C L O S L E R
Moving Us Closer To Osler
A Miller Coulson Academy of Clinical Excellence Initiative

Never Forget Where You Came From

Takeaway

Reflecting on my journey to becoming a cardiothoracic surgeon reminds me of how far I've come. This also helps me to imagine the rewards of giving clinically excellent care to future patients. 

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. 

 

 

“Let us know if you need anything,” I said to the 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 said 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 this. 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 but 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. Any thoughts unrelated to the current task dissipate. 

 

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’d performed her surgery just two days earlier, my thoughts in that moment couldn’t be further from having saved her life. 

 

As I walked down the hall to the next patient, I had a sudden flashback to my first day as a med student shadowing in CT surgery almost 14 years ago. After a long and complex case, the attending surgeon, who was also my mentor, asked me to accompany him in talking with a family. He introduced me as a medical student who helped with the surgery, even though my participation was 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. 

 

 

 

 

 

 

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