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Never Forget Where You Started

Female doctor standing in front of a group.

“Let us know if you need anything,” I said to my patient as I hurried toward the door. With many more patients to see before heading down to the OR, morning rounds are kept short and concise.

“Doctor,” she stopped me before I opened the door, with a slight tremble in her voice, “thank you for saving my life!”

I turned around, frozen for a minute.

While many may think cardiothoracic surgery (CT) is glamorous and exciting, the life of a CT fellow is far from these descriptions. The surgeries are long and challenging, patients are complex and sick, and the schedule is makeshift and unpredictable — not to mention the frequent complications, unfavorable outcomes and deaths that occur more than in any other specialty. The difference between a stable, conversant person and a sick, dying patient requiring mechanical life support could be a tiny, overlooked detail that develops in a matter of minutes. As a result, I keep on track by focusing only on the details at hand: the last unstable patient in the ICU to check up on, the current emergency procedure to perform and the next potential calamity to attend to. Life, broken up into these short segments of intense focus, is instilled with a sense of equanimity, even in most difficult times. The time becomes almost still, and any thoughts unrelated to the current task dissipate beyond the sterile field.

In that moment of morning rounds, I was only focused on the patient’s vitals, physical exam, lab work, X-rays and postoperative recovery. These details filled my tunnel vision, preventing me from thinking about anything else. Although we had performed her surgery just two days earlier, my thoughts in that moment could not be further from having saved her life.

As I walked down the hall to the next patient, I had a sudden flashback to my very first day as a medical student shadowing in CT surgery almost 14 years ago. After a long and complex case, the attending surgeon and my mentor asked me to accompany him in talking with the family. He introduced me as a medical student who helped with the surgery, even though my participation entailed nothing more than observing and occasionally cutting a suture. The whole family encircled us, shaking our hands. One by one, they thanked us for saving the patient’s life. In that moment, the elation in their eyes at the successful surgery melted any fatigue or doubt inside me. And that was the moment I decided to become a CT surgeon.

There is a Chinese saying that goes, “Never forget why you started, and your mission can be accomplished.” As I looked back at where I started, the same sense of mission washed all over me. Peeling away from the details of the moment, I can reflect on what I am doing and see the bigger picture. These moments of reflection continue to remind me where I started and the road ahead.

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