Cocky or Confident?
David said to me last week after reading my blog, "sounds like you're getting a little cocky". I thought about that for a while, and re-read what I had written. I wasn't trying to be cocky or obnoxious or haughty, but to emphasize the point that not a whole lot of people do what we do, and that it is difficult surgery. When I was in the Navy, my last year and a half was spent at Pensacola where the Blue Angels are based. I took care of quite a few of their wives, and while some of the guys were very nice, ordinary guys, a couple were real arrogant, acting like they were some sort of hot shots, quite obnoxious in the way they made everybody feel like they were less important than them, the hot dog fighter pilots. At first I couldn't stand them, but then I realized that being a fighter pilot is a lot like being a surgeon. Both pilots and surgeons have to have a very strong confidence in their own abilities because what we do has life or death consequences. As a surgeon, I have a sacred trust and bond with each patient I operate on. Both of us has to believe and I have to know absolutely that no matter what happens in the operating room I will still be in control. I have to know that regardless of how abnormal the anatomy is, how bad the bleeding is, or what complications I get into, that I will not give up, I will not panic, I will not stop thinking and acting in the best interests of the patient. Because if I do, bad things will happen. This confidence starts small and builds just like it does with anything in life. The more difficult cases I do, the more I build the confidence that, yes, I can do anything I need to; I can remove endometriosis wherever it is. My favorite book when I was a baby was "The Little
Engine That Could". The little train would chug up the mountain and chant "I think I can, I think I can...." until he finally got to the top. Most of the time confidence comes slowly but steadily. Sometimes you back up a few steps when several complications lump together (as they usually do) and you think "what the heck am I doing? Should I be doing this?". Once in a while you figure out something you're doing that's different, but most of the time there's no reason for what happened, and you move on, a little more slowly and carefully for a while until things get back to even keel. Rarely, confidence comes in a big leap, usually after prevailing over a seemingly unconquerable challenge. I remember most of my "giant steps" in confidence, whether in surgery, sports, or relationships. This past two weeks we've done 3 very difficult bowel cases, and I personally did my first laparoscopic bowel resection. I've gotten to be able to see the things that David does, not only the endo lesions, but the anatomy: the small blood vessels hiding beneath the surface, the contours of different structures and their significance. All of a sudden it's all coming together, and what seemed difficult a few months ago is now a whole lot easier (there's still a few more levels to go before it will all be easy, and some surgeries will never be easy, but they will all become possible). I remember the day I learned to trust the edges of my skis. I was at Stevens Pass, WA, on top of this short but really steep outcropping (I think I was 13 or so). I stood there scared to come down because of the steepness, but then I thought about what I knew about how skis worked, and what I had learned in my lessons about weight forward and all that. And all at once I thought "I can do this" and took off down the hill. After about 3 or 4 turns I was down off the steep, and with that one experience I knew that I could ski down anything (maybe not really fast or pretty, but I could make it down). That's how I feel now about my surgical abilities - I may not be as good or as fast as I uptimately will be, but I'm to the point that I can get through anything I face, and I know that (mostly) without a doubt.
Now, having confidence doesn't give you a license to act like you're better than anybody else - actually, it's just the opposite. My confidence in my abilities
hopefully will allow me to act with humility, valuing the relationship I can develop with my patients that allows us to achieve our common goal. What makes me continue this quest to be the best endometriosis surgeon possible isn't the notariety, money or respect. It is the experiences like I had last week, where a scared, traumatized young woman came to us after 3 failed surgeries for endo. She had a difficult lesion that others said couldn't be resected. We took care of her, excising her disease, and when she said good-bye she nearly cried from relief that her 10 year search for resolution of her pain was over, and from joy that she was finally pain free. There is no way to describe the satisfaction, joy, elation, and yes, a little pride, involved in an experience like that. It's like knowing that I'm doing exactly what I was put on earth to do. That's a pretty good feeling.
Take care, and have a great week.