Core Memories In Surgery

My four-year old rarely give me any good advice, but I was quite impressed by the Academy Award-winning Pixar film “Inside Out.” The story is based on the concept of “core memories” and how memories shape personalities, emotions and behaviors. Portrayed as glowing blue orbs, these core memories thoroughly affect a young girl’s move to San Francisco and her response to everything new. During the film, I could not help but think that surgeons also have core memories. From internship to attendingship, our years of training and practice fill us with memories. Certain memories, however, are bluer than others. I wonder if these core memories also shape our “surgical” selves.

Core memories, generated through development experiences, shape the beliefs we have in ourselves and in the world. These beliefs deeply influence our personality, emotions and behaviors. Evidence across the neuro-psycho-social sciences suggests that core memories help us define the “self” and may actually help explain well-being and on the other end, constructs like mental disorders [1]. Having many positive core memories, as an example, has been associated with a greater sense of well-being and health, especially as one gets older [2]. On the other hand, individuals suffering from mental health disorders have been characterized by greater sets of negative memories [1]. Functional neuroimaging has demonstrated that distinctive regions of the brain hold distinctive types of memories [3], suggesting those blue orbs in “Inside Out” really do sit somewhere.

Many key moments come to mind when I think about my own surgical core memories. On retrospection, these memories are characterized by three criteria: (1) They were unexpected (2) They were shaded by joy and sadness and (3) perhaps most importantly, they were meaningful. My core memories include my very first surgical case (a Portacath for which I was a little too excited), my first transplant (and first M&M – same transplant), the day I almost quit (explains why I did not go into vascular) and the time I finally grew up as a chief resident with the Boston Marathon bombings. From technical quirks to emotional proclivities, all of these core memories have influenced, and continue to influence, my personality, emotions and behaviors in the surgical workplace.

To limit the definition of core memories to the unexpected and emotionally-laden would describe the entirety of any residents’ typical Monday. Meaningfulness, however, is what seems to separate the episodic memories from the core ones. The definition of meaningfulness opens a whole Pandora box of debate, but I like one definition stating that meaningfulness is “the cognitive and emotional assessment of purpose and value” [4]. While this assessment is undoubtedly subject to interpretation from person to person, finding purpose and value may be the most worthwhile exercise in surgery… and — here is where my eight-year old will roll her eyes — perhaps in life.

I was recently reminded at the 2016 Academic Surgical Congress that core memories continue to be made. Many joked about the Jacksonville location with perceived few things to do. But in unexpected ways, the fewer distractions presented more opportunities for meaningful encounters. These moments, however mundane from sharing ideas in Uber rides to meeting new colleagues over food, produced a new set of core memories that, for me, embodies some of the purpose and value of our profession. Even more recently, the hashtag #SurgStory has exploded on Twitter – take some time to read these 140 characters-worth of core memories.

We all have core memories. These are not static and continue to accumulate through our lives, often unexpectedly but all with some meaning. Sometimes we might not even realize it.

So what are your core memories?

References

1. Rathbone, C.J. and C. Steel, Autobiographical memory distributions for negative self-images: memories are organised around negative as well as positive aspects of identity. Memory, 2015. 23(4): p. 473-86.
2. Rathbone, C.J., et al., Autobiographical memory and well-being in aging: The central role of semantic self-images. Conscious Cogn, 2015. 33: p. 422-31.
3. Levine, B., et al., The functional neuroanatomy of episodic and semantic autobiographical remembering: a prospective functional MRI study. J Cogn Neurosci, 2004. 16(9): p. 1633-46.
4. Baumeister, R.F., et al., Some key differences between a happy life and a meaningful life. The Journal of Positive Psychology, 2013. 8(6): p. 505-516.