TSRA Presidential Address

Xiaoying Lou, MD
2019-2020 TSRA President

TSRA Inaugural Presidential Address: Preserving the Passion in Cardiothoracic Surgery Training

I remember the awe of feeling the human heart beating in my palm for the first time. I was in high school – impressionable, mesmerized by its beauty, its persistent drumming, and the sense of purpose and commitment of the team around me working towards a common goal. I knew then that cardiothoracic surgery was what I wanted to do with my life. 

Over the years, I remained devoted to this singular drive, fueled by the image of who I wanted to become, the patients I hoped to help, and the support and encouragement of those around me. Throughout college and medical school, grueling days spent juggling numerous exams, research, and all my other activities, I never lost sight of this passion and confidence.

But nothing quite prepares you for training. Fast forward a few years, and now I’m over half-way through my residency. There are days when I look back and feel as if I were naive – particularly on days when sleep is hard to come by, when the demands seem endless, and nothing you do seems quite good enough.  

There was a particularly difficult day last year when I got complacent, and a mistake on a routine part of a case almost led to catastrophe. I was absolutely devasted, completely shaken by the experience, replaying the moment over and over again, and feeling as though I could not move on from it. Noticing that I seemed upset and down on myself, one of my attendings asked me a question that I’ve thought about often ever since, “but are you better than you were two weeks ago?” And I realized that yes, I was. Despite the mistake that seemed insurmountable to move past, I was better. I was more aware of the infinite number of things that can go wrong at any point during a case – that every step can potentially have devastating consequences. Much to our relief, the patient ended up doing well.

In the midst of training, it is hard to step back and realize that you are improving, gaining a little more responsibility in the OR, becoming a bit more facile at finding that needle angle that seemed impossible a month ago, feeling a little more confidence in dealing with that unstable postop patient in the ICU.

Sometimes it is hard to see the forest through the trees when you’re in the depth of the struggle. It is easy to lose sight of the confident, competent, and compassionate surgeon we all want to become. It is no wonder that burnout is a real phenomenon within our specialty affecting up to half of current surgeons.1 But through it all, we must realize that challenges and mistakes are part of the training process – making fewer of them as we move forward is what is ultimately important. Particularly on the tough days, realize that being a resident is temporary, and most practicing cardiothoracic surgeons are happy with their career choice.2

Cardiothoracic surgery is hard, and it’s supposed to be hard. None of us entered this field expecting it would be easy. We wanted to put forth our time and energy into something infinitely challenging to make a difference in peoples’ lives while contributing to society in a meaningful way. I think this sentiment is most aptly described by Dr. Michael Debakey in a book I first read in medical school and one I like to go back to from time to time, entitled Medicine, Preserving the Passion in the 21st Century (Manning and DeBakey, 2003). He writes,

“Despite the frustrations…if you were attracted to medicine because of a genuine desire to help others and because you enjoy intellectual challenges, you will find immense satisfaction in your daily work and can preserve the passion for medicine…As physicians, we are invited into the most intimate chambers of our patients’ lives. We should acknowledge that unfettered trust with dignity, deference, and respect. For a physician, caring for patients is not only a duty; it is a privilege. Alleviating pain and restoring health for another human being induce an exhilaration that few others experience in their careers. That professional gift deserves exquisite care.”

The start of a new year and a new decade brings along all the hopes for everything to come. And my hope for all of my fellow residents is to never forget what drew us to the field in the first place, what we love about it, and preserve that passion through training and beyond. Remember the joy of touching the heart for the first time, the first time you watched the lungs inflate before your eyes, and never forget that we have been given a gift to be able to make a priceless difference in someone’s life. And realize that there is nothing else like it.

I end this inaugural TSRA presidential address with a Winston Churchill quote that is particularly fitting for embarking on this lifelong journey:

“Every day you may make progress. Every step may be fruitful. Yet there will stretch out before you an ever-lengthening, ever-ascending, ever-improving path. You know you will never get to the end of the journey. But this, so far from discouraging, only adds to the joy and glory of the climb.”

References

  1. Squiers JJ, Lobdell KW, Fann JI, DiMaio JM. Physician burnout: are we treating the symptoms instead of the disease? Ann Thorac Surg 2017;104:1117-22.
  2. Ikonomidis JS. The Society of Thoracic Surgeons Thoracic Surgery Practice and Access Task Force: 2014 Workforce Report. Ann Thorac Surg 2016;102(6):2118-25.
  3. Manning PR, Debakey L. (2003) Medicine: Preserving the Passion in the 21st century 2nd edition. Springer, New York, NY.