A Fullness of Uncertain Significance:

Surgery, Clarity, and Grace

BRUCE CAMPBELL, MD FACS

 

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Medicine differs from many other professions. Once a physician joins a practice, it is possible to become a perpetual-motion machine, working day-after-day, seeing patients and generating revenue. As long as the physician directly or indirectly generates enough cash flow to pay salaries, keep the lights on, and move the enterprise forward, the process can continue unabated. Theoretically, this hamster-on-a-wheel activity can continue for around 13,000 days. That’s thirty-five years. Then the hamster retires, and another is recruited to keep the wheel turning. 


Of course, I don’t usually view myself, our students, or our residents as hamsters, but there have been days when the thought crossed my mind. Still, what can medical educators do to prepare the next generation of physicians in ways that will enrich – rather than deaden – their lives and careers? And how do we help our trainees step back and begin to grasp the arc of their journeys from graduation to retirement?



Talking with trainees about their careers


Recently, I held a session on retirement with our otolaryngology residents. We read an article where the authors asked Johns Hopkins internal medicine residents in the very first weeks of their internships to write down and then share what they thought a colleague would say about them at their retirement celebration many years down the road. I also asked our residents to imagine what others would say about them at retirement, which of their character strengths would be most noticeable in their careers (from the list at www.viacharacter.org/), what they think they will miss about their careers after they retire, and what aspects of retirement they are thinking about now. 


Not surprisingly, the residents in the article and our otolaryngology residents all see the distance from where they are now to retirement as being an incredibly long time. The brand-new interns hoped that their colleagues would see that they had lived out their core values, been accomplished in their careers, and been good teammates. Among possible character traits, our residents hope that they would have been most admired for their dedication to teamwork and their humility. They anticipate that they will find their greatest personal satisfaction – and what they think they will miss the most – from being part of a team focused on helping others in times of great need. Like the interns in the study, our residents worried about retirement but, being so far off in the future, they could not imagine what it will feel like to get there.


Our residents realized that they differed from the internal medicine interns in the study. Although they know they will miss many things, they believed they will be able to replace professional relationships, the joy of helping others, and stimulating conversations with other post-retirement activities. As surgeons, though, they worried that they will have difficulty replacing the unique privilege of performing surgery. As one resident said, “I can’t imagine not operating again. That’s why we went into this.” Everyone agreed. 


Our residents, having been in training longer than the interns in the Hopkins study, focused on how quickly time passes, even in training. “I am already realizing how much I will miss my fellow residents,” one of older trainees noted. “I’m sure my career will seem to pass by just as quickly.”



The challenges of helping students, residents, and faculty gain insight into themselves and others


There are data that strong relationships and lifelong self-care habits can yield benefits much later in life. MCW faculty members and the Kern Institute are building a portfolio of curricular and extracurricular opportunities that encourage resilience and insight including the REACH curriculum, the KINETIC3 Teaching Academy, MCW Common Read, and a variety of transformational initiatives. (A partial list is at the end of the other version of this essay.) The challenge is to make these types of offerings available, appealing, and effective. Baking caring and self-care into the institutional culture and the curriculum creates opportunities for both transformation and scholarship. 


But, let’s get real. Finding time for reflection, creativity, and long-range personal planning is difficult and, frankly, of low priority for busy students, residents, and faculty. Institutions can readily measure clinic slots, RVUs, grant funding, and margins, but we don’t (yet) have metrics that measure sustained empathy, strengthened character, and successful prevention of burnout. If we cannot demonstrate that these habits can be nurtured, or if they aren’t seen as valuable, our interventions will have little impact and won’t be sustained. 


Yet, raise your hand if you think that a graduate who is unprepared to thrive in practice will also be less likely to thrive in retirement. 



Retirement isn’t for sissies


Over the decades that I have been at MCW, dozens of colleagues have retired. I have noted that the end of a career rarely goes exactly as planned. Some have retired amid accolades for lives and careers well-spent while others have left baffled and reluctant, having no idea what they would be doing a week later. Some, after long and productive careers, were forced out after bitter disputes. Some packed up and left in disgrace. Some became ill or died before they had the opportunity to retire. Some, unfortunately, held on too long. Some left huge holes in the institution when they retired. Others barely caused a ripple. 


Guiding our students and trainees toward rewarding careers and eventual retirements carries responsibility. We must do more than suggest they be financially responsible and keep track of their retirement account outlook. We have equally important responsibilities to help them develop well-rounded professional identities, “seize the day” mentalities, and careers as reflective, empathic, and mindful physicians. If they enter practice self-aware and focusing on character and caring, they should have a better chance of emerging into retirement possessing the same values. 



Living each day


The act of living intentionally came to mind when I read a story in an interview with Duke University’s director of medical humanities, theologian, and pediatric oncologist, Raymond Barfield, MD: 


“Think of each day as a gold coin that you are required to trade for something. You’ll never get that coin back, so whatever you trade it for had better be worth it. You also don’t know how many coins you have left to trade, and you don’t know what will happen when your bag is empty.”


My career has shot past me like a rocket since I completed my fellowship and joined the MCW faculty 12,043 days ago. I now wish I had learned early on to intentionally treat each day like a gold coin. 


Whenever I do retire, I know I will carry memories of my colleagues and mentors with me and try to take advantage of the self-care and reflective skills I have acquired along the way. And, as I look back, I will be grateful for how rarely my career made me feel like that hamster running on a wheel. 


__________


This essay also appears in the 8/21/2020 issue of the Kern Transformational Times.

 
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