As surgeons we are trained to fix what’s broken. The breaking point is our starting line... at work. But in our lives the breaking point is a sign of weakness and we’ll do everything we can to avoid it.
Bones break. Organs burst. Flesh tears. We can sew the flesh, repair the damage, ease the pain. But when life breaks down...when we break down...there’s no science. No hard and fast rules. We just have to feel our way through. And to a surgeon there’s nothing worse, and there’s nothing better.
In 6500 BC, some guy looked at his friend and said "Let's drill a hole in your head... that will make you feel better." And thus surgery was born. It takes a certain brand of crazy to think of drilling into someone's skull, but surgeons have always been a confident bunch. We don't always know what we're doing, but we act like we do. We walk into a country, plant a flag and start ordering people around. It's invigorating and terrifying.
We like to think we're fearless, eager to explore unknown lands and soak up new experiences, but the fact is, we're always terrified. Maybe the terror is part of the attraction. Some people go to horror movies. We cut things open. Dive into dark water. And at the end of the day, isn't that what you'd rather to hear about? If you've got one drink and one friend and 45 minutes. Slow rides make for boring stories. A little calamity. Now that's worth talking about.
I am a rock. I am an island. That's the mantra to pretty much every surgeon that I've ever met. We like to think we're independent. Loners. Mavericks. That all we need to do our jobs is an OR, a scalpel, and a willing body...But the truth is, not even the best of us can do it alone. Surgery, like life, is a team sport...and eventually, you've gotta get off the bench and decide... which team are you batting for.
The thing about choosing teams in real life.. It's nothing like it used to be in gym class.. being 1st picked can be terrifying And being chosen last... isn't the worst thing in the world. So we watch from the sidelines, clinging to our isolation, because we know as soon as we let go of the bench, someone comes along and changes the game completely.
For a surgeon, every patient is a battlefield. They're our terrain. Where we advance, retreat, try to remove all the landmines...And just when you think you've won the battle, made the world safe again. Along comes another landmine...
Some wars result in complete and total victory. Some wars end with a peace offering. And some wars end in hope...But all these wars are nothing compared to the most frightening war of all. The one you have yet to fight.
If you’re a normal person, one of the few things you can count on in life is death. But if you’re a surgeon, even that comfort is taken away from you. Surgeons cheat death. We prolong it. We deny it. We stand and defiantly give death the finger.
We're born, we live, we die... sometimes not necessarily in that order. We put things to rest, only to have them rise up again. So if death is not the end, what can we count on anymore? Because you sure can't count on anything in life. Life is the most fragile, unstable, unpredictable thing there is. In fact, there's only one thing in life we can be sure of. It ain't over till it's over.
It's intense, what happens in the OR, when lives are on the line and you're poking at brains like they're silly putty. You form a bond with the surgeons right next to you. An indescribable, unbreakable bond. It's intimate being tied together like that. Whether you like it or not, whether you like them or not, you become family.
The ties that binds us are sometimes impossible to explain. They connect us even after it seems like the ties should be broken. Some bonds defy distance and time and logic; Because some ties are simply... meant to be.
When you're little, night time is scary because there are monsters hiding right under the bed. When you get older the monsters are different. Self doubt, Loneliness, Regret. And though you may be older and wiser, you still find yourself scared of the dark.
Sleep. Its the easiest thing to do; you just close your eyes. but for so many of us, sleep seems out of grasp. We want it, but we don't know how to get it. Yet once we face our fears and turn to each other for help, night time isn't so scary because we realize even in the dark, we aren't all alone.
My mother called it the greatest and most terrifying moment in her life, standing at the head of the surgical table knowing that the patient’s life depends on you and you alone. It what we all dream about because the first person that gets to fly solo in the OR, kind of a badass.
We enter the world alone and we leave it alone. And everything that happens in between, we owe it to our self to find a little company. We need help. We need support. Otherwise we’re in it by our self. Strangers, cut off from each other and we forget just how connect we all are. So instead we choose love. We choose life and for a moment we feel just a little bit less alone.
We all get at least one good wish in a year over the candles on our birthday. Some of us throw in more, on eyelashes, fountains, lucky stars. And every now and then, one of those wishes come true. So what then? Is it as good as we hoped? Do we bask in the warm glow of our happiness or do we just notice we’ve got a long list of other wishes waiting to be wished.
We don’t wish for the easy stuff. We wish for big things. Things that are ambitious, out of reach. We wish because we need help and we’re scared and we know we may be asking too much. We still wished though because sometimes they come true.
My mother used to say this about residency, “It takes a year to learn how to cut. It takes a lifetime to learn not to.” Of all of the tools on the surgical tray, sound judgment is the trickiest one to master. And without it, we’re all just toddlers running around with ten blades.
We’re human. We make mistakes. We mis-estimate. We call it wrong. But when a surgeon makes a bad judgment call, it’s not as simple. People get hurt. They bleed. So we struggle over every stitch. We agonize over every suture because the snap judgments, the ones that come to us quickly and easily without hesitation, they’re the one that haunt us forever.
Any first year med student knows that an increase heart rate is a sign of trouble. A racing heart can indicate anything from a panic disorder to something much, much more serious. A heart that flutters, or one that skips a beat, could be a sign of secret affliction or it could indicate romance which is the biggest trouble of all.
It seems we have no control what so ever over our own hearts. Condition can change without warning. Romance can make the heart pound just like panic can. And panic can make it stop cold in your chest. It’s no wonder doctors spend so much time to keep the heart stable, to keep it slow, steady, regular to stop the heart from pounding out of your chest from the dread of something terrible or the anticipation or something else entirely.
Every patient’s story starts the same way. It starts with them being fine, it starts in the before. They cling to this moment, this memory of being fine, this before, as though talking about it may somehow bring it back. But what they don’t realise is that they’re talking about it to us, their doctors and that means there’s no going back. By the time they see us, they’re already in the after. And while every patient’s story starts the same way, how the story ends depends on us, on how well we diagnose and treat. We know the story hinges on us and we all want to be the hero.
Patients see us as gods or they see us as monsters. But the fact is, we’re just people. We screw up, either way. Even the best of us, have our off days. Still we move forward. We don’t rest our laurels or celebrate the lives we’ve saved in the past. Because there’s always some other patient that needs our help. So we force ourselves to keep trying, to keep learning. In the hope that, maybe, someday we’ll come just a little bit closer to the gods our patients need us to be.
Every surgeon I know has, a shadow. A dark cloud of fear and that follows even the best of us into the OR. We pretend the shadow isn’t there hoping that if we save more lives, master harder techniques, run faster and farther it will get tired and give up the chase but like they say... you can’t outrun your shadow.
Every surgeon has a shadow. And the only way to get rid of a shadow is to turn off the lights, to stop running from the darkness and face what you fear, head on.
Surgeons aren’t known for being warm and cuddly. They’re arrogant, impatient, mean as often as not. You’d think they wouldn’t have friends 'cuz who could stand them? But surgeons, are like a bad cold. Nasty, but persistent. Surgeons: nasty, aggressive, unstoppable, just the kind of people you want on your side when you’re really screwed.
Practicing medicine doesn’t lend itself well to the making of friends. Maybe because life and mortality are in our faces all the time. Maybe because in staring down death everyday, we’re forced to know that life, every minute is borrowed time. And each person, we let ourselves care about is just one more loss somewhere down the line. For this reason, I know some doctors who just don’t bother making friends at all. But the rest of us, we make it our job to move that line. To push each loss as far away as we can.
Defeat isn’t an option. Not for surgeons. We don’t back away from the table til the last breaths long gone. Terminals a challenge, life threatening's what gets us out of bed in the morning. We’re not easily intimidated, we don’t flinch, we don’t back down and we certainly don’t surrender, not at work anyway.
To do our jobs we have to believe defeat is not an option. That no matter how sick our patients get, there’s hope for them. But even when our hopes give way to reality, and we finally have to surrender to the truth, it just means we’ve lost to today’s battle, not tomorrow’s war. Here’s the thing about surrender, once you do it, actually give in, you forget why you were fighting in the first place.
Remember when we were little and we would accidentally bite a kid on the playground. Our teachers would go, “Say you’re sorry”, and we would say it, but we wouldn’t mean it cause the stupid kid we bit, totally deserved it. But as we get older, making amends isn’t so simple. After the playground days are over you can’t just say it, you have to mean it. Of course when you become a doctor, sorry is not a happy word. It either means you’re dying and I can’t help. Or it means this is really going to hurt.
As doctors we can’t undo our mistakes, and we rarely forgive ourselves for them, but it’s a hazard of the trade. But as human beings we can always try to do better, to be better, to re-write a wrong even if it feels irreversible. Of course, “I’m sorry” doesn’t always cut it. Maybe because we use it so many different ways: as a weapon, as an excuse. But when we are really sorry. When we use it right. When we mean it. When actions say what words never can. When we get it right, “I’m sorry” is perfect. When we get it right, “I’m sorry” is redemption.
When something begins, you generally have no idea how it’s going to end. The house you’re going to sell becomes your home, the roommates you were forced to take in become your family and the one night stand you were determined to forget becomes the love of your life.
We spend our whole lives worrying about the future, planning for the future, trying to predict the future, as if figuring it out will cushion the blow. But the future is always changing. The future is the home of our deepest fears and wildest hopes. But one thing is certain when it finally reveals itself. The future is never the way we imagined it.
Did you say it? "I love you. I don't ever want to live without you. You changed my life." Did you say it? Make a plan. Set a goal. Work toward it, but every now and then, look around. Drink it in 'cause this is it. It might all be gone tomorrow.
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