PRSonally Speaking

Thursday, February 13, 2014

Vacations and Expectations

by Anu Bajaj MD

The beginning of a new year can be a time for reflection and calm after the chaos of the Holiday Season.  For many surgeons, this chaos extends beyond the usual flurry of activity surrounding families and the holidays -- many patients choose to have surgery at the end of the year for many different reasons.


My husband, Trevor and I, had planned a trip at the end of the year to relax after this chaos – we were going to Ecuador to go climbing.  Vacations where we go climbing or hiking have no cell phone access, no patients, and offer the ability to push your body to the limits – these types of trips have always been the most therapeutic vacations for me. 



However, I have to admit that my preparation for this trip was the least prepared that I have ever been for a vacation.  Normally, I plan, and plan, and plan – I buy travel books.  I read them. I highlight the interesting points, and I make lists – lists of what we’ll do, lists of what we need, and lists of what we’ll eat.  I would explain to my husband that this intensive planning was part of the vacation – the time I spend planning and surfing the Internet before bed was a part of my relaxation and allowed me to anticipate our trip.  Essentially, I planned for a vacation in the same way that I would plan for a complex surgery – I would read, make lists, and strategize.  Well, for this trip, the time I spent was at a minimum mainly because there just wasn’t enough time in the day.


In some ways this approach was liberating.  I packed quickly, forgot many things – had to buy a few things that were forgotten -- but still had a great trip.  While this approach usually doesn’t work well in the operating room, I do believe that it was the right approach for a vacation and I might try it again.  As surgeons, we plan all of our activities, and we analyze our results.  By looking at our outcomes, we hope to be able to improve our results and minimize our complications. 


A perusal of this month’s PRS has many lists – Nahabedian’s list of high risk patients for implant-based breast reconstruction – obese, smokers, multiple comordities; lists of what patients look for in a cosmetic surgeon – experience, referral by someone we know, cost; and lists of which patients get readmitted to the hospital after surgery – those who are obese or who have multiple comordities.  While these lists allow us to become better surgeons and provide better care to our patients, other aspects of being a good physician may be less easy to quantify. 


As a medical student, I was attracted to surgery because of the procedural nature of the field.  I became a microsurgeon because I loved the challenge of reconnecting tiny vessels and watching a piece of dead tissue spring to life with pulsations and blood flow.  But that is not the only reason that I enjoy my job today.  The things that give me the most joy about my job today are the patients – the human aspect of the specialty, not the lists that I make of how to do a surgery (although a well-executed surgical plan is like a beautiful ballet).  We have to take the time to remember the patients who will tell you that they feel blessed that you are their doctor or the ones who tell you how you have changed their lives.  I love the way that my patients can share with each other too  -- the ones who will show their breasts to fellow women with breast cancer, the ones who will leave anonymous Christmas envelopes of cash for those who are less fortunate.



As a student who was considering a career in surgery, my father had said to me, “Surgery is not easy.  It becomes very stressful to hold the knife.”  Yes, the actual act of doing surgery is extremely stressful – the risks, the complications, the consequences of one misstep -- hence the lists that we make.  But the joy comes from the relationships that we form.


As I sit down to take stock of 2013, I realize that it was a great year during which I learned about my family, my career, and myself.  During the past year, I have explored challenges that many of us face including the difficulty of achieving balance in life.  As I begin 2014, I’m trying to use what I have learned to help me in the year ahead. 


As a surgeon, I have incorporated my need for excessive planning and organization into other aspects of my life – sometimes to my detriment.  While my lists are important, I have to learn when to put them aside.  Some of these changes have been small and have been as simple as not running with my cell phone – being unavailable for one hour is not the worst thing that can happen for me for my patients – or not uploading the data from my Garmin after each run the minute I return home.  While these changes are baby steps, they have been huge for me.  


I will likely continue to use my lists and in the operating room, but I will also learn to enjoy the relationships that I form with my patients.  Sometimes, the key to enjoying it is to throw away the lists and allow the human emotions to show through.  Or maybe not….This past weekend, I ran the Houston marathon, and I packed three running watches – all GPS enabled (I actually have four).  I nearly panicked when the one that I wore to the race on Sunday morning decided not to work.  Then I took a deep breath, and said that I would run based on how I felt, not based on a watch.