Is this an adventure?

Abstract

June 30, 1998, my last day at Stanford University as a resident before moving to St Louis to join the faculty at Washington University School of Medicine. It was a busy 24 hours. My final case was a 4-way bypass with Phil Oyer, and for those of you who don't know Dr Oyer, he was a commanding presence in the operating room and fastidious when it came to the subtle maneuvers that comprise an elegant technical performance. My residents would probably say the same about me, but now more than ever, it has to be that way. Gone are the days when we could let a resident fumble through a case on their own to learn by trial and error. Educators today have to practice "Continually supervised, corrected perfection." 1 We constantly monitor and modify needle angles, graft orientation, bite technique, and spacing on every anastomosis.So, there we were. Dr Oyer with a keen eye on my performance as I sutured my final distal. "That bite was too big," he grumbled. I hesitated for a fraction of a second, made a slight adjustment and continued on. "That bite was too small," again with a grumble. His voice rivaled that of George C. Scott's Patton in its capacity to command action from those within earshot. We carried on. "Too big," another bite. "Too small," another bite. "Too big," another bite. "Too small," another bite. Finally, I had to stop. "Dr Oyer, tomorrow I am going to be an attending, doing cases on my own. Without your continually supervised, corrected perfection, what am I going to do?" He looked me straight in the eye. "You're going to put your bites too big and too small." He was right, but I recognized it. It is essential that we as educators build into our trainees' mindset the capacity for self-assessment, the ability to understand how even what we may consider the most minor of actions, both in and out of the operating room, can have a profound impact on those around us. Both positive and negative.Later that night, I finished packing up the house. It was pretty hectic, but my sons Tyler and Justin did their best to not get in the way. We woke up very early the next morning. I settled the boys into my Chevy Cavalier just before dawn. We were all a little nervous. Our life was going to change, forever. I remember, like it was yesterday, watching Tyler look out the backseat window at the dark morning sky. Before we drove off, with a thoughtful gaze, he stopped me as I sparked the ignition, "Dad, is this an adventure?"According to Webster's Dictionary, an adventure is an exciting and dangerous undertaking usually involving unknown risk. Adventures are typically bold with the potential for significant loss and are undertaken to create psychological arousal or to achieve a greater good such as the pursuit of knowledge. Adventures generally involve narrow escapes with bravery dependent on acts of great courage, founded on intelligence, skill, and good fortune. Does that sound familiar? Is cardiothoracic surgery an adventure? It is without a doubt a challenging quest. The journey into our specialty is protracted and arduou...