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As every operation began, the sweat poured off, and then, even though the lights were just as hot as before, I cooled off as things came under control.

I could only look inside myself for reassurance. There was no one to whom I could transfer it. Now the knot was in my stomach, and everyone else relaxed. When a patient was taken to the operating room with severe bleeding, the staff was tense and panicky-until the surgeon walked in. Unfortunately, I hadn’t yet learned that my typical physician’s response-to hide my pain when something went wrong-helped no one. To become a surgeon in order to help people and then to end up disfiguring someone was a shattering experience. Seeing her wake up with half her face paralyzed made me want to hide forever. The one case that most shook my faith in myself was an injury to a facial nerve in a young girl I operated on early in my career. Although disheartening, they keep us grounded and prevent us from starting to think of ourselves as gods. We always do our best, but complications still occur. It was only later that I became able to look upon the emergencies, and even the breakdowns in hospital procedure, as extra opportunities for helping people. I would have loved an easy day when everything went according to schedule and I had only routine cases. After several years, however, the challenges themselves became monotonous. It was an exciting challenge it kept practice from becoming dull. When I’d started out, I’d looked forward to facing new problems each day. Intuitively I felt there must be some way I could help the hopeless cases by going beyond my role as a mechanic, but it took years of difficult growth before I understood how to do so. Since people often don’t get better and since everyone eventually dies, I felt like a failure over and over again. This is how a doctor’s success is defined. But I’d been trained to think my whole job was doing things to people in a mechanical way to make them better, to save their lives. It wasn’t a typical case of burnout I could cope with the unending problems, the intensity of the work, and the constant life-or-death decisions. In the early 1970s, after more than a decade as a practicing surgeon, I was finding my job very painful. I was not healed during my training, and yet I was expected to heal others. I didn’t have a class on healing and love, how to talk with patients, or the reasons for becoming a doctor. I came to it only after a long period of unhappiness and soul searching in my profession. The idea of the exceptional patient is not taught in medical school. FYODOR DOSTOYEVSKY The Privileged Listener

It has to be paid dearly for and only acquired with much patience and great effort. A new philosophy, a way of life, is not given for nothing.

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