I’m sitting alone at a gate at the Detroit airport as I write this, on the way to Shanghai for an educational adventure. I’ve been flying internationally since before I could remember flying at all. My first flight was at the tender age of 3 months, and I started flying alone overseas (shepherded by flight attendants as an unaccompanied minor) around the age of 5 or 6. This raises a few eyebrows when told today, but you have to take into account that it was a different era. Pan Am still ruled the skies; pilots and flight attendants lead glamorous lives, and the Internet had not yet corralled the wild unknown romance of the far-flung corners of the Earth into the tidy little package that we know today. As a 6-year-old child, life was already a grand adventure. To travel alone as a 6-year-old child made that adventure the stuff of legend.
This was truly surreal. I had seen these phenomenally talented young women and men on the stage many times, but to be sharing pizza with them during their off hours? And yet there we all were – what a privilege. I listened, fascinated, as they exchanged stories and gossip and wolfed down meatballs – these incredibly disciplined and talented professionals at the peak of their craft were still kids at heart. Two ex-dancers who had risen to great heights and then gone on to reach the pinnacle of the teaching and management sides sat down. The tone of the conversation instantly changed, and the younger dancers stiffened up a little the way medical students might if two respected professors suddenly sat down in the student lounge.
A conversation I’d had earlier in the day was still on my mind. A medical student had wondered aloud how and when the confidence to operate alone – and make management decisions alone – arises in the process of becoming an attending. I thought back to the first time I operated completely alone – it was a lonely, scary, adrenaline rush of an experience to realize that no mentor or colleague was there at my side to offer tips or jump in if I ran into difficulties. I asked my father (also a surgeon) for advice, and he said: “Pray at the scrub sink, leave all other thoughts at the OR door as you walk through, and remember: If not you, then who? You’re the only one there. You have to fix it. Your patient is depending on you.” That last bit is what he told himself as a surgery intern in New York City in the 1960s – long before the Libby Zion case, 80-hour work week rules and all the tight regulations regarding precepting and supervision that we have now. The interns in those days really knew fear, and exhaustion, with nearly continuous q2 call. If that was the mantra my father and his generation of physicians swore by, I would certainly use it. It’s the best advice I’ve ever heard in that regard.
During a lull in the dancers’ conversation, I asked a question of the entire group: “How did you get over stage fright?” I bet myself that not only would there be common ground between professional ballet performers and physicians, but also teaching points that physicians could take away. The answers I got were these:
One of the principal male dancers answered first: “Complete preparation. If you’ve practiced nonstop, you have muscle memory and you know you’ll be able to perform whenever it’s asked of you. And repetition. You know what your body can do, because you’ve trained over and over again, and that gives you confidence.” This is the rote memorization, the knot-tying, the repetition of procedures until we attain mastery.
His fiancée agreed, and added: “And practicing with your partner, so you know exactly what the other will do or is thinking.” This is the teamwork to which we aspire in our medical and surgical teams – making processes look and feel effortless because everyone knows their role and plays it smoothly.
Another engaged pair of dancers had wildly different personalities. His perspective was this: “Sometimes I have to remember what a privilege it is to be on stage doing what I love. When I look at all the people in the audience, I have to remember that they have made an effort to dress up and be there, and that I get to make them happy as part of my work. The audience is either already happy and looking to celebrate, or needs an escape from their everyday life, and what a privilege it is to be able to provide that joy through my art.” What better reminder is there for us? Isn’t it a privilege for us to be able to do what we love, and to often make people healthier and happier through our efforts? When we can’t do that, isn’t it a privilege to share in the lives of our patients, to earn their trust, and to ease their pain where we can?
Her perspective is what impressed me the most that evening – and it was seconded heartily by her friend and colleague who cited her as inspiration. “My mantra is: ‘No *bleeping* hesitation.’ I trained with a dancer who had performed with Cirque du Soleil, and they perform hundreds of feet in the air without nets. If you hesitate in that situation, you die. And I don’t want to die. So, no *bleeping* hesitation.”
In the heat of battle, in a trauma, in a code; in surgery, in the clinic, and in necessary patient and family discussions; isn’t that our mantra, too? Physicians don’t hesitate to put themselves in difficult situations: If not you, then who? If we hesitate, our patient might die. No *bleeping* hesitation. (Having the preparation and practice to back up that lack of hesitation is key, as in any high-wire act.)
Finally, it was the turn of the two retired professionals. The teacher, who had danced on stage all over Europe, told of her experience of stage fright in dancing before one of the most famous ballerinas of her day; in the taxi on the way to the theatre, she realized that if she was too nervous to get on stage, she needed to find a new line of work. As she loved ballet too much to consider quitting, she went ahead and danced. Just as for us, at some point, it’s too late to turn back now. We can branch out but never really turn back, for our experiences have shaped us.
The dancer who had transitioned into the upper echelons of management said he had never had stage fright, at which everyone laughed. “No, really!” he protested. “I can still dance in front of anyone, anywhere, without getting nervous. But I am deathly afraid of public speaking. I use that old trick of imagining that everyone in the audience is in their underwear to make myself laugh and relax.” Which proves that everyone is afraid of something – even the most seasoned performers have an Achilles heel. No different for us – my theory is that whatever appeals to you and does not scare you as a medical student determines your eventual specialty.
So, remember, if you have anxious trainees on your watch, or whether you yourself need bucking up now and then in your career:
• Prepare until it’s second nature.
• If not you, then who?
• It is a privilege to make people better and bring joy.
• And lastly, no *bleeping* hesitation.
I’m a fan of bumper stickers and car window decals. My favorite is not the Coexist, nor is it the Jesus Fish, nor is it the Darwinian Jesus Fish with feet, although I love all of these. It is not the Stick-Figure family; nor is it the My T-Rex Ate Your Stick Figure Family; nor is it the Zombie Stick Figure Family, complete with Zombie cat. (I really don’t understand why zombies are a “thing.”) My favorite is a simple saying: “Wag More, Bark Less.” And so, here are a list of New Year’s resolutions.