When my now ex-husband and I first met, he asked me about my favorite things to do. At that time, I did not have a ready answer. It was my third year of general surgery residency, a time for proving that I could handle it all: being the in-house senior surgery resident on call, starting to manage surgical teams, and being responsible for lists sometimes reaching dozens of patients. I was completely overwhelmed. Unlike some of the residents in our program who seemed made for this, nothing about surgery or residency came easily to me.
Every day was a process of already having failed, actively failing, or about to fail. Many days, I came home, showered and collapsed on the couch. Sometimes no shower before collapsing on the couch. And this without kids, dogs, or other essential obligations that some of my friends juggled. Favorite things to do, and hobbies in general, were something I either remembered or dreamed of having.
When we first met, I told Lance that I used to like to do so many things like dance, read and spend nights out with friends, but it hit me that residency had become all-consuming. I will not make light of the early days, long calls, or landing in disasters transferred from St. Elsewhere or traumas that became never-ending trips back and forth between OR and ICU. Nor will I make light of the arguably tougher mental aspects of dealing with bad outcomes, angry patients, irascible staff, or the constant expectation of being everywhere at all at once like light fractured through a prism. It felt like I was losing my identity, or at least significant pieces of it.
But amongst the chaos and time vacuum, I also felt a glimmer of hope. The hope was that the meaningful times would outweigh the rest. And there were times that did. I cried for the first time with a family when they hugged me after I shared that their daughter had been successfully resuscitated and had a stable airway reestablished in the OR after suddenly losing her airway and coding earlier that morning. I stayed at the bedside of a trauma patient in our ICU after we could not repair the damage done by a severe car crash while she received cooler after cooler of blood product to make sure she stayed alive until her family could visit to say goodbye. I nervously walked over to the transplant clinic after being paged by one of the surgeons, only to be hugged by a patient and given a copy of his Mom’s cookbook signed with a thank you note. I sobbed sitting in my car in the hospital parking lot where I was a fellow when the email came stating that I had passed boards and was now a board-certified surgeon. If this makes me sound like a crier, so be it.
More recently, the question was asked again about some of my favorite things to do. By this time, I was several months into practice as a bariatric and general surgeon. I had done my first surgeries as an attending, started patients on bariatric surgery journeys, and completed my first bariatric cases, my first foregut surgeries, and my first robotic cases. As the number of “firsts” was dwindling, I had a new answer. One of my favorite things to do, if not my favorite thing to do period, is surgery.
I love operating. In these moments, the focus is on one thing: the connection between you and the patient. The chaos calms. Every movement, every action, and every reaction is as controllable as it can possibly be in life. I use a robot for surgery, which has the added benefit of sounding like a shell from the ocean when using the console. Imagine being able to listen to the ocean while getting to be the director, engineer, plumber, and architect of someone else’s precious body. Far from every case is perfect, and some make me question my life choices, but at least some surgeries can feel almost like meditation in the depth of calm and focus.
To be honest, I never expected meditation and surgery to be linked in my mind. Many steps along the path before and after surgery are far from smooth. Any number of variables can unleash the four horsemen of the OR apocalypse: delay, frustration, missing equipment, and miscommunication. Considerable preparation is essential to ensure these four stay in their stables. But there is no denying that when a case goes smoothly, no poetry, music, art, food or feeling can compare. Maybe sharing this experience can help someone who feels despair or simply lost in residency. At least for me, this side has unveiled the joy of surgery.
Maria Iliakova is a bariatric and general surgeon.
