By Roger Cornwall, MD
Last week, at the end of a long and stressful day balancing clinic, surgeries, and lab grant applications, I did something that no sane, nearly 50-year-old hand surgeon should probably do. But it ended up being exactly what I needed. I walked into a local gymnastics gym to practice with the university team – my first gymnastics practice in 30 years.
When I was nine years old, I was thrown into a gymnastics class because I was a bit too wild at home. It worked. I competed through high school, even traveling to the Olympic Training Center on the road toward the 1992 Olympics before a cervical spine fracture got in the way. That level of commitment took work, and that work took a toll, especially socially, since I spent nearly all my free time in the gym. Needless to say, adolescence for me was especially awkward. But none of that mattered nine feet off the ground, upside down, flying around a stainless steel bar holding on with only one hand. Completely locked into the task at hand, I was truly captivated. At such a moment, there were no crushes, rejections, homework, bad days, good days. There was nothing but that moment. The rest of the world melted away. Gymnastics forced me to be present.
That exact experience returned last week when I hopped up onto the pommel horse and started performing some of the moves that somehow my body remembered how to do (albeit quite badly, and with a fair bit more pain than I had remembered). There were no unhappy patients, difficult cases, rejected grants, or missed revenue targets. There was only the familiar feel of the wooden pommels in my hands and the aching exhaustion in muscles that hadn’t been used that way in decades. Gymnastics once again forced me to be present. It was an immediate and immersive holiday from my worries as a surgeon and scientist, and as a father and husband.
What if we could cultivate that same sense of presence in our daily lives as hand surgeons? Would it help us? Would it help our patients?
I am not an expert in mindfulness, a topic that’s all the rage right now. But the late Tibetan meditation master, Chogyam Trungpa, describes enlightenment by stating, “As a famous Zen master said, ‘When I eat, I eat. When I sleep, I sleep.’ Just do what you do, completely, fully.” This concept of being fully present in what you are doing is so simple, but it is the antithesis of multitasking, something we reward and encourage in society and in our profession. How can we reconcile these concepts?
A chief resident gave me some important advice when I was a general surgery intern: “Never let them see you run.” We would round on our inpatients in a hurry, but whenever we passed a patient’s door or entered a patient’s room, he would make sure we walked slowly, as if we had all the time in the world to spend with our patients. That approach can work wonders in the clinic as well. I am often overbooked and behind schedule in clinic. But in those situations, no matter how stressed I feel about the time pressure, I will actively try to forget the rest of the clinic as I enter an exam room to see a patient, so that I can be fully present with the patient in front of me. It doesn’t slow me down. It calms me down. The patient interactions are better for me and for my patients. And I end up making up time as well.
It is perhaps easier to achieve a sense of being fully present in the operating room, where our surgeries demand our continuous attention. But even there we can become distracted, and at times we must actively manage those distractions. For instance, in the middle of a brachial plexus clinic, with patients from several different states waiting to see me, the on-call resident pulled me out of a room to show me a picture of an entirely avulsed thumb, with the FPL tendon pulled out from the muscle belly. Understanding that such an injury may not be amenable to replantation, I elected to take the part to the operating room to search for a distal artery. If no artery could be found, then a revision amputation could be performed in the emergency department. But I found an artery, so we brought the patient to the operating room. The clinic coordinator decided to hold the patients in my clinic until I knew whether or not the replantation was going to be successful, since so many of the patients had travelled so far to see me. But understanding that my judgement regarding the progress of the replantation could be colored by my awareness of a clinic full of waiting patients, I made the difficult decision to send the patients home to be rescheduled for a later clinic, so that I could be fully present in the surgery. Was this the right decision? For me it was. And for my patients it was. Despite the purely avulsion mechanism, the replantation was successful, and the 16-year-old girl now has her dominant thumb. And when I ultimately saw all of my rescheduled clinic patients, every single one of the families asked with genuine concern how the girl was, and whether or not she had her thumb. They cared. And they fully understood my need to be present that day, even if that presence was not with them.
We must be aware of the power of being present, as well as the threats to being present. We must be aware of opportunities to be more present in our professional and personal lives, both with others and with ourselves. This awareness doesn’t come naturally, and it sometimes takes vivid reminders, like last week’s experience on the pommel horse did for me. And it takes practice, just like anything worth doing well. But I do believe that with that practice, we can all eventually learn to eat when we eat and sleep when we sleep. We will enjoy our food, our sleep, and our lives more when we do.