Sunday, November 6, 2011

Love your Freedom of Choice, if not your Job

At age 20, I awoke summer mornings in a sleeping bag under blue sky. My best friends and I then drank coffee while making pancakes and bacon for our twenty-four guests. After loading the rafts, we crashed class-IV rapids till the blazing sun left the canyon. Twenty miles downstream we set up tents again, grilled steak, baked apple cobbler, and played guitar by light of fire and stars. The beer was free, and we guides got our money's worth.

We got tired of this routine.

By late August, mornings were too cold and dark for our hangovers. Our backs ached from heaving rafts off exposed rocks. We missed girlfriends and newspapers. Our inside jokes grew stale and our cassette tapes were eaten or river-soaked. We finished all the beer halfway through each trip, leaving us dangerously thirsty for a couple of days. Then, just when spending 24/7 with the same few friends brought us close to throttling one another, we parted ways and went back to school.

Nine months later - best friends again. New jokes and mixed tapes, rested backs - thirsty boys, thrilled to be alive on the river again.

A short time ago, I was one cranky surgeon. Our three-man practice had lost one. For eighteen months, there were just two of us. With the extra work, I stopped writing notes; instead I simply co-signed resident notes. I starting trusting residents more, and seeing fewer patient with my own eyes. I got pretty good at supervising, I thought, as I did less and less doctoring.

While I was taking on more work with tremendous efficiency, everyone around me continued at the unbearable pace of always. What's more, every change of resident teams brought dumber and lazier residents. The nurses became incompetent. The hospital operators, useless. Hospital admin? Don't even get me started. Patients became more entitled. The residency program director took away our ICU intern. The processes and protocols of patient care were grinding to a halt, as I struggled ever more to meet my responsibilities. The government, insurance companies, and empowered patients all stood in my way, more all the time, without an end in site. Even my family failed to understand how much my patients and the whole department depended on me. I had no choice but to remain available, reliable, responsible. Right?

Advice to senior residents: negotiate lifestyle early in your career. Whatever job you take, you'll be asked to do more. You'll take it on because of your work ethic. Then you'll get a partner who does bariatrics or vascular and you'll be covering their patients on the weekend, though you don't care much for those cases or their complications. The senior partner then decides to take off all of August. The OR closes two suites for renovation. The other level one trauma center closes. Your new recruit bails last minute. Your favorite patient gets an enteroatmospheric fistula - and you get a long-term relationship with said patient.

Professionalism demands you be flexible and sacrifice plans to keep your patients well.

But, is it necessary to work years in a job barely resembling the one you signed up for? (Much less the one you envisioned?) Nope. Even the free-beer dream job of a summer rafting guide demands a re-set, and eventually, moving on.

Americans have freedoms unlike 99.9 percent of humans who ever walked the earth*. When you run out of choices in the land of opportunity, you've probably actually run out of imagination or energy - or miscalculated what your loved ones want for you.

A related post, Optimism, appears at

*This observation is borrowed from Christopher Hitchens who, though facing a diagnosis of esophageal cancer, commented to an interviewer on his relative long life and good fortune.

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