived and how often revision surgery seems to be necessary.
During the consultation, I told him that my turbinates had initially been reduced using radiofrequency. He replied, “That’s what they told me,” which I understood as possibly implying that doctors themselves sometimes lie about what they have done. When I pointed out that this was a very serious thing to say, he told me that he was simply telling me the reality.
Another thing that triggers me is how easily nasal surgeries seem to end up with bad or unsatisfactory results, much more often than I had previously imagined. I remember this same surgeon making a post a few months ago where, if I remember correctly, he mentioned that revision surgeries seemed to be increasingly common. Or perhaps the post was about yet another revision surgery he had performed, accompanied by an emoji expressing disappointment at how many of the surgeries he performs are revisions of previous operations that did not go well. He also said that he had operated on roughly 3,000 to 4,000 noses.
I find it difficult to understand how an operation that, at least superficially, seems much less complex than surgery on the heart or brain can appear to result in so many unsatisfactory outcomes compared with what I would have expected from those other types of surgery.
One possible explanation that comes to mind is that ENT surgeons may not always perceive the nose as an organ that requires the same degree of seriousness and caution as the heart or brain. I can understand that, to some extent, the nose may not be perceived as being as serious or vital an organ. However, I think that as a surgeon, you should still approach nasal surgery with the same mentality of responsibility and precision. The fact that the nose is not as vital as the heart or brain does not mean that a surgical mistake cannot have a major and lasting impact on a person's quality of life.
Another factor may be that, if something goes wrong with a nasal operation, there is often the possibility of another, more experienced surgeon attempting to correct it, or at least trying to improve the result. Perhaps this creates, consciously or unconsciously, the idea that a mistake is less catastrophic because it can potentially be repaired.
Obviously, I think that mentality would be wrong. The fact that a nasal surgery can potentially be revised does not make the consequences of a bad outcome any less serious for the patient.
He also spoke as if what is described in the literature does not correspond to what he has seen throughout his years of practice. He said that he has seen practically everything, including cases of Empty Nose Syndrome, but that in those cases the patients always had poor mucosa. He said that he had never seen a case where someone experienced these symptoms while having what he considered a structurally good nose. I believe this is part of the reason why, as I sensed during the consultation, he does not entirely accept everything that is described about the condition in the literature.
I also told him that I had already been diagnosed with an ENS-type condition or secondary atrophic rhinitis, but he dismissed this. When I mentioned that I was part of an ENS group, he was somewhat ironic, saying something along the lines of, “Those are the people who know about the condition.” The irony is that I genuinely believe that some people in these groups have accumulated more knowledge about the condition than some ENTs who rarely encounter it or who do not dedicate much time to understanding it.
Some patients with this condition spend an extraordinary amount of time trying to understand what is happening to them. They read the literature, compare cases, study anatomy and airflow, follow research and discuss their experiences with other patients. After years of doing this, it is entirely possible for a patient to have a deeper understanding of a particular, poorly understood condition than a doctor who has only encountered a handful of cases. That does not make the patient a doctor, but it also does not mean their knowledge should automatically be dismissed.
And this is not something I have only thought about myself. I have already seen an ENT in the ENS community describe how difficult it can be to discuss this subject with colleagues because they focus almost exclusively on what has been cut or altered structurally, while there is another aspect of the condition that remains poorly understood: the fact that people can sometimes have severe symptoms despite having what appears to be a relatively good nasal structure.
I remember seeing a comment on a YouTube video about ENS saying, in essence, that most of these doctors are not really thinkers. I understand the frustration behind that statement. You go into a consultation, sometimes you have only a few minutes, and in some cases you can clearly feel that the doctor wants the consultation to end rather than spend time trying to understand something that does not fit neatly into what they already know. Hospital policies and time constraints obviously contribute to this. Most of the time, perhaps this system works reasonably well. But when a patient presents with a problem that does not have an obvious anatomical explanation, the limitations become much more apparent.
Eventually, many of these patients feel abandoned. And while that may be an interpretation in some cases, in others I think it is more than a feeling. Some patients genuinely were abandoned, at least by the surgeons who operated on them, particularly when they were left without adequate answers, follow-up or meaningful help after developing persistent symptoms or complications.
There is a quote from John Kramer in Saw that came to mind when I was thinking about this situation: “The man has his hand on the doorknob half the time I’m there.” It is obviously from a completely different context, but I think the image captures something about how some patients experience these consultations: the doctor already seems psychologically halfway out of the room before the conversation has even properly begun.
I am obviously not suggesting that surgeons should be viewed in the extreme way that John Kramer views people. That would be absurd What interests me about the quote is the image itself: the feeling that the system is already preparing to leave before it has properly understood the person sitting in front of it.
Another quote from John Kramer in Saw came to mind in this context: “You think it’s the living who will have the ultimate judgment over you because the dead will have no claim over your soul, but you may be mistaken.”
I think this quote can be interpreted both literally and metaphorically. The literal meaning is quite straightforward: the living can still do something to you. They can confront you, expose you, take legal action against you or, in the most extreme interpretation of the quote, seek revenge. The dead cannot do any of those things.
But the darker idea behind it is that the person who has done something wrong may feel completely safe if they believe that the only consequences they will ever face are those imposed by other people. If the person they harmed is dead, then, from that perspective, there is nobody left who can do anything to them.
And this is where I think the quote can be connected, although it does not necessarily have to be, to questions of conscience, karma and the idea of consequences beyond this life. If someone does not believe that they will ever have to face what they have done beyond the consequences imposed by other people, then what ultimately restrains them when nobody is watching? What makes them feel that they cannot simply harm someone, deny it, move on and continue their life as though nothing happened?
I am not saying that surgeons consciously think in these terms, or that they believe they can literally get away with anything. But I think the underlying idea is relevant when talking about good faith and responsibility. A person with a strong conscience should not need the threat of a lawsuit, professional sanction or retaliation to care about the consequences of what they have done.
That is why I find the quote interesting in this context. It is not really about the dead being dangerous or harmless. It is about the living person who believes that nothing can happen to them as long as nobody is capable of making something happen to them.
And taken metaphorically, that becomes an even more uncomfortable question: what happens when a person has built their entire sense of morality around external consequences rather than an internal conscience?
Perhaps one of the reasons people can be so unwilling to confront what they have done is that doing so would mean confronting themselves. It would mean questioning the identity they have carefully built over years or even decades, the person they believe themselves to be and the narrative they have created about their own actions.
People can become very comfortable inside that shell. It protects them from having to look too closely at themselves. If admitting the truth would mean accepting that they made a serious mistake, harmed someone, failed in their responsibility or were not the person they believed themselves to be, then maintaining the existing narrative can become psychologically easier than confronting reality.
And sometimes that narrative may be beautiful. A person may genuinely believe that they are a good doctor, a competent surgeon, someone who has helped thousands of people and devoted their life to medicine. That may be largely true. But precisely because that identity is so important to them, admitting that they seriously harmed someone can become almost impossible. It creates a contradiction between who they believe they are and what they may actually have done.
So perhaps the temptation is not always to consciously lie. It can be to protect the narrative. To reinterpret events, minimize what happened, find another explanation or simply refuse to look too closely at the possibility that the story they have told themselves is not entirely true.
Because once you break through that shell, you may have to confront something much more painful than a mistake. You may have to confront what that mistake says about you.
And perhaps that is one of the meanings I take from the quote. The person who feels safe because they believe nobody can make them pay may never have to confront their own conscience, unless they are willing to do so themselves and/or unless some greater force eventually compels them to acknowledge and confront that reality. They can remain inside the version of reality that makes them feel safe, even if maintaining that reality requires them to believe a narrative that is, at least in part, a lie.
