A new surgeon confronts self doubt

A chief resident about to graduate wrote the following to me:

I just read—twice—The New Yorkers review of Henrys Marshs [a renowned UK neurosurgeon] memoir you tweeted about. Wow.

It seems like he is grappling with so many of the things Im feeling now, as Im trying to sort out if Im trained "enough" to head out into the world. Of course, Marsh is at the other end of his career. So fascinating how the same anxieties can flourish and grow in entirely different soil.

I want to read the book, but I wonder if now is the right time. Seriously! Might be better to wait a few years.

Only 38 more days to go until I complete residency.

Congratulations on finishing your training and becoming self-aware.

When I was a program director I used to laugh at residents who felt that they were so stressed. I would say to them, "If you think youre stressed now, wait until youre on your own and have to make a life-and-death decision in the middle of the night with no attending surgeon backup."

I havent read Dr. Marshs book, but the excerpts had an impact on me as well. Ive been retired for 2½ years, and I still go over complications and mistakes in my mind. Even now, it is so real for me that sometimes I cant sleep.

I once had hoped to become a stand-up comedian, but after several months of auditioning at comedy clubs, I realized that I couldnt pursue that and still practice surgery.

In the process, I took a class in comedy. Although it was 35 years ago, I still remember what the teacher said about observational humor. "The more personal a story is, the more universal it is." The same goes for writing in general.

Dr. Marsh has written a personal memoir which should resonate with any conscientious surgeon. He has done all of us a service by confessing that even the great ones make mistakes which haunt them throughout their careers and beyond.

Im sure Marshs book is very much worth reading. I think the next 38 days would be a good time for you to read it.

That you appreciate the gravity of the situation you will find yourself in come July 1 is a very good thing. Its a sign of maturity. You are ready to go out on your own.

You will make mistakes. We all do. Its part of the job. I once had a surgeon tell me that he had been in practice for 22 years and had never made a mistake. The only surgeons I knew that didnt make mistakes were not very busy, deluded, or liars.

You just have to be certain that you have given your very best effort for every patient you encounter. I have no doubt that you will be a fine surgeon.

To which the young surgeon replied:

Ill see about reading the book. I definitely want to, its just a matter of when is the right time. Marsh is courageous in sharing these complications, but he has the benefit of a lifetime of knowing that he can "do it" (presumably much more often than not). While useful, I do think there is an attendant risk to engaging so fully with ones complications and mistakes and for a more sensitive person, or one still working to establish the foundation that he or she can "do it", it seems as though there is some risk that he or she could become paralyzed by self-doubt. Thats what I meant by the timing has to be right.

All that said, I suspect its a masterful book and I look forward to hearing more of his stories.

Should he or she read the book now, later, or not at all? What do you think?

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