It was a clinic visit about three months after an orchiopexy. The testis sat in a good position in the scrotum, the wound had healed well, and there was nothing to be concerned about. The consultation finished, and as the mother reached the door she turned back and asked.
"So the operation went well, didn't it?"
I thought for a moment, then answered. "Yes. I think it went well." She came straight back at me.
"You think? What does that mean? If it went well, it went well."
That stayed with me for a long time. Looking back, her reaction was entirely reasonable. She had gone back and forth before agreeing to surgery, waited outside the operating room, and watched her son for three months afterwards. What she wanted to hear from the doctor was not complicated. "It went well."
So why could I not say that simple thing? Part of it, looking back, is temperament. I am not someone who sees a good result and readily calls it good — faced with something that has gone well, I think first of what has not been checked yet, or of what only time will tell. The job has probably sharpened that tendency rather than softened it.
That day was no different. The testis was in a good position, with no sign suggesting atrophy. On everything up to that point it was plainly a good operation. And yet, in the moment before saying "it went well", a set of more distant thoughts followed. Whether the position and size would hold as he grew. What spermatogenesis would look like years from now. And the long-term risk of testicular cancer that comes with having had an undescended testis at all. None of those unarrived things cancelled the good result in front of me, but knowing they were there tugged quietly at an answer that had been about to come out lightly. She was asking about the present; I was already a long way into the future.
That does not make listing every future possibility a good explanation. Parents are already worried enough. Going through every low-probability problem that has not happened can create new anxiety rather than convey accurate information. And saying "there's nothing to worry about now" because you would like to put someone at ease is not accurate either. What matters, probably, is neither explaining every risk nor removing every worry. It is marking accurately the line between what has been confirmed and what cannot be confirmed yet. And then speaking plainly about what lies inside that line.
If I were asked the same question now, I think I would answer like this. "Yes, the operation went well, and he has done well so far. There is one thing we will want to check again as he grows, so come back and see us around puberty." Looking back, in trying to be precise I let too much of the future into an answer about the present. "It went well" and "nothing will ever go wrong" are different statements. Once those two are kept apart, what is going well now can actually be said more clearly.
This is not peculiar to cryptorchidism. Much of what we operate on in paediatric urology is operated on very early, and the question of how it turned out keeps coming back long afterwards. After hypospadias repair the immediate questions are the position of the meatus and the complications; once the child is through puberty, new ones appear — curvature that could not be assessed in a small boy, voiding, sexual function. And above all, how he comes to regard his own body is not something a parent or a surgeon can decide on his behalf.
So the person who judges whether an operation went well also changes with time. First the surgeon looks. Then the parents look. But the one who will live in that body is the patient. The three judgements are not always the same. There are people whose result is not perfect in a photograph and who live without the slightest difficulty, and others whose result looks good to the surgeon while they themselves are bothered by it.
Surgical success, then, is not settled in a single clinic visit. The surgeon has to do well what can be done that day, and the parents watch over the years the child grows. Whether what we built in childhood was really good is something that becomes clear as that child lives in his own body.
"A good result", it turns out, holds a longer stretch of time than it sounds like it does. And the last person to say whether the operation went well — might that not be the child who had it?