My Experience in Surgical Residency

During my surgical residency, it was common to work long hours without adequate rest. I trained in an era when restrictions on working hours for residents were not in place. We worked tirelessly, even on holidays, often completing grueling 36-hour shifts every few days. While this experience taught me to cope with sleep deprivation, it wasn't the most effective way to prepare a new doctor for a long career in surgery.

After enduring four exhausting days on call, I found myself back at work on a Monday evening, still grappling with the cases that had accumulated. I was attending to a patient—a senior man who had arrived at the emergency room with puzzling abdominal pain. My task was to perform an upper endoscopy to rule out a stomach ulcer.

However, my findings revealed a large diverticulum in his small intestine. While these outpouchings are generally harmless, the appearance of this one raised concerns. I dismissed the procedure as unremarkable and hurried to see my next patient, barely making it home to tuck my children in before collapsing into bed.

The Realization

The next morning, I woke up before my alarm, and the thought struck me: "That wasn’t just a diverticulum." When I resumed my rounds, the elderly man's condition had deteriorated—he was now experiencing nausea, vomiting, and a rising fever. I felt a wave of dread; I had likely overlooked something critical.

I ordered an X-ray of his abdomen, and as I continued my rounds, I couldn't shake the feeling that I had missed a crucial diagnosis. The X-ray later confirmed my suspicions, revealing the true issue: a gallstone that had eroded through the gallbladder and caused an obstruction.

This oversight was not due to a lack of knowledge; it was a direct result of my exhaustion.

The Dangers of Prioritizing Busy

In this situation, my preoccupation with busyness hindered my ability to perform at my best. Being overworked left me without the time or energy to analyze my patient’s symptoms thoroughly. Instead, I rushed through the endoscopy and moved on to the next case.

My fatigue clouded my judgment, preventing me from recalling vital information when I needed it most. The answer came to me easily only after I had rested; the exhaustion had impaired my performance.

Busy Does Not Equal Effective

Ultimately, I failed my patient because I failed to prioritize my own well-being. I had to realize that my most significant responsibility was to take care of myself. In my profession, I abstain from alcohol when on call, but working while sleep-deprived equated to being functionally intoxicated.

The societal norm celebrates busyness as a sign of success, but this mindset can lead to detrimental outcomes. Many people equate constant activity with being valuable, but this is a misconception. True value lies in effective performance, not in simply being busy.

The Misconception of Busyness

People often view overwork and fatigue as badges of honor, boasting about their long hours and exhaustion. However, being excessively busy does not equate to being essential or successful. Instead, it can detract from the quality of your work and well-being.

Being overbooked and under-rested does not demonstrate your value; in fact, it may indicate the opposite. The acceptance of overwork in society does not lessen its harmful effects. My patients deserve a surgeon who is fully present and capable, and anything less is a disservice.

The Need for a Cultural Shift

We must stop measuring value by busyness. Success should be defined by how often we show up at our best and deliver 100%. Working long hours without being fully present only leads to incomplete work, requiring more time and effort to fix later.

Delays in my patient's treatment resulted in a longer hospital stay and additional complications, adding to my own workload. If I had been at my best from the start, I could have prevented much of this additional stress.

Recognizing the Importance of Self-Care

I didn't learn this lesson overnight; it took years for me to understand that caring for my patients starts with caring for myself. We must prioritize how often we perform at our best rather than how busy we are.