How to Take Stress while Doing Surgery

By the end of my medical school, I was set to become a cardiologist. At that time, a prominent cardiology department in Warsaw Medical School even offered me a position. Then I had a conversation about my future with a professor who was the head of general surgery powerhouse, well known not only in Poland, but also around the world. After several meetings officially and in the private, he convinced me to become a surgeon. Surgeons, he said, get results of their treatment quicker and the results are more definitive. He changed my mind. And I am grateful to him for that until this day.

I didn’t think, at that time, that higher dynamics of treatment came with a higher price. Higher ups inevitably were coming with lower downs. I had to learn how to cope with the emotional and physical roller coaster of surgical life.

The practice of surgery provides doctors with colossal rewards. The satisfaction of being able to help your patients in such a short time is immense. The life in the operating room can be a lot of fun, if you know what are you doing. The best part is to see your patients in the office after successful surgery and compare them with how sometime miserable they felt before.

But that comes with trade-offs. The general wisdom is that surgeons work under a lot of stress.

That’s true. But it also stands true with other professions.  If you are accountable, the pressure to perform is everywhere and even recreational fishing on a serene lake comes with dangers.

How do we measure stress? We can only gauge it by a response of the individual. Psychological testing, blood levels of hormones secreted in response to stress, blood pressure and heart rate, all can help to estimate the level of stress and each reflects a different factor. Pretty elaborate stuff and open to interpretation. No reliable yardsticks and the results are vague. Just like measuring the strength of a punch by how loud does the recipient screams. Which brings me to the point that the severity of stress is not as important as the reaction to such. Seemingly the same stressful situations may elicit different responses in different people, and that response may vary a lot. So, it’s not as much about stress as about how we respond to it. I can see it in the operating room, where some surgeons, and not only surgeons, have quiet, civilized cases and the others would be fit for a reality TV. And a few stories are quite colorful. There was a neurosurgeon, who couldn’t take well the pressure during his time in the operating room. At the most tense moments, he used to stand in front of the wall and bang his head against it. No class. For the next cases, he found a pillow taped to the wall exactly in the same place. The nurses didn’t want him to suffer a concussion. At least not during the time when his patient was asleep.

There are surgeons whose cases are well organized, tranquil and devoid of drama. These are the surgeons everyone is looking to work for. They come in to the room, do their job with or without the music, close the patient, say ‘thank you’ to the operating team and leave. ‘Boring case’ the patient’s family hears from the surgeon during the conference after the operation is over. And that’s the words describing that nothing unexpected had happened and whatever had, he handled it well. No accidents.

And there is the other group. They come to the operating room already ‘on edge,’ looking for problems. The operating room crew is tiptoeing around them, not to provoke outbursts of their ire. Everything is wrong, nothing is right and all the problems are always caused by somebody else. Their results are poor, the complication rate is high, and they always get the sickest patients (right!). There is always an explanation for mishaps, and neither of them points to the surgeon. The instruments are thrown, requests for the change in OR crew are made, and the air in the operating room is thick with anger.

There is no question which doctor would OR crew work with. Don’t make mistakes, they all carefully check morning assignment before the first cases start. The assignment to the room of a former surgeon puts a smile on their faces. The crew of the latter one rolls their eyes, ‘not again’ and ‘why me’ and counts the hours before the time to ‘clock out.’

These two diametrically different types of response to stress bring the question; which one is better for the involved physician? The first one, when he absorbs the stress with all the physiologic consequences, or the second where he unloads the anger and doesn’t let it get to him. Or does it make any difference?

But this is a topic for another blog.