This is the third in the series of letters to my son the medical student who grew into a surgeon. The letters have helped me renew my commitment to compassionate healthcare and medical education. It is too easy to lose your way as a physician when faced with the daily stress of real medicine. Spending time with the next generation of physicians gives me faith that we will always have a few doctors who stand out as not just competent, but caring healers.
My son is currently a surgical intern. The intern’s life is far from the glamorous stylized Grey’s Anatomy experience. It’s grueling and exhausting. I struggle as I watch him endure his chosen path. As a physician, I know exactly how he feels and I know that he will survive. As a mother, I want to smother him with love, make him sleep more and fix his schedule so that he can have two days off in a row to come home for Christmas. My husband reminds me when I hang up the phone in tears, “Keep the faith. He will be fine. You did it too and you survived.” I know in my heart that he will not only survive residency training but he will thrive. I hope you enjoy my letter and stay tuned for the next letter. “That Which Doesn’t Kill Us Makes Us Stronger or … Leaves Us Bitter and Broken. A Letter to My Son the Intern.”
A Chance to Cut
A Letter to My Son, the Surgeon
Published in Blood and Thunder 2014
University of Oklahoma School of Medicine
Tracey Lane Delaplain, MD
I envy you. I will never again feel the tumult and rush of surgical training. I’ll never feel the uncertainty of the first cut into human flesh, the adrenaline surge of a catastrophic bleed, the sickening grit of a malignancy in my hands, or the joy of knowing that in the moment my hands are the solution.
I envy your hands. I willingly retired my scalpel so passing the scalpel to you should be worthy of celebration and yet I feel grief. Ridiculous as it sounds, I envy your bone weary exhaustion; the exhaustion of endless learning and overwhelming uncertainty. I miss the burden of never knowing enough and the physical pain of sleep deprivation. These are the realities of post graduate education that I will never feel again. To say that I lament those days sounds absurd, even to me, but that angst is in a physician’s DNA. We wouldn’t be who we are without its influence.
I am proud of you. I suspect that I’m not alone in my mixed feelings of pride and jealousy. Every leader whether a monarch, an Olympic champion, the chairmen of the board, or a surgeon must without a doubt pass their power and burdens onto the next in line; the heir apparent, the younger athlete, the junior executive, the newly hooded surgeon. You bent a knee to accept the academic hood from me at graduation. I was overwhelmed with genuine pride, not just unconditional maternal love, but the deeply respectful pride of a mentor.
Take my scalpel. You’ve earned it but you have much to learn, my first born child. You have been given the chance to cut so make every cut a chance to cure. I will expect nothing short of excellence in the operating room from you but the time spent in the operating theatre is only a fraction of the time that you will give to your patients. The best surgeons know when not to operate. Be exceptional out of the operating room.
Draw strength and knowledge from your life’s lessons outside of the OR. I am a surgeon and your father is an exceptional helmsman. You are both. By his example, your father taught you how to be a great captain. You learned to set the course and inform your crew of the plan before you set sail, much as you will do during your pre-surgery time outs. He has shown you that every one on his boat is important and he always gives clear instructions when he needs their assistance. As the captain you learned to acknowledge all safety concerns expressed by your crew with a thank you, even if you had already seen the potential collision and adjusted your sails well in advance. The surgeon like the helmsman can’t see around every corner and has to rely on his crew to be alert and secure in the knowledge that they can voice their concerns to him at all times. The culture of medicine is changing but you will find surgeons who still believe that they don’t need to listen to their crew. I hope you teach those around you the importance of team work and courtesy on a safe journey. The surgeon takes the ultimate responsibility for the safety of his crew and the human vessel entrusted to his hands.
The helmsman can not control the wind or the tides but he can adjust his course. You, the surgeon, can’t change the circumstances that bring a patient to you. Your choice to serve or to set sail will have been made long before the crisis. When a patient enters the trauma bay or your office there’s no reason to spend any energy wishing it wasn’t so. What good ever came from shouting at the rain? You will curse more than once when your trauma pager goes off for the twentieth time in as many hours. You will feel real anger when your patient is drunk, high, foul mouthed, careless or ungrateful. You will wish that the patient had made better decisions, hadn’t waited so long to seek care or better yet that another surgeon was on call instead of you. Regardless of your feelings in the moment, take a deep breath and do your job. When you are truly in the moment you will find exactly what you need to carry on and all of the should haves and could haves will no longer matter. You can reef your mainsail or heave to and slow the forward progression of your vessel, but you can’t get off the boat in a storm. I hope you find the gift and perhaps the quiet divine guidance that allows you to realize that in the moment, you are the only one who can help that patient. At the darkest moments, adjust your course and engage the patient by saying, “I’m here to help.” There is no judgment in, “I will help you.” It will bring you and the patient into the moment where you can work together. Listen to the patient. What do they fear? What do they expect after surgery? Can you take the yoke from them and carry their fear for them? Can you align their expectations with the reality? Even an unconscious trauma patient needs to hear that you care and that you are there for them. Believe me; you will forget the surgery and eventually the patient too. The patient will never forget you or their surgery.
Allow yourself to feel uncertain. You will never know everything. You will feel less certain and occasionally fearful in uncharted waters. Is the injury beyond repair, will the bleeding never stop, will the Mets win again? Learn to say, “I’m sorry. I’m sorry you are in pain. I’m sorry you are dying. I’m sorry I couldn’t do more.” Forgive yourself for being imperfect because you will make many mistakes. It is arrogant to believe that you can save every patient so learn to say goodbye and when appropriate just get out of the way. It helps me to believe that there is a higher power to assist every patient at the end of their journey.
Learn to hesitate occasionally. Surgery is not always the best course of treatment. Do you need to change course, adjust your sail, or rethink the surgical plan? Don’t be afraid to question the dogma of surgical certainty; question the technique, the equipment, the motivation, and the efficacy of the old and the new.
You have been given the power and burden of the scalpel. Wield it with wisdom. Stay centered and focused. I once wrote to you, “All first year students start out as a shiny piece of new glass, none of us knowing what will be left of us at the end of our training. I wonder if you will become a weathered, beautiful piece of sea glass or will nothing but sand remain of the original glass that is you.” You have kept your clear center despite the torrent of medical education so don’t let your surgical training take that away from you. Stay true to your ideals and teach your colleagues how to be exceptional helmsmen. Be an outstanding mentor and pass on the scalpel when the time comes with envy and pride.