Looking Through The Mirror

What does it take to be a good surgeon?  I've spent a lot of time thinking about this question over the years.  Raw skill?  Steady hands?  An exquisite knowledge of the involved anatomy?  A respect and understanding for how to handle the tissue layers?  Sure, being a good surgeon involves all of these things, but I've come to realize that it takes much more than this to be a great surgeon.



A great surgeon understands that s/he plays as important a roll outside of the operating room (talking to the patient and with families) as inside the O.R.


Back when I was studying to be a doctor, my medical school really placed a priority on what they called, "humanism in medicine," an ability to demonstrate a good bedside manner, recognizing that being a physician involved more than just the basic diagnosis and treatment of disease.


Coming out of medical school, I naturally felt as though I had a good foundation in this area.  I would sit down with my patients and their families and discuss their medical condition in great detail, making sure that they would fully understand what they were facing.  Even during a busy operative morning, I would make sure that I met all of the family members before the surgery, and then talk to them again upon completion of the operation, enduring that all questions were answered and all concerns were addressed.


But then again, there were a few questions that would grate on my patience, and usually it would usually involve the question, when? "When will we have the results of the pathology?" I don't know - I just sent it. "When will you come by to talk to my husband?" I don't know -- I have to go do a 13 hour case, so it will have to be some time after that. "When will I get my surgery done? You said 10 o'clock, but it's now 12 o'clock."


To most of these questions, I recall thinking to myself, "Why can't people just learn to be patient?  We're a hospital, not a hotel.  We're physicians, not concierges!"


But then I experienced an epiphany through the most unlikely of circumstances.  Just recently, I went through a very horrific and terrifying experience.  Someone in my family was very sick, and was hospitalized in critical care.  Things were touch-and-go for a while, and when I discovered how critical her situation was, I immediately flew out to be with her.  After all, my critical care expertise would undoubtedly be of benefit.  My entire family descended upon the hospital.


Now I'll pause here to disclose that my family is a little unusual in we all have a medical background.  My father has been a physician and surgeon for over 34 years, and of course as a physician myself, we certainly had no trouble in understanding all of the particular intricacies of the situation.


So as we sat there in the hospital while the person we loved went from one surgical procedure to the next, I could not help to still wonder, "When are we going to get some information?"  "When is the doctor going to come out here and talk to us about the results of the latest test?"  "When will we know whether she's out of the woods, or not?"  

It suddenly hit me like a load of bricks ... I was "guilty" of the same thing that I attributed to my patients and their families.  And so I realized a legitimacy to the very thing that had previously annoyed me.


The fact that we were physicians made no difference whatsoever, for on that day, we were simply an anxious family sitting there, pensively awaiting word regarding our loved one.  Looking through the mirror, I was able to realize this from the other side of things.  It became apparent just how important the physician's words were, for when she finally came out and sat down with us, answered all of our questions, and eventually told us that everything would ultimately be fine, an incredible weight was instantly lifted.


This is an incredible lesson that all of us who are physicians, surgeons, and aspiring doctors, should do well to remember.


My field, Neurosurgery, is a tough field, and working at a level-1 trauma center, I deliver bad news almost every day.  "I'm sorry, but your loved one did not survive the accident."  "I'm sorry, but your loved one's injuries are not compatible with survival."  "I don't want to alarm you right now, but if your tumor turns out to be glioblastoma, you may only have as much as 15 months left."  There are many different ways to say the same thing.  As physicians we must keep in mind that during these times, we are ministering to the family.  On these occasions, medicine becomes a priesthood, for the patients and their families need for us to provide a high level of truth, compassion, and comfort.  For us, it's just another day -- for them, it's a life-altering day.


I rediscovered this when I looked through the mirror on my own life-altering day.  As physicians, we must answer the "when" question.  We must find the time necessary to sit down and answer all of the questions.  We must place our hands on the patient, and reach out and touch the shoulder of that family member as we are talking to them.  In so doing, we will impart to them a sense of comfort and peace during their difficult moment.


In the 1957 Annual Meeting of The New York Academy of Medicine, Charles Garside first wrote of the Priesthood Of Medicine. We'll all do well to look through the mirror from time to time, and remember that this key principle that is central to our profession.

Today's A New Day! Yesterday Can't Help Me Today

The road to becoming a doctor is a long road, and one that is filled with many pitfalls and traps. Along my way, my experience has taught me that fortunes can change quickly, without scarcely a warning. It's like the weather in Oklahoma. They say, "If you don't like the weather, just wait a minute -- it'll change!" Undergrad, medical school, and residency, is much like this. You can easily go from the penthouse to the outhouse, from the so-called golden-boy to the red-headed stepchild, from being at the top of everyones adoration, to being an after-thought. How do I know? Because I've been there. In fact, anyone who's walked this long road into medical school and residency has undoubtedly had this happen to them at some point in their training.


I remember getting my acceptance letter to medical school, scarcely finding the words to convey my happiness. Little did I know that it was the start of a huge journey, where I've experienced some very high "highs", and some very low moments.


A key high point for me in medical school was my research that I presented at a neuroscience research symposium. At that point in my life, I felt intellectually invincible, and thought that there was nothing that I couldn't accomplish if I put my mind to it. Much of the faculty were patting me on the back for a job well done. Then along came an exam in which I did poorly, and many of the same people lavished me with accolades, now were muttering that I would not amount to much. The good news is that I persisted when others would have given up, and now I've been able to get to this particular point in my life. There's still much work to be done, but I've come a long way.


It's important to remember that throughout your experience, you'll be continually buffeted by storm clouds - by the naysayers that will always question your abilities on one day, even as they lavish you with praise on days that you perform well.


Here are things that I remember to get me through those times.

1. No one wants you to do well, more than YOU want yourself to do well! Therefore, don't listen to people who aren't positive and uplifting. YOU are your own best judge of whether you can do something or not. A very high percentage of success is believing that you can do it, and then very diligently with an unwavering devotion in order to make it happen.
2.  Don't get outworked! I remember one day, I went to the library early in the morning to study for a difficult exam. I ran into one of my colleagues who was already there studying, his books opened up elaborately on his table. I studied diligently all day long, and after an exhaustive study session, prepared to go home. Gathering up my books after the long day, I walked by my colleague's study area. He was STILL there studying. What's more - he always scored better. This is when I realized that even though I was studying hard, I was still being outworked by my colleague. In order to make it, you must work harder than anyone else. It's the only way to ensure success!
3. Don't become to satisfied with your successes that you may enjoy along the way. It's tempting to settle in after enjoying a good result, and say, "Now that I've accomplished this goal, I can now take it easy." There is NO SUCH THING as taking it easy, for it is perilous to do so. All it takes is one mediocre result to de-mast all that you've worked hard to achieve. One slip is all that is required to go from the penthouse to the out-house.

One of my favorite allegories for this is the gazelle and the lion. When the lion wakes up, he knows that he's at the top of the food chain. All the same, he knows that he must successfully hunt the speedy gazelle in order to maintain enough food to survive. When the gazelle wakes up, it knows that it's at the bottom of the food chain, and must continually be "on-the-run" in order to survive. The concept is this -- in the morning, it doesn't matter whether you're the lion or the gazelle, you'd better be running!


I always tell myself, "Today's a new day. Yesterday can help me today!" Keep working!