Share How They Decompress After an Intense Surgery
As a surgeon, you need to be ready to perform at your peak for hours on end, day in and day out. While the intense nature of your job requires you to “turn on” at a moment’s notice and a small amount of acute stress may actually enhance performance, it’s just as vital to decompress afterwards. Failure to do so can have devastating consequences both in the O.R. and in your own quality of life. Studies show that burnout rates among surgeons range from 30% to 38%.
Below, 9 surgeons share the habits, rituals and routines they turn to After an intense surgery:
Dr. Lee L. Q. Pu, MD, PhD, FACS
Dr. Pu performs facial, plastic,
and reconstructive surgery at the University of California-Davis Health in Sacramento, where he
is also a professor of surgery.
“The complex microsurgeries I perform can easily take anywhere from 10 to 15 hours. I’ve been at this a long time—I’m 60 now—and I swear by the old adage, ‘Prevention is the best cure.’ The more I can stay relaxed during surgery, the less I need to decompress afterward. Sometimes there’s just no time.
I can recall one particularly stressful surgery where I’d worked with my thoracic surgery colleagues to help perform an esophageal reconstruction and the patient ended up turning his neck in his sleep and developed a hematoma in his neck. It was a Sunday and I had to come in and do an emergency revision. Blood was everywhere. I worked on that patient all day, and then I had to turn around go immediately to my younger son’s birthday dinner.
Dr. Dane Wukich, MD
Dr. Wukich is a professor and the chair of the orthopaedic surgery department at University of Texas Southwestern Medical Center. He also holds the Dr. Charles F. Gregory Chair in Orthopaedic Surgery and is the medical director of orthopaedic surgery at University of Texas Southwestern Hospitals.
“One of the aspects of a surgeon’s job that people don’t necessarily understand is the way the cumulative stress catches up with you over time. I had to make the decision to amputate a young woman’s leg intraoperatively, which was just terrible. I’ve been a war surgeon performing amputations in Iraq. When your adrenaline is flowing, you don’t realize how stressed you are until much later, when you’re back at home and it hits you all at once.
Over time, I’ve developed strategies that help me ‘erase the blackboard’ at the end of the day. For example, in the notes app on my phone, I’ll type in a few lines of scripture that resonate with me. Between surgeries, I might sit in the lounge and read that while I have a quick cup of coffee to regroup.
I enjoy taking a break to sit down with someone, not necessarily another surgeon, but maybe an orderly or a nurse, and talk about something that has nothing to do with surgery. Asking someone else about their family or how they’re doing is a nice distraction that really recharges my batteries.
I also find it helpful to inject some movement into my day. Even if I don’t have time to get outside, just walking around the perimeter of the O.R. or doing laps in the hallway with music on my headphones and a coffee cup in my hand helps keep my adrenaline in check.”
Dr. Gregory J. Jurkovich, MD
Dr. Jurkovich is a distinguished professor and vice-chairman at University of California-Davis Health in Sacramento, where he serves in both an administrative leadership role and is also active in acute care surgery.
“Leaving work behind at the end of the day is a learned skill. Simply sitting in the car for a couple of minutes helps me regroup before I start the ignition and drive home. I might spend that time doing some mindful breathing with the Headspace app, or I might just pause and ask myself what’s next and what I need to focus on right now.
Dr. Benjamin Levi, MD
Dr. Levi is an associate professor in the surgery department at the University of Texas Southwestern Medical Center. He also serves as the division chief of burn, trauma, acute, and critical care surgery and holds the Dr. Lee Hudson-Robert R. Penn Chair in surgery and plastic reconstructive surgery.
“Our entire department is using Positive Intelligence, a program that’s made a tremendous difference in multiple areas of my life, including helping me be more present when I leave the O.R. It teaches you to identify your ‘saboteurs,’ or your limiting beliefs and attitudes, and gives you the skills to keep them from interfering with your work and relationships by using a positive approach.
It’s been about a year since I went through the six-week curriculum, and I still use the app to access daily, mental fitness exercises. The exercises range from 2 minutes to 12 minutes, so I can do one even if I only have a small chunk of time as I’m walking down the hall after a surgery.
Going through the program and doing the exercises take time, but in the long run, you save time because you’re avoiding acting from a reactive place and making critical errors as a result. As I’ve become more self-aware, I’ve not only become a better surgeon and colleague, I’ve also become a faster runner and improved my relationships outside of work.”
Dr. Jeffrey Upperman, MD, FACS
Dr. Upperman is a professor and chair of the department of pediatric surgery, vice chair for pediatric surgical services, at Vanderbilt University Medical Center, and surgeon-in-chief at Monroe Carell Jr. Children’s Hospital.
“The most stressful part of my job isn’t necessarily performing surgery. It’s walking with families during some of their most difficult moments. Whether they’re dealing with a new cancer diagnosis or a bad car crash, I’m caring for parents’ most prized possessions, their children. That’s a lot of pressure.
My one-mile walk home really helps me leave a hard day or a stressful interaction behind. Usually, I don’t listen to music or a podcast or anything. I’d rather listen to the birds. By the time I get home, I walk in the door feeling rejuvenated.
Prayer is an anchor for me as well. I find it really grounding to pray after a stressful moment. I also might read something spiritual or listen to a short sermon or gospel music on my phone while I’m walking or hopping on the treadmill during short breaks in my day.
Dr. Tito Vasquez, MD, FACS
Dr. Vasquez performs plastic and reconstructive surgery, cosmetic surgery, microvascular hand surgery, and breast reconstructive surgery at Yale Medicine, where he is an assistant professor of plastic surgery.
“Music really helps me switch gears after surgery. As an undergraduate, I minored in jazz and I’ve played in a band during college. I play piano, keyboards, and a little bit of saxophone. I’m also working on learning the guitar. Everyone in my family, including my two teenage kids, plays multiple instruments, so it’s fair to say music
is a huge part of my life.
”I think the ability to be fully present following a tough surgery is an acquired skill but listening to music on my commute helps me put some distance between myself and my work. What I listen to depends on my mood, but it could be jazz, classical, pop or country. While I’m driving and listening, I think back to the surgery and reflect on how it went.”
Dr. Justin Sacks, MD, MBA, FACS
Dr. Sacks is the Shoenberg professor and chief of the division of plastic and reconstructive surgery at Washington University in St. Louis.
“One of the most difficult challenges I’ve faced in my career was performing two intense surgeries back-to-back. The first was a total scrotal and penile transplantation we performed as a team on a wounded warrior. I was up until the early hours of the morning, got into bed for a few hours, and woke up to do a scheduled bilateral breast reconstruction. I returned home that evening, physically and mentally exhausted after working for many hours. However I knew I was part of changing lives for the better.
It’s really important for me to reset myself at the end of every day so I can come in the next day and do it all over again. Surgery is like the tide; sometimes the waves are big, sometimes they’re small, but they never stop, and we have to find ways to deal with the waves as they come.
My car is my sanctuary. I use the drive home from work in my Tesla to decompress. My phone goes into driving mode automatically so I don’t receive calls or text messages. I like to listen to podcasts about electric vehicles and science in general or else I’ll listen to the American composer Phillip Glass.
Dr. Ken Egol, MD
Dr. Egol specializes in orthopedic surgery and orthopedic trauma surgery at NYU Langone Health, where he’s the orthopedic surgery chief. He’s also the Joseph E. Milgram professor of orthopedic surgery and vicechair of academic affairs at the NYU School of Medicine.
Like anything else, as a surgeon, the more practice you have the better you get — and the more frustrated you are when things don’t go well. But the fact is, things are always going to happen that aren’t in your control. That’s life. Sometimes a surgery takes longer than you expect. But the fact that my kids are now out of the house reduces some of the stress; I’m not worried about trying to make it home for their band concert or sports event or something like that.
But I can honestly say, I’ve never felt burnt out in my life and I think part of the reason why is the varied nature of my role. In addition to working in the O.R., I also teach, research, and publish. I love coming to work every single day.”
Dr. Lee L. Q. Pu
Dr. Benjamin Levi
Dr. Gregory J. Jurkovich
Dr. Tito Vasquez
Dr. Jeffrey Upperman
Dr. Ken Egol
Dr. Justin Sacks
According to Shapiro, consistently taking steps to unwind after surgery can pay huge dividends. We talked to nine general, plastic, and trauma surgeons to find out how they decompress after intense surgeries so they can transition to the next patient or re-enter active roles as parents and spouses.
But high stress doesn’t necessarily have to cause burnout. “Some surgeons enjoy long exposure to high stakes procedures and even if they find them tiring—also find them invigorating,” says Dr. Dan Shapiro, PhD, clinical psychologist and CEO of DES Health Consulting. In fact, the research shows that many surgeons don’t mind a work-life balance that tips more toward work than life, as long as the work environment is supportive and as long as they have access to outlets including exercise, friendship, and intimacy. “The absence of these can lead to worsened health,” he notes.
If possible, I take a quick break mid-surgery to have a snack or use the restroom. It’s unorthodox but stepping out, even for a moment, keeps me sharp during a long surgery. I always wear compression socks and super supportive shoes to minimize the physical stress of standing for long periods. I also get regular massages.
When time permits, I run or swim right after work before heading home. Even a 20-minute workout is enough to clear my head and make me feel refreshed.”
When I need to clear my head during the workday, a ‘micro nap’ often does the trick. I’ll sleep for 5 to 10 minutes anywhere I can find a bed. Sometimes that’s an empty patient room or on a gurney. If I have time to make it to my institution’s designated nap area, I’ll head over there. It’s not as close as it used to be but I don’t mind the walk; having some physical distance from the O.R. helps me re-center myself.”
“I also find it helps to talk through a challenging work situation with friends outside of my organization or even in other professions. They might offer a solution I would never have thought of because they’re coming at it from a different perspective.”
“You need some time to decompress and unwind after a big surgery. I work in the city and live in the suburbs so I use the drive home to think about things that went well, things that could have gone better, and how I can be more efficient next time. I’ll usually do that with talk radio or sports in the background.
I also sketch the details every single operative procedure I’ve ever performed in a Moleskine notebook with a black Muji pen, which in my opinion, is the best pen on the planet. After surgery, I jot down general details of the surgical procedure. It helps me learn and become better. It also makes me remember the human condition and cherish my time helping.
Even when I know my wife and kids need me at home, I’ll still take 5 minutes to complete this ritual. It helps create a visual memory of every single patient I’ve ever touched in the operating room. Doing it the same way every single time feels spiritual to me.”
Dr. Nilda Garcia, MD, FACS
Dr. Garcia is chief of the division of pediatric surgery, a professor in the department of surgery and perioperative care, as well as the surgeon in chief and medical director of children’s surgery at Dell Children’s Medical Center at the University of Texas at Austin.
Dr. Nilda Garcia
But even with years of experience, I can’t help thinking about my patients when I get home from work. For me, that preoccupation never fully goes away.
That said, I got into tending bonsai trees about 14 years ago and it has been such a joy.
Caring for the bonsais complements my work really nicely because, like surgery, it requires attention to detail plus lots of different gadgets (and I have many). But it also serves as an outlet. I get to be artistic and take my time without the pressures of the O.R.
“Over time, I’ve developed the self-awareness to notice when I’m getting stressed or agitated. When I find myself taking shallow breaths, that’s when I know I need to shift gears. If I can, I go into my office, close the door and just relax.
Plus, the bonsai tree community gives me the chance to meet people I would never normally socialize with; I’ve made friends with a jeweler and a photographer. I have so much fun connecting with people outside of the medical community.”
Dr. Dane Wukich
Dr. Lee L. Q. Pu