It was an extraordinarily complicated surgery. Anatomy was altered and distorted, everything dissected bled more than expected, and tissues were friable and delicate. The thought of an easier, quicker surgery with a more significant ultimate disability was briefly considered but was not an option. After 7 hours of meticulous dissection and preparation, the final portions of the case were starting to materialize. I close my eyes briefly, feeling the fatigue wash over me. I slowly roll my sore neck and open my eyes to survey the operating room. It was an arena of blood covering the drapes and floor. My gowned arm and gloved hands were crusted with dried blood, and I could feel the sweat soaking through my scrubs under the gown. Taking a deep breath through the surgical mask, I could smell the distinctive mix of the patient's dried blood and my sweat. Looking around the room, time froze. My mind returned to a moment in high school history class, listening to the ionic passage of Theodore Roosevelt’s 1910 speech in Sorbonne Paris, France, called “Citizenship in a Republic.”
“It is not the critic who counts; not the man who points out how the strong man stumbles, or where the doer of deeds could have done them better. The credit belongs to the man who is actually in the arena, whose face is marred by dust and sweat and blood; who strives valiantly; who errs, who comes short again and again, because there is no effort without error and shortcoming; but who does actually strive to do the deeds; who knows great enthusiasms, the great devotions; who spends himself in a worthy cause; who at the best knows, in the end, the triumph of high achievement, and who at the worst, if he fails, at least fails while daring greatly, so that his place shall never be with those cold and timid souls who neither knows victory nor defeat.”1
After what seemed like a few minutes, but was a few seconds, I returned to the present. The final surgery segment started, and at hour 9, we successfully completed our reconstruction and were rolling out of the operating room. Having the “Man in the Arena” quote in my head allowed me to reflect upon another meaning. I had always considered it applicable to a gladiator or an athlete, never a surgeon. But today, my arena was the operating room, and every element of Theodore Roosevelt’s message resonated with me as a surgeon. Roosevelt was talking about individuals who are engaged and involved in situations that require courage, tenacity, and skill, as opposed to those who sit on the sidelines and watch. As surgeons, we have many critics—from other surgeons, patients, insurance companies, and even society that have not been engaged or involved and only observe. Roosevelt rallied against cynics and pointed out there was “a readiness to criticize work which the critic himself never tries to perform.”1 A surgeon's career is marred by blood, sweat, and successes and failures. From our failures, we strive to improve to diminish complications and failures, but they still occur, yet we continue to enter the arena repeatedly, aiming to improve.
Roosevelt’s underlying message is that if the cause is worthy, we must constantly strive to improve despite failures and become the best we can be, whether we succeed or fail. This is a brilliant and enduring message for all of us to incorporate into our daily lives.
Walking to the locker room after surgery this day, I lifted my head, smiled, and thought that today I was the “Man in the Arena.”
1. The Man in the Arena. Theodore Roosevelt Digital Library, Dickenson State University. Accessed March 18, 2023.https://www.theodorerooseveltcenter.org/Learn-About-TR/TR-Encyclopedia/Culture-and-Society/Man-in-the-Arena.aspx