December 17, 2019
What is resilience?
Resilience is defined by Merriam Webster as both “the capacity of a strained body to recover its size and shape after deformation caused especially by compressive stress” and “an ability to recover from or adjust easily to misfortune or change.” On the surface, cardiothoracic surgeons are the embodiments of resilience. After persevering through years of grueling training, we’ve successfully come out at the other end where some of our would-be colleagues did not make it through the rigorous demands of medical undergraduate or graduate education. We then charge into the workforce and manage the daily challenges of a high-stress clinical practice, conducting research and training the next generation of surgeons while holding the line against a near constant barrage of administrative and regulatory onslaughts. But at what cost? Do we really recover back to our original size and shape, and how easily do we bounce back from the inevitable catastrophes?
CT surgeons are not indestructible.
Recovery back to one’s original state is rarely the outcome of stressful situations. For some, it seems as though difficult circumstances can be catalysts for tremendous growth and development. Yet for others, these difficulties can either be absolute breaking points or, more commonly, they slowly deplete the mental and physical reserves over time. Surgical practice, especially cardiothoracic, has traditionally emphasized the absolute strength of the individual where indefatigability has been a badge of honor. Admissions of physical fatigue increasingly are becoming tolerated due to focuses on patient safety, but the need for surgeons to build and maintain emotional resilience remains largely ignored.
Surgeons are not alone in the reluctance to either admit weakness or ask for help, and with good reason. The existing structures of credentialing and licensing require physicians who have sought mental health assistance to disclose this information and provide explanations that could negatively impact their ability to practice. Reputations are critical for maintaining one’s referral base, especially in competitive areas, such that any potential cracks in the armor present a real threat. However, the stigma itself is a far greater threat to the individual physician/surgeon for whom untreated depression can lead to devastating consequences, including suicide. The incidence of suicide among cardiothoracic surgeons is unknown, spoken even less about than the contributing factors, but such tragedy does occur.
Admissions of physical fatigue increasingly are becoming tolerated due to focuses on patient safety, but the need for surgeons to build and maintain emotional resilience remains largely ignored.
In the face of these less than ideal circumstances, cardiothoracic surgeons need to develop reliable methods with which to manage the effects of stress and adversity. And no, this is not the overwrought concept of “work-life balance.” Rather, it is the recognition that each and every one of us faces either constant low-level stress and/or catastrophic events that need to be met with adaptability and a solutions-focused mindset. The ability to generate such a response is linked to one’s ability to move past automatic and potentially maladaptive responses into a more thoughtful and productive approach. Proactive building of a strong physical and emotional base can go a long way in maintaining the resilience we already possess. We already know how to persevere, not give up on our goals, and do what it takes to succeed. Doing so while maintaining our well-being is the next challenge.
In their Harvard Business Review article, “The Making of a Corporate Athlete,” Jim Loehr and Tony Schwartz outline a deliberate series of actions that address the physical, emotional, mental, and spiritual reserve of executives. Among these, attending to the body’s need for physical activity, quality nutrition, and adequate sleep should not be deemed a luxury. Rather, these components should be considered just as important as the seemingly more pressing clinical and administrative duties because they are critical for achieving the peak performance to which we all strive. Let me be real here: the average cardiothoracic surgeon will never sleep 10 hours a night, have the time to cook nutritious meals every day, train for marathons or iron man/woman competitions, or be present for each and every family event. But we can still take advantage of any opportunity to effect small incremental changes, such as adding 15-30 minutes of sleep per night or catching up on/banking sleep when not on call. Perfection is not the goal here. Instead, it’s about taking the time to consider that no one is indispensable, and sometimes the best way to be of optimal service to our patients and families is to attend to our own needs first.
We can still take advantage of any opportunity to effect small incremental changes, such as adding 15-30 minutes of sleep per night or catching up on/banking sleep when not on call.
Ask for help.
There will be occasions when maintaining personal well-being is not enough. A series of bad outcomes, conflicts with group members and the almost super-human demands placed on cardiothoracic surgeons may eventually take their toll—and what then? Isolation is a particular risk for poor mental health, so work to develop a network of trusted individuals in whom you can confide when the pressure mounts. Despite the potential risks to one’s career, the risk to an individual’s survival from untreated depression is far greater, so please seek professional help if you feel the need.
National Suicide Prevention Hotline: 1-800-273-8255.
The opinions expressed in this article are those of the author and do not necessarily reflect the views of The Society of Thoracic Surgeons.