Life is hard, Part 2

In my previous post, I discussed that by accepting that life is difficult, we have taken the first step to preparing ourselves for those difficult times. 

This is not a new concept. In fact, the first of the “Four Noble Truths” that Buddha taught is that “Life is Suffering.”

The Myth of Sisyphus is an essay by French philosopher Albert Camus. It analyzes the Greek myth of Sisyphus who was condemned to the underworld to roll a giant boulder up hill, only to have it roll back down and for him to start again. At the outset, all of us would think of this as the ultimate punishment. It would seem as if you could never reach a state of contentment. However, Camus argues that one could imagine Sisyphus happy. How could that be? He suggests that Sisyphus was able to find happiness only after he acknowledged the futility of his task. After that, he was freed to reach a state of contented acceptance.

Really? Happiness?

His task is not much different than the series of tasks that we all face in life.  We all have difficult tasks, whether it is in our jobs, our family, or simply our home life. We work hard to get these tasks done, and before long, there is a new task at hand. Just because our lives are taken up by a series of difficult tasks, is that a reason for despair? Are we to think of ourselves as condemned to the underworld? I think not.

Happiness is achieved by taking pride in the accomplishments of our individual achievements. Conversely, happiness is hard to find if all we do is focus on the fact that we have a lot of work ahead of us. In fact, it can be overwhelming to think of all the projects that need to be accomplished. There seems to be an infinite number of boulders to roll up the hill. In fact, there probably are. But, acceptance of that fact helps us to move on to something more important, which is doing a good job, and finding happiness at our current task. 

I like to think that Sisyphus focused on pushing the boulder up the hill each time like it was a new task. He could take pride in looking at the boulder sitting at the top of the hill. And by thinking this way, he was able to find happiness in a situation that seems awful.

Noted sculptor Donald Gialanella* was commissioned to sculpt an interpretation of the myth of Sisyphus, seen here. 

In it, Sisyphus is depicted holding a chain, in a never ending effort to hold up four solid granite slabs. Sisyphus must be proud to demonstrate that he is so strong that they never move. In the metaphorical sense, he is not really holding up the slabs. No, they are holding him up.


*http://www.donsculpture.com/

Life is hard

Surgery is hard. Of course there are always technical aspects which are difficult but I am speaking of something completely different. I think most surgeons will tell you that one of the hardest parts of their job is telling the patient and his or her family bad news. Certainly other specialties have this same issue. But somehow, taking a patient to surgery is usually viewed as a major, invasive step toward improving their lives. It is an aggressive intervention which at its heart, is designed to result in immediate gratification.

For instance, most patients with colon cancer go into the operating room with a tumor and leave the operating room an hour or two later without a tumor.  With or without the use of additional chemotherapy, they may be cured. However, if this scenario doesn't happen, it can be anxiety producing at best.

Not long ago I had a patient present with what appeared to be a “routine” colon tumor. At the time of exploration the patient was found to have tumor widely spread throughout the abdomen and was unfortunately completely incurable.* From a technical aspect, this operation was not hard. I removed the tumor in order to prevent intestinal blockage and sampled the tumor throughout her abdomen for microscopic diagnosis. Nothing there was technically difficult.

The difficult part of the operation came next. That was telling her friends and family the news. As it turned out, the patient had only recently gotten out of a 35-year abusive relationship, and the hope prior to this surgery was that she could live the rest of her life in peace. All that had changed now. The rest of her life would be spent with increased abdominal bloating as this tumor progressed, possibly toxic chemotherapy, and getting her affairs in order for her untimely death. The prognosis was months, not years, and months of pain, not happiness.

It's a terrible, sad situation. To somehow see hope or goodness in this is difficult. But, life is difficult and inherently, we all know that. It just sometimes takes situations such as this to make us remember that.

I find that as I get older, and hopefully wiser, I deal with these situations a little easier because I approach them with the underlying understanding that yes, life is hard. There are times in everyone's lives when we will experience pain, sorrow and sadness. Without that we would not be human. Without that, we would not know happiness. And, without that, we would not be real.

Life is hard. Approaching life with this attitude doesn't make sad times any less sad. But it does normalize it. And in some way, it helps me to put everything in perspective.

*some patient details are changed so as not to identify a specific patient

Pushing the Envelope, Part II. Life's Lessons

In my previous post, I commented about the need to push the envelope of surgical technique to continue advancement of the discipline of surgery. This is the argument against complacency. For complacency does not lead to advancement but to stagnation.


Life is not different. Like surgeons with careers of simply doing what they know, the rest of the world is equally full of people who keep the status quo. On the surface, these people may live very successful lives. But, where would we be if that is all we had? If we had no-one who pushed the envelope?


Examples of people who have pushed the envelope are easy. These are people who have gone beyond what might be expected in their respective careers. Take Bill Clinton. He could have stopped after leaving office. Certainly, after 8 years, he could have used a break. Instead, he started the Clinton Global Initiative. This organization convenes global leaders to devise and implement innovative solutions to some of the world's most pressing challenges. Impressive. Or how about Richard Saul Wurman, an author who founded TED (Technology/Entertainment/Design) conferences. TED now represents a global partnership of forward thinkers whose goal is to spread new ideas to change attitudes, lives and ultimately, the world. In short, they inspire people to push the envelope. Or, Lance Armstrong. Like him or not, doper or not, he has changed the face of surviving cancer.


My list could go on and on. There are surely millions who could be named. But we all know that the list of those of us who are complacent is a bigger one. Why?


One of my best classes in college was a philosophy class called "Man's quest for meaning." It included a diverse reading list, or seemingly so. But, as I delved into the underlying themes in each book, they all started to sound the same. The common theme was that people who are genuinely happy are those that dedicate themselves to a singular goal. And through that dedication to a higher goal, they find that they can in fact go beyond what would be expected.


Which brings us back to pushing the envelope. I believe that for us to progress as a society, we need to push the envelope, and encourage others to do the same. Whether it is in your job, in your hobby, or in being a good parent, spouse or friend, going beyond what might be expected will ultimately advance us to a higher purpose. And, happiness is sure to follow.

Pushing the Envelope

Complacency is extraordinarily common in every line of work. This is no different in surgery. Surgeons will commonly learn new techniques only after they have been widely published with prospective randomized placebo controlled trials. Less often, they will learn new techniques if there is a public demand. And even less commonly, surgeons will learn new techniques simply because they push the envelope of surgical technology.

A great example of this is SILS, or single incision laparoscopic surgery. This technique utilizes the same instrumentation and essentially the same operative technique as traditional laparoscopic surgery but it does so through one incision site which is hidden inside the belly button. As a result, patients get a virtually scar-less operation. This technique is being slowly adopted throughout the United States.

Surgeons are commonly reluctant to learn this new technique because it achieves only cosmetic improvement and makes fairly simple operations slightly more time-consuming and certainly more difficult. I learned this technique almost 3 years ago and immediately began to adopt this in my practice. Admittedly, it was a steep learning curve and no doubt added some extra time to my operations. However, as my technique improved, operative times decreased to roughly the same as traditional laparoscopic surgery.

Interestingly, I have noticed an added benefit. By pushing the envelope and forcing myself out of my comfort zone, I have become a markedly better technical surgeon. In all aspects of my laparoscopic surgical technique I have noticed better conservation of motion (a technical quality of no wasted movement; more efficient) and much improved surgical technique.

It is important to note that many surgeons will never learn this technique and will still have excellent outcomes and excellent patient satisfaction. So why would one want to do this? I propose two reasons.

First, I have come to realize that pushing the envelope and putting yourself outside of your comfort zone to learn new techniques is really an integral part of being a good surgeon. Without learning this technique, my skills would not have advanced as they have. I am convinced that my patients all benefit from this regardless of the operation they are getting.

Secondly, it contributes to the advancement of surgical care not only by improving one's general operative techniques but by pressuring technology to improve. Already, we have seen integration of single incision surgery and robotics and without the push towards the single incision movement this may not have been realized as quickly.

Currently, this technique is usually applied to the more routine operations, such as gallbladder and appendix removal. But, given the speed of technological innovation, it is reasonable to imagine most major abdominal operations being performed through one very small incision in the abdominal wall, and probably by robots with extremely small but versatile instrumentation. 

However, for this to happen, surgeons need to continue to push the envelope in not only their operative technique but also their forward thinking.

My opening remarks prior to a Cancer Benefit walk...

“Here’s looking at you.” We all know that great line from Humphrey Bogart to Ingrid Bergman in Casablanca. I tend to remember interesting lines from movies. How about “You can’t handle the truth.” That was Jack Nicholson yelling at Tom Cruise in A Few Good Men. Or how About this one. “Cancer.”

That's a bit more obscure. It was Judd Nelson talking to Alley Sheedy in an old favorite of mine called St Elmo’s Fire. In it, he said there are a few words that are just too awful to say out loud, so, you have to whisper them. Like, Mrs Smith has “cancer.” I thought that was pretty funny, and probably used that line a few times.

About ten years after that movie came out, I got that phone call that many of you here can relate to. It was my Dad. “Chris, I have cancer. Prostate cancer.” He didn’t whisper it.

Immediately the line “you can’t handle the truth” came to mind. How can my Dad have cancer? That can’t be right. But, it was.

After the initial shock, we talked frankly about it and planned our attack on it. And thanks to the great care of the doctors at Ohio State, he is still around to talk about it. That was 14 years ago.

Oddly, it was ten years after that phone call that got another call. This time it was my brother. “Chris," he said. "I have cancer. Prostate cancer." He didn’t whisper it either. Again, we talked, planned and called the docs at Ohio State. He too is cancer free to this day.

I don’t whisper the word cancer anymore. Because cancer is not about to go away if we shy away from it. It is a fact of life. A fact that all of you here are intimately familiar with.  We have all, in one way or another learned to handle the truth. The truth that cancer affects so many of us. The truth that cancer kills. The truth that cancer affects not only the lives of the people with cancer but the lives of all of their friends and family.

But, part of handling the truth is acceptance, and part of acceptance is learning that we can’t whisper the word cancer. We need to fight it. We have learned to fight by supporting programs that encourage early screening. We support research for better treatments. We support agencies that are there for the emotional and financial support of those families going through cancer. And, we simply provide our own personal support for those that we know that are going through it. It takes that sense of community to help us beat cancer and that is why we are all here today. We have learned to handle the truth. We don’t whisper the word cancer.

Here’s lookin at you.

POSTED AUGUST 2, 2010

• 0 responses
• Comment