July 29, 2015

Addicted To Perfection: A Surgeon’s Story

perfectionist

I was sure that we had cut the ureter. Every time we looked and found it intact, I became even more certain that we had cut it. Finally, my exasperated chief resident told me to stop. I was emergently operating on my next door neighbor for what turned out to be cancer, and that’s how I excused my paranoia. (She’s now cancer free, and yes, her ureter is fine). That kind of worrying had taken over my practice of surgery, though. The joy of operating, teaching residents, watching patients heal and recover from major and minor illness had been replaced by a constant vigilance for the next complication, unexpected finding, or patient that I was unable to help. Every decision, every operation, whether straightforward or difficult had become agonizing. I was consumed with trying to make sure everything was perfect. I stopped believing in chance, uncertainty, and incurable disease. Unfortunately, that was all in my subconscious. Consciously, I felt like I was being diligent and holding myself accountable in an admittedly high stress career. After all, I was responsible for people’s lives, right? Though I didn’t see it at the time, I had lost focus on my patients because I was completely focused on making sure I didn’t make a mistake. At the same time, I was winning teaching awards from residents and medical students. I had the trust of colleagues who asked me to operate on their loved ones. By all accounts, I was a well-respected and competent surgeon, yet I was having chest pain on my drive in to take out an appendix. I desperately wanted the pain to stop, so I started looking for ways to quit surgery.

It had started during my third year pediatric surgery rotation. A 3-year-old girl died following a simple procedure, and I felt the soul-crushing reality that even the small things we do have major consequences. From there it was double thinking every decision, replaying each operation in my mind sometimes dozens of times, lying sleepless, staring at my pager and dreading the next call.

When I reached the point where I was having chest pain and suicidal ideation, I got into counseling. At the first session, I spilled all of my angst. The counselor looked at me and said “You’re an asshole.” That was a bit less support than I was expecting, but he continued. “Look at how you’re treating yourself, is this how you treat your patients? Your family? Why have you put up with this abuse for so long?” He also pointed out (to my horror) that I had a God complex – I had convinced myself that if I did my job perfectly, I would get perfect results. I had thought I was rooted in reality, but I really wasn’t.

Opening myself up to counseling (which required swallowing a lot of pride) honestly may have saved my life. Like any other recovery, the first step was realizing that I needed help. The next step (and the hardest for me) was asking for help. I had to trust someone else the way my patients trusted me. I had to be open to things I didn’t really believe in at the time. I had to accept that things could get better, but that there was no quick fix to my pain, like finding a new job or career. At first, it was simple relaxation techniques. I’ve since learned about the power of mindfulness, meditation, and practicing gratitude. I’ve found a peaceful bliss in yoga. Yeah, picture your favorite (or least favorite) surgeon quietly meditating or posed in a downward facing dog. Trust me, it’s funny. I’ve gradually learned to quiet the storm that had taken over my consciousness. It was hard work. Harder than anything I’ve ever done. No joke.

The next thing I needed to do was to take an honest look at what was going on in my head. What I found was that I had lost track of reality. I was spending so much time ruminating in my head that I had become unaware and not accepting of what was really going on in the world. I was caught up thinking about how things should be rather than accepting how things actually are. I was addicted to perfection and would accept nothing less. Accepting reality meant accepting imperfection – my own, and that of the world around me. I had to realize that I have a lot less control over reality than I want. What I do have control of, though, is how I react to and interact with reality. I’ve learned that striving for perfection is different than expecting perfection. Perfection is not an outcome measure. Reality is the outcome. Perfection is doing the best I can with the situation presented to me, accepting the reality of the outcome, and realistically assessing if I can do better the next time.

It’s been a long road, but I’m better now. I’m eight years into practice, and I like being a surgeon. I can schedule a major case without chest pain. I can deal with a major complication without falling into depression. I can separate myself from the pain and suffering I see every day so that I can be fully present with my family. Despite that separation, I feel even more compassion and have more satisfying relationships with my patients and colleagues. The energy I was putting into angst can now go to my family and to myself without the guilty feeling that maybe I’m not doing enough for my patients. I think my complication rate has actually gone down, too.

Am I cured? No. I’m in recovery, just like any other addict. And just like any other addiction, it has gotten easier with time, but I know it will never go away. I slip. I pick myself up. I ask for help. The trick is to have the awareness to realize when I am slipping. I’ve moved from counseling to career coaching, but this is still the foundation I have to keep coming back to as I work to shape my career. I strive for the strength to change what I can, the serenity to accept what I cannot, and the wisdom to know the difference. The world is not perfect. It never will be. And that’s okay. I’m not here to make it perfect, I’m here to make it better.

A big “Thank you!” to one of my great clients for sharing his story.  I talk with many doctors who think they may have to leave medicine. In many cases, this is not true. If you are questioning your career choice, it is worth the time and effort to find out what is possible for you. There is a right answer for you, and it can be found.