Tuesday, March 15, 2011


Those of you who are close to me know I have been going through some rough times recently; those of you who aren’t may have inferred that from the previous post. While I will not discuss details or circumstances here, I choose to write this post in the hope that it may help someone somewhere in a tough spot as well as perhaps help me be a better person as well.

Besides events that have happened, the other thing that prompted me to write this was reading “How Doctors Think” by Dr. Jerome Groopman, which made me reflect on how I think and do things. While the book guides doctors and patients on a journey of what kinds of errors doctors can make and why and how to avoid and mitigate them, his discussions on different types of “cognitive traps” are illuminating in a personal sense as well. Recently, I attended a “Night for Sight” event where Neil Beidelman, a guide mountaineer, related the events of “Into Thin Air”: in 1996, 8 climbers on Mount Everest died during a storm. When he talked about how a cascade of decisions, decisions that were a bit off but taken in unbelievably challenging moments, “stacked up in the aggregate” and led to the tragic outcome, that really hit home.

As a surgeon, I realized long ago how important it is to minimize mistakes and how it is even more important how you to react to mistakes. Panic and despair make you lose your mental equilibrium and you make further decisions which “stack up” and make the situation worse. And sometimes no matter what you do, the outcome will not be good or what you want but you do the best you can anyway. I teach these lessons and focus on them in training my residents and students, but probably should have, somewhere along the way, tried to absorb these lessons in my heart as well. As Dr. Groopman emphasizes in his book, lowering your emotional temperature in a tough situation is key to slowing down your thought, enhancing your perception and analysis, and thus permitting clarity to dispel clouded thinking. It’s just really hard to do when it comes to your own life.

Pressing for a solution when none is apparent can be the exact wrong thing to do. “Picking up a scalpel and cutting can be just the wrong thing” when you don’t see the whole picture. The good surgeon is not defined by technical dexterity or superior hand-eye coordination, but by sound decision-making and judgment that enable clarity and effectiveness in the operating room. Understanding issues and realizing what intervention can and can’t remedy takes a while to learn in a surgical career; I guess it takes even longer to learn that in life. Groopman, an oncologist, relates one of his mentor’s quips, “Don’t just do something, stand there” as he counsels against the impulse to jump in and do things. It’s awfully hard to do that as a surgeon, who by nature are gamblers, risk-takers who have to have confidence (perhaps arrogance) in what they do.

Which ties into one of the most essential qualities to being a doctor, indeed a good person: that of being a good listener. When I fall into panic and despair, I’ve realized I sometimes lose the ability to listen. And when you don’t listen, you make even more stupid decisions. You fail to appreciate the other person, where they’re coming from, and the importance of their perspective and thoughts; you lose the ability to put yourself in their shoes. You deny yourself a lot of important insight, and screw things up more. Being a good listener is something one has to work at, consciously, and something I can get better at.

I wonder a lot about “what ifs” and “if onlys”. It is, I suppose, the natural thing to do after bad things happen. But there is no rewind button on the VCR of life, no matter how ashamed I am of all my mistakes or tears I have caused. Theodore Roosevelt provides a little solace:
"It is not the critic who counts; not the man who points out how the strong man stumbles, or where the doer of deeds could have done them better. The credit belongs to the man actually in the arena, whose face is marred by dust and sweat and blood; who strives valiantly; who errs, who comes short again and again, because there is no effort without error and shortcoming; but who does actually strive to do the deeds; who knows great enthusiasms, the great devotions; who spends himself in a worthy cause; who at the best knows in the end the triumph of high achievement, and who at the worst, if he fails, at least fails while daring greatly, so that his place shall never be with those cold and timid souls who neither know victory nor defeat."
Falling short and the gnawing sense of not being good enough are awful things, but it is better to have loved and lost, to have tried and failed, than to have never loved, never tried at all. Or is it? That doubt can be banished only by the knowledge of all the good that I experienced, which outweighs whatever pain I am now left with.

The ancients provide some guidance. The Bible, in Ecclesiastes, states, “The race is not always to the swift, nor the battle to the strong, neither yet bread to the wise, nor favor to men of skill; but time and chance overtake them all.” One of the Geeta’s core precepts is encapsulated in this verse from Lord Krishna to Arjuna in a moment of doubt and despair, “You must perform the right action, but you are not entitled to the fruits of action. Let no desire of the fruits be your motive, and yet be not attached to inaction.” I first read this 11 years ago when I was a senior resident, and wrestled with the concept for a long time. It finally dawned that what it means is that in a crisis, you must focus on doing your best to do what is right, but be detached from the outcome. It helped me be a better surgeon by helping me concentrate in the moment during a case. How much harder it is to accept on a personal level…

When you feel useless, the present is dim & bitter, and the future seems cold & barren, it is tempting to forfeit hope. Yet one (I) must remain grateful for life’s blessings – health, a life in the US as opposed to suffering in the Middle East or Africa, a good career where I can still make a difference, wonderful friends who are good listeners and care. And while others or the world can take away so much from you – your money, job, reputation, even people you love – be thankful for what can’t be taken away: personal honor, what you’ve learned, and service.

Pandora released the world’s evils from her notorious box but the last thing that came out was hope. While sometimes memory and even hope can feel like a prison, in truth they are the roots of change. Why you may ask? As for memory, Mark Twain said, “Good judgment comes from experience; experience, well, that comes from bad judgment.”

And, as for hope, George Bernard Shaw said, “The reasonable man tries to adapt to the world; the unreasonable man tries to make the world adapt to him. Therefore, all progress depends on the unreasonable man.” Perhaps success does lie in effort as much as in result. And the need for struggle is not grounds for avoidance.

As Bruce Wayne’s father said in Batman Begins, “Why do we fall? So we can learn to pick ourselves up.” All I can do now is take a long look in the mirror, make some changes to try to be the best person I can be, and hope for the best. I’ll try to start as I head off tomorrow from Salt Lake to Australia.


At 4:07 AM, Anonymous Anonymous said...

A quote from one of my favorite attendings when I was training: "Don't just do something! Stand there!"

At 6:21 PM, Anonymous Anonymous said...

To err is human, to try your best to do the right thing is devine. Thanks from a stranger for a very good post. Good luck to you.


At 3:49 PM, Anonymous Anonymous said...


At 6:40 PM, Anonymous Anonymous said...

"Remember that there is only one important time and that is now. The present moment is the only time over which we have dominion. The most important person is always the person you are with, who is right before you, for who knows if you will have dealings with any other person in the future? The most important pursuit is making the person standing at your side happy, for that alone is the pursuit of life."
-Thich Nhat Hanh


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