RAS-ACS Essay Contest: Balance on a very thin wire

Editor’s note: The Communications Committee of the Resident and Associate Society of the American College of Surgeons (RAS-ACS) offers an annual essay contest. Contestants in 2018 were asked to write about a time when their commitment to be a surgeon conflicted with their commitment to personal wellness. The winning essay follows.

I leaned back against the wall, breathed into my palms, and brushed beads of sweat from my forehead. I wondered if I wasn’t crying because I lacked the emotional capacity, was too exhausted to expend the energy, or maybe I was simply dehydrated. Sounds from the preceding hours played on repeat: congratulations on a clean dissection, the panicking voice of the anesthesiologist unable to ventilate, the sad songs of bradycardia and hypoxia playing on the monitors, the crunch of fractured ribs beneath my overlapping palms, time of death called, and exchanges of appreciation for valiant efforts. The cycle was broken by the attending’s hand patting my shoulder and saying, “You okay? Don’t worry about dictating this one. I’ll take care of it. Get some rest.”

I had followed the patient for months. I knew her family. I rearranged my schedule to be available for the case. It was my first and last on-table death. Eventually, I mobilized to finish the plus-four part of a “24+4” (a 28-hour shift), which was fine because I was invincible. I didn’t need sleep or help of any sort. A six-year residency was ahead of me and I was intent on sprinting all 26.2 miles—the length of a typical marathon. I switched on autopilot and started home.

No more scrubs, a soft comforter, and finally allowing heavy lids to close over burning eyes appealed to me the way breathing does after being held under water. I woke to a loud bang and the visage of an old truck staring into my driver-side window. At that moment, I realized I had hit the truck and careened away from it. The road curved to the right, and the reflexive turn serendipitously corrected my path into the designated lane. Frantically looking around, the flow of traffic appeared unfazed. My blood pressure skyrocketed as we pulled over to evaluate the damage. Only our mirrors had collided. Relief washed over me, but a deluge of concern followed. I yearned to confess the worst-case eventualities that haunted me despite not coming to fruition. Should I call my program director? Training program coordinator? Mom? Embarrassed as I was ashamed, I spoke to no one about the incident for years.

Hunter S. Thompson wrote, “Luck is a very thin wire between survival and disaster, and not many people can keep their balance on it.”* I remain proud of staying for the case, treating a patient I cared about, staying true to myself and my profession, but contrary to my oath, I could have harmed myself, or worse, others. All of the “sleep and fatigue” modules I had clicked through had failed me. Reading about resident wellness and physician burnout had failed me. The warm intent of duty-hour restrictions had failed me. Most of all, I had failed me. What have not failed me since that incident are sleep, exercise, food, bathroom breaks, friends, family, and choosing these necessities when I need them. Fortune or fate kept me in the right lane that day, but maintaining balance, in every sense, keeps me from relying on luck to avoid disaster.

*Thompson HS. Fear and Loathing in America: The Brutal Odyssey of an Outlaw Journalist 1968–1976. New York: Simon & Schuster; 2001.

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