Start by doing what’s necessary, then what’s possible; and suddenly you are doing the impossible.
—St. Francis of Assisi (1181–1226)
As I travel around the world, I’m often asked what I do and how I do what I do. I will share with you a typical day in my life, the life of a plastic surgeon, a teacher, mentor, physician, husband, and father.
There is no magic in what anyone does. It merely evolves into what becomes your life over time. It is not precalibrated, predetermined, or even predestined how your order of life becomes you or you become the order of life. I am one of those fortunate (or possibly unfortunate!) human beings that require only 3 to 4 hours of sleep a night. Since my childhood in North Dakota, my entire family, including my two older brothers and me, had to get up at 4 or 5 in the morning to do the ranch chores and milk the cows on our dairy farm before going to school at 7:00 AM. Although I did not particularly like doing this, as it required a lot of consistency and focus, such early discipline instilled those values in life at an early age. Little did I know that this was preparing me for the rest of my life! For that, I must thank my German Russian ancestors and my parents for imprinting this deeply in me, and whether it was hardwired into my DNA or pressed into me environmentally I do not know. All I know is that it stuck, and I now have instilled it, I hope, into my children to a certain degree!
One ramification of this is that I have never used an alarm clock in my life. I have an internal alarm clock and so, when I awake at 4:00 AM, I will shower and get going whether I exercise in the morning or at night. I live only 6 minutes from the University of Texas Southwestern, so I will usually go to the Plastic and Reconstructive Surgery journal office and/or spend 30 to 40 minutes there prior to academic meetings. Department meetings usually begin at 6:00 AM; I’ll meet with the research directors from my research division and outline the entire week’s goals. This week, at 7:00 AM, as Chair of the Clinical Chairs Executive Committee at the University of Texas Southwestern Medical Center, we had a meeting to delineate some of the challenges and opportunities for the accelerating growth of the Medical Center as we build a new university hospital at the University of Texas Southwestern in addition to a new Parkland Health and Hospital System. The minutes for this meeting were dictated during my way back to the North clinical campus, where I will usually be in the operating room from 8:15 AM until 1 PM performing usually one or two operative procedures. Today, it happened to be face lift, blepharoplasty, and a rhinoplasty all on the same patient. In the operating room, I teach our residents, medical students, fellows, and our international visitors. We average two to three international plastic surgery visitors every month; the number of visitors is limited because we have one of the largest residencies in plastic surgery in the United States and five clinical fellows each year. Therefore, we need to focus primarily on training our medical students, residents, and fellows first and foremost.
In between cases in the operating room, I will work on e-mails; take calls; solve problems; and meet with my division administrator, departmental manager, or clinic manager as needed. From 1:00 PM until 4:30 or 5:00 PM, I see between 20 and 30 patients in my private university practice clinic, providing consultations, making follow-up visits, performing injections with fillers and neuromodulators, and documenting these encounters in our electronic medical record at the same time (electronic medical records have greatly facilitated my practice efficiency). In the interim, I continue to answer e-mails (I receive 200 to 250 a day) and solve administrative problems as a department chairman. From 5:00 to 6:00 PM, I will generally have another University of Texas Southwestern administrative meeting. Today, I chaired our University Hospital and University of Texas Southwestern billing and compliance committee. It is not infrequent that I will return at 6:15 PM to the Plastic and Reconstructive Surgery office for another hour to review manuscripts either for acceptance, revision, or rejection, and then write my template three goals for the next day and then try to be home by 7:00 PM either for dinner or for an evening of helping our two children with their homework as needed. (With that said, however, my spouse is superb in leading this effort on most nights!) I try to dedicate this evening time to my family until they go to bed. About 10:00 PM, I continue to answer and finish most of my e-mails. I try to reduce e-mails from 250 to fewer than 25 per day, if possible. Sometimes I accomplish that goal, sometimes not. After that, I finalize the three goals for the next day, listing the top three goals and then three secondary goals. I may also in the evening have a conference call, visit/mentor a faculty member (which is usually on a weekend morning meeting at my home), have dinner with a visiting professor, or be planning my next academic trip. I go to bed between 12:00 and 1:00 AM and that concludes my day, a day in the life of a plastic surgeon.
As I have matured in my personal and professional life, I have found that I need to recharge my batteries from time to time with days away from work, especially in the summer months. Many a summer weekend I take my family for weekend-long trips to our lake home without even opening a computer until late Sunday evening! I admit that doing this can be hard—relaxing goes against my nature—but it is essential to take time off in which to reenergize, rethink, and revitalize as well as refocus on what is really important in life. For me, and probably for many of you, the really important things are family (especially my spouse and kids), friends, my practice, residents, and patients. Recently, I have taken up running again after work or at night, which has been very invigorating to me, because it was a passion of mine for years. It’s time for me to get back into real shape for the second half of life! I find that it is so much harder now to get in shape, even though my iPhone is playing the best of the 1970s and 1980s from Pandora. Although running is hard, I really enjoy allowing myself to take the time to melt away the stresses of the day or week through the exertion. The beat of life goes on!
For me, the hardest thing to learn is that I can never really complete what I want to do each and every day. My ideas, ambitions, and best intentions far outweigh any reasonable way to realize them. Nevertheless, all of us have to at least attempt to do the best we can do for our families, our patients, our staff and our plastic surgery partners, our residents, and our fellows. We all only have 24 hours in each day, so let’s try to live each day—each moment—to the fullest and make it count.
Let me tell you the secret that has led me to my goals: my strength lies solely in my tenacity.
—Louis Pasteur (1822–1895)