How to Measure Success in the Life of a Surgeon

Success is not the key to happiness. Happiness is the key to success. If you love what you are doing, you will be successful.

Albert Schweitzer

But how to get there?

It was the second half of the 19th century. In Albany, New York, a middle age woman developed sharp, protracted abdominal pains. Local physicians could not diagnose the problem, let alone treat it. The young surgeon was called from New York City. Shortly, he was on the way with his assistants and his instruments. After a thorough examination, he decided that the patient had a gallbladder problem and the surgery was recommended. He proceeded to operate right away. Surgery was done on the kitchen table.

Now, the kitchen table was in those days a very versatile piece of furniture. Besides being a place for family gatherings, midwives used it for the deliveries and abortions. During the wake, the deceased was presented there and after moving the body, the family continued with the funeral meal.

The surgery on the woman was done in a local anesthesia, in the middle of the night, with lighting provided by candles. The patient recovered nicely, and most probably her life was saved. For the young surgeon, it was certainly an unusual way to reciprocate his mother for having and raising him.

In these years, Europe was the place where the progress in medicine was made and the pace of it was astounding. The discovery of general anesthesia made surgery less chaotic, more precise and subsequently more innovative; daring surgeons were able to achieve heights only imagined before.

So our young surgeon decided to go to the old continent. He studied German and French and soaked all the knowledge he could. There he learned three things.

First.

The importance of following one’s mentors. The surgical apprentices, and yes, the young surgeons were treated as such, were taught to learn and repeat all the elements of surgical technique displayed by their teachers. There was their way or no way at all. The patients were draped in a particular way, knots were tied the same way and first antisepsis then asepsis were mercilessly and meticulously applied. The youngsters were under absolute control of master-surgeons and graduated only when their mentors decided they were ready. It took from seven to sometimes ten years before one was deemed being able to go on his own and make his own decisions. When one of the apprentices asked his mentor after ten years of training, when will he be able to continue oh his own, he heard “Where’s the hurry?”

Second.

The hospital’s experimental laboratory was essential to young surgeons training. The problems encountered during the surgical treatment were brought to the dog lab and solved there. One or two years in the research lab became an essential step in the surgical curriculum. This part of the training curriculum is still a part of some of the surgical residency programs even now.

Third.

While in Europe, he learned about cocaine. Sigmund Freud was touting the miraculous properties of the white powder. Its properties as a stimulant and analgesic seduced the young American surgeon, who became first voluntary then the addicted user. The good thing was that diluted cocaine could be successfully used as a local anesthetic instead, or in conjunction, with the general anesthesia. The terrible thing was he didn’t appreciate its addictive potential, and the horrendous habit stayed with him virtually for the rest of his life.

The young surgeon eventually became the most revered persona in the history of American surgery. The question comes up whether his monumental achievements were helped by the powerful drug, or he did it despite being terribly addicted. The fact remains that most of his surgical innovations came about before addiction took over his life and before his erratic behavior became more and more obvious to his immediate circle of friends and co-workers.

He got married late in life and did not recommend an early marriage to his residents. His marriage was secondary to his hospital life and with his wife, they were living separate lives, often maintaining separate households. They had no children. His work was his life.

The second young surgeon took quite an opposite path. He came from Europe to learn here since by that time the United States become surgical powerhouse. Tried to go back, but realized that he will not be able to realize his dreams in his native country. So he finished his training in the United States. He also married late in life and established his practice in a modest community hospital. Had four children. Brought his mother here and saved her life by operating on her, just because she requested him to do so. Spent his entire life here, in the same hospital, and was working with his wife. Then they both retired on the same day and moved to different part of the country.

The first surgeon established the scientific basis for modern surgery in this country, designed a surgical residency program and developed a system to treat many common surgical problems. His name stays in medical textbooks forever. On the other side, he has fought cocaine dependency all his life, sometime taking months off his hospital life. He had no family to speak of.

The second surgeon had a much less dramatic professional life, but had abundant family life and occasionally had problems with integrating both. His name didn’t show in surgical textbooks, but his picture did!

So which surgeon was more successful? Which one was happier? And how do we measure happiness? Psychometric tests have been designed. But, judging by the number of them, neither is perfect. A person can be successful in his professional life and be a failure in the personal. We can measure by how many people each of them made happy, including his patients, his family and himself. Was the career of the first surgeon hampered or helped by his using cocaine? Would the second one do better staying in his native country and helping to develop better surgical care there? One would define success as doing the most with his or her God-given abilities. But this is subjective and difficult to specify. Then one will have different assessment from their patients, their friends, from their families and quite often their own. When you have a fiftieth reunion of your high school or medical school and compare your achievements with those of your peers, who comes up on top? And does it really matter? Do you compare yourself with the other people? Probably at your own risk.

So what’s the magic formula? There is none. There are as many paths to success as are successful people. I would argue for everyone to define his or her own success, design their own paths, and mercilessly follow it.

And never, never give up.