One of my greatest challenges and personal disappointments treating patients for 30 years is when I have failed to communicate the responsibility for the safety of a patient, which I believe is paramount. Manytime , there are choices for surgery that run from minor to major risks to a patient. Caring physicians look at the totality of risk factors prior to offering surgical choices. I have patients that are unaware of the association of smoking, obesity, hypertension, cardiac, pulmonary and a variety of other comorbitities that can lead to tragic consequences. I have seen examples of death and infections as well. In select cases, I try to stage solutions offering less invasive surgery to lower the risk of complications in high risk patients. Unfortunately results may be less then perfect, in higher risk patients, but most cases would allow a choice of additional procedures at a future time. I try to manage patients expectations so they never cross into the abyss and feel that they have no possibility of further recovery. I take complications and the results of surgeries extremely personal since I realize my patients have a choice in surgeons and they have put their trust in me.