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Explore why this general surgeon wrote a novel, and how writing helps with the stresses that accompany a surgery career. What is his #1 tip for those interested in surgery? What are the challenges facing the profession today? How can surgeons find that elusive work-play balance? And why should aspiring doctors start a journal?
Arthur Williams is a surgeon.
He shares his story and discusses his book, The Surgeon’s Obol.
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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.
Transcript
Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Today on the show, we have Art Williams. He’s a general surgeon, and he’s the author of The Surgeon’s Obol. Art, welcome to the show.
Arthur Williams: Hey, thanks very much, Kevin. Thanks for having me.
Kevin Pho: So we’ll get into your book in a little bit, but first off, can you share your story and your journey to where you are today?
Arthur Williams: Sure. I’m a general surgeon in Cincinnati, Ohio. I work for the VA Medical Center there. I’m a general surgeon who does primarily bread-and-butter general surgery, but I also do some dialysis vascular access and have a good practice there at the VA.
Kevin Pho: Fantastic. And we’re speaking in the middle of September. How is the pandemic affecting you and your practice?
Arthur Williams: Well, things have slowed down. There’s a lot of cautious preparation for worries about the pandemic worsening. So we’ve slowed down a little bit, but we’re still at about, I’d say, half the volume that we usually do. It’s still an all-hands-on-deck kind of approach to the pandemic, even at this point.
Kevin Pho: Now, from a general surgery standpoint, what kind of COVID-related cases are you seeing?
Arthur Williams: Well, thankfully, we’re not seeing a lot of COVID-related general surgery issues. Mainly, it’s sparing. We do see some emergency procedures, but it’s mainly just cutting back on our general surgery, or doing the emergency or urgent cases that need to be done, and letting the more bread-and-butter things wait until things have cleared a little bit.
Kevin Pho: So let’s talk about your book, The Surgeon’s Obol. And you submitted a KevinMD excerpt from that. It’s called “The first night on call as a surgery intern.” Now, for those who haven’t read your excerpt or your book, can you walk my audience through it and share the story of why you decided to write it?
Arthur Williams: I began it as kind of almost decompressive therapy for some of the stresses that surgeons often see. It’s about an intern in surgery, and it’s through the eyes of a young female intern who enters a program a lot like the program that I went to. And it was a very, very stressful seven-year program at that time of surgery residency. There are a lot of things that you see that can really affect you down the road, especially if you see a lot of trauma.
And one of the things we saw a lot of was burns and pediatric burns. With that type of patient population, I don’t know how the nurses in the burn unit can be so dedicated to what they do. But in effect, there was one case in particular that affected me. And like most kind of macho surgeons, we try to squelch those uncomfortable feelings that you sometimes have. And it comes back later to haunt you.
So the book was written almost as a decompressive therapy, to get me thinking about things that happened and writing them down to make them concrete, to in some ways deal with some of the horrific things that I saw as a resident.
Kevin Pho: Share some of the stories in the book that particularly affected you, or I guess your protagonist in the book.
Arthur Williams: Yeah, I can remember one case particularly. There was a bad case of this young, young kid, three or four or five years old, who came in with a horrific case of purpura fulminans and just had extensive mottling and ischemia of all of the extremities. And we had to do amputations of his hands, just little kid’s hands. He should be out, you know, skipping puddles and throwing rocks, and there we are, you know, amputating, in this awful, awful case of purpura fulminans.
And so I talk about that in the book a little bit, how that affects a person, knowing that things like that are out there. It affects you, maybe not wanting to even have kids. And she talks about that in the book.
Kevin Pho: And can you share how writing has helped you through some of these difficult times during your surgery training and as your career as a surgeon evolved?
Arthur Williams: Well, I’ll go back a little bit. My father was a surgeon as well. He was a transplant surgeon, and he actually trained under the father of liver transplantation, Dr. Thomas Starzl. Growing up with that kind of a background, I knew I wanted to do surgery in medical school, but I knew I didn’t want to follow that path.
So for me, surgery has been a career that’s allowed me to do the things outside of the hospital that I’ve been interested in, hobbies like riding and woodworking and other things that have motivated me to decompress in other ways. And I think that’s a very important thing for surgeons to really, really think hard about doing: finding some way to decompress from the stresses of the OR and the intensive care unit. For me, the surgery and being in a government hospital have allowed me to really have some time off to pursue things that maybe some other surgeons don’t get a chance to do or don’t have the time. I think that’s pretty important as a decompressive therapy.
The writing in and of itself, like I said, gets you to really hash through some of these emotions. Putting it down on the page and then going back and editing it really solidifies your feelings and your experiences that previously were kind of nebulous and maybe eating at you a little bit. By getting it down on the page, it’s almost like talking to a therapist and getting out of the co-pay.
Kevin Pho: Whenever you think about surgery training, there’s a stereotype associated with it: endless nights, always on call, difficult cases. Now, has surgery training changed today compared to what you went through when you trained?
Arthur Williams: Yeah, I think it definitely has changed, and you can argue whether it’s all for good or all for bad. I think, by and large, it’s been for the good, especially for the emotional health and even the physical health of the trainees. My time during residency was very, very tough. I hate to be the old guy, “get off my lawn” kind of thing, but it was too brutal.
I think they’ve got a relatively good balance of training versus, you know, being out of the hospital. It’s incredibly important to get out of the hospital. I mean, when I was a chief resident, we were on call 365 days of the year, unless you were on vacation, and even some guys wouldn’t even take vacation. You never got a chance to really decompress. So I think that’s for the better.
Some would argue that maybe there’s not as much time in the operating room, but I think people are working around that. They’re doing extra training afterwards, or if they really want to pursue something surgically demanding, they’ll get a little bit more training.
Kevin Pho: Now, what do you see as some of the challenges facing the specialty today?
Arthur Williams: Well, I think finding that balance is still a challenge. When you get into practice and you have maybe a busy private practice, it’s very difficult. Once you get a routine set and get a practice set where you’re very, very busy, it’s hard to go in reverse.
There are a lot of people who are looking at work-life balance. I think there’s an investigator named Carol-anne Moulton, in Toronto, who’s looking at how surgeons under stress can make decisions. And one of the things that she says is that finding that decompressive hobby or some form of stress relief is critically important.
Kevin Pho: We’re talking to Art Williams. He is the author of The Surgeon’s Obol. He is a general surgeon, and he wrote the excerpt from that book, “The first night on call as a surgery intern.” Art, for those medical students who are interested in surgery, what’s your number one tip for them as they consider the profession?
Arthur Williams: I think it’s very important to find a program where you get well-rounded training, but also not to skip out on the other things in life. For me, surgery has been a way to have a fulfilled profession and have a really great sense of self and sense of accomplishment each day, but at the same time, not being overwhelmed. So finding that work and play balance is incredibly important.
Things I tell my residents, you know, things like taking up a musical instrument. Learning to play the piano is fantastic stress relief, and it also does something neurologically. We do a fair amount of robotic surgery, and learning to manipulate, say, your left hand without thinking about it is something that’s beautifully accomplished in music, and it carries over into surgery. And even if it doesn’t carry over into surgery, you’ve learned to play the piano. You know, there are so many outlets online and things like that to be able to teach yourself something like that.
So that kind of thing, being a well-rounded kind of Renaissance surgeon, where maybe you’re learning a language, maybe you’re traveling to France, maybe you’re learning to play a new instrument. Those things are critically important, in my opinion. It makes a happy surgeon, it makes a relaxed surgeon, and it probably improves your outcomes, and it improves your demeanor, and people are just happier to be around you.
Kevin Pho: And my final question: Do you have a take-home message that you want to share with the KevinMD audience?
Arthur Williams: Perhaps for the residents who are coming through and are interested in this kind of writing and decompressing in that way: Start a journal. I wish I had done that. With the book that I wrote, I could write 10 more, probably, just based on the patients that I’ve forgotten about during training. And there’s a gold mine of great stories in the oncology ward, in the burn unit, in the trauma bays.
Sit down and write. Yeah, I know it’s hard when you don’t have a lot of time, but when you can, it’ll be a great crown jewel to go back and read, you know, 30 years later. Even if you don’t publish it, or even if you don’t do anything with it, it’ll be a timeless treasure if you’re able to do something like that.
Kevin Pho: Art, thank you so much for sharing your insight and time, and thanks again for being on the show.
Arthur Williams: Hey, appreciate it, Kevin. Thanks very much.
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