How is your ego serving you?

Medicine is a hierarchical entity. More so in surgery.

There is a linear line of command from the chief to the junior to the intern to the med student to the aspiring med student.

“Shit rolls downhill,” we said as interns while we powered through the 29th-hour on-call or the seven pending discharge summaries we had to finish, while a nurse was yelling or paging us 12 times to get the order for Tylenol. Hierarchy is inescapable.

I was thinking back to the time I was interviewing as a medical student for my urology residency. I came out of the elevator, and as I stepped out nervously, I met Dolores. Dolores was the front desk receptionist. She had been at her job for more than a decade by that time. I was just one of the hundreds of students that passed by each year during interview season.

She could probably smell the fear, just like dogs are trained to smell for drugs. Or maybe she had a bit of compassion for me because at that time, women urologists made up about 7 percent (now 10 percent) of urologists, and Latin women urologists stayed steadily at around 0.5 percent of all urologists. So, maybe she was rooting for me so we could bond about the latest Shakira song or the best place to buy burritos nearby. Maybe she hoped I could be someone to joke with during a long day where she was already on the 415th call in which she was trying to appease an unhappy patient or someone yelling at her while checking in.

She was the first stop off the elevator — the gatekeeper.

I assembled a nervous conversation while waiting for the interviewers to be ready. And when I left, she told me: “I hope you get in,” as she had probably done thousands of times before. As fate would have it, I did get in. I was the fourth woman urologist to come through the program.

Now Dolores and I instantly became pals. We had exchanged a quiet pact of sisterhood. It was unspoken. She guarded my schedule like a fierce lion protecting her cub. She made sure I could eat and that I was not overbooked as a resident. If things were crazy, she found a way to work miracles and get that patient into my schedule somehow. She was my protector, my cheerleader, my gatekeeper.

Almost 15 years after first meeting her, multiple jobs, cross-country moves, she is still someone I have fond memories of. I still comment on the Facebook posts she makes, or we laugh and reminisce when a previous nurse we worked with will post something funny.

The point of that story is that if we lead with humanity and not ego with all encounters, the fruits you will bear are amazing.

Likely, most people stop by, frustrated they could not find parking, annoyed and complaining they must wait because they are so important as a medical student. Or perhaps are frankly rude to her because she is not the attending and not the top of the food chain in the hierarchy of medicine.

But the reality is that everyone deserves equal attention, regard, and respect, whether it is the receptionist, the cleaning lady, or the department’s chief.

If religion is your compass, you will think that “God is always watching.” Whether you speak with compassion and respect to the scrub tech or your chief resident, but if you are not religious, or you have never thought about it, think about it.

If you are a surgeon, and even if you can try to remember your traumatic experiences in the operating room during your time as a medical student, you may recall that although the primary surgeon seems to be the one that the world revolves on — it is not.

Surgeons have a narcissistic tendency. I get it. I am a surgeon. It can be your fuel or your kryptonite.

There are a million moving pieces to make the surgeon succeed.

The processing department has to bring up the correct tray of instruments. Back-up equipment has to be ready to go if anything fails or breaks. EVS has to have the room cleaned on time. The transport has to pick up the patient on time. The X-ray tech has to be in your room to start the case … the laser also has to be there. The schedulers have to put you on time. Your scrub tech has to be engaged and not passive.

I mean, the list goes on — and I have not even described the anesthesiologist’s role or the surgeon, who on the surface appear to be the most important players.

But if all the moving pieces are not right, the surgeon will not succeed. There will be delays. Wrong instruments will be given or available when critically needed.

What would happen if, instead of only seeing those who are “important” as only our fellow physicians, we treat everyone with respect, kindness, and compassion? Not only when the lights are on us, but when no one is looking. When perhaps only God is watching, as they say.

How could that transform your success?

Would it empower the X-ray tech to be in your room on time? Would he be actively engaged and not on the phone the entire case? Would the cleaning crew be motivated to do a quick turnover because they love seeing you — because you always greet them and ask about their grandkids and about how their husband is battling COVID? Or will they clean it as slow as molasses because you are an egotistical or unpleasant surgeon?

You decide.

Who do you want to be?

How do you want to show up?

Show up with compassion and curiosity.

Leave your ego behind and show up with humanity in all your interactions because it will transform you.

Diana Londoño is a urologist and can be reached at her self-titled site, Dr. Diana Londono, on Twitter @DianaLondonoMD, and on her blog. She is one of the 10 percent of U.S. urologists who are women, and 0.5 percent who are Latina and female. 

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