“Let me tell you what I wish I’d known, when I was young and dreamed of glory…you have no control who lives, who dies, who tells your story,” George Washington warns a young, scrappy, and hungry Alexander Hamilton near the end of Act One of “Hamilton.” Having just seen the musical for the third time (obsessed, I know…), and sitting here on the eve of July 1, I find myself scrolling through multiple Twitter posts and feeds about “Tips for New Docs” and “Advice For Interns.” I’ve read a few, and they all pretty much note the same things: ask for help, patients come first, get plenty of rest, exercise, etc.
Unfortunately, while there are plenty of things people will tell you as you start your surgical career, there are a number of things no one tells you.
No one tells you that work-life balance is an illusion. At best, you can hope for work-life integration, but it’s critical to recognize that sometimes work will take priority. It’s paramount in our commitment to our patients and our job. Sometimes, you’ll simply have to be there for the patients who put trust in you and you alone. You can’t hand that off or outsource it.
No one tells you that you WILL hurt a patient. As an intern, I was exceptionally skittish. In fact, I was roasted at the end of my intern year as the “person most likely to pee their pants in a high-pressure situation.” I deserved it. But, I grew in knowledge, skill, and confidence, and by the time my training was completed, I felt prepared to handle pretty much any surgical problem that came through the door. Once I began my first faculty position, I thought that if I just tried hard enough, I could avoid complications. The first complication felt like running full-speed into a brick wall. I was devastated that a person who had trusted me to provide top-notch surgical care suffered harm directly in my hands. Thankfully, I have a phenomenally supportive group of colleagues, one of who pointed out “if you don’t have complications, you aren’t operating.” The key is to learn from each one and keep moving forward.
No one tells you HOW to move forward after a complication. No one tells you how hard it can be to have a complication (minor or major) and then immediately turn around and return to the OR for the exact same case in a different patient 30 minutes later. You simply must get back on the horse.
No one tells you that you’ll want to quit. At least once. You may even consider and actually research other job options. If you truly reach a point where providing surgical care to patients does not bring you any joy, then perhaps that may be for the best. Some of the most courageous people I know have bravely followed their own truths into different careers.
No one tells you that everyone will have an opinion. You’ll hear from tons of different voices as you move on in your training and career. Some will matter, some won’t, and some will be loud. The key to success is figuring out which voices matter the most to you. I found that during surgical residency, some of the loudest voices actually weren’t the ones I cared the most about. Several of my most trusted mentors weren’t the ones who spoke the loudest, but the ones who spoke truest to me.
Finally, no one tells you how truly wonderful this job can be. We hear more and more about the harsh and demanding parts of our training, about burnout and resilience. Everyone tells you how hard it can be. No one tells you how wonderful it feels when you tell a patient’s parents that the surgery was successful, or when you run into a patient 2 years post-op with no evidence of disease and she gives you a hug in the grocery store. At the end of the day, the good almost always outweighs the bad. No one seems to tell you that. And oftentimes, that would be enough.