Moving Us Closer To Osler
A Miller Coulson Academy of Clinical Excellence Initiative

How writing helps me as a clinician


Writing helps me reflect on the surgical decisions I make each day.

Once the bleeding stops, vessels are sewn together, and the heart is beating vigorously. The operation appears to be nearing its elegant conclusion. The tension in the operating room dissipates as the lighthearted music comes back on. We begin to close the skin. 


I can hardly remember what we were so anxious about just eight hours ago, no one feeling certain we were making the “right” decision to operate. What does it mean to have a 20% chance of dying on the table anyway? 


It’s high enough to make you second guess your intent to cut, but low enough to make you second guess your intent to say no and walk away. Can any of us ever confidently see the line between healing and harming, being hero or being reckless? It’s too early to say. Even if we make it out of the operating room, sometimes it’s hard to know whether we’ve done something meaningful. 


When I started my career as a surgeon, I learned to cut with speed and precision. It wasn’t easy to learn, but it turns out that only a small part of a surgeon’s development is technical. 


The rest is a lifetime’s worth of questioning myself. We’re often sewing well after the sun sets, but it’s not the sewing that keeps us up at night. I wonder whether I waited too little or too long to operate on a patient, whether I let fear or overconfidence get the best of me. 


Most days I’m too tired and behind to reflect on the answers. But on rare days, I write in hopes of finding that difference. I write about what I saw and what I felt. I write about the parts of myself that don’t make sense to me. And usually by the end, I can find a few words that feel good and right and true, at least until tomorrow. 







This piece expresses the views solely of the author. It does not necessarily represent the views of any organization, including Johns Hopkins Medicine.