Yes, I’m a Surgeon and Yes, I teach Mindfulness

At the most recent ACS Clinical Congress, I was really struck by a presentation on mindfulness given by Sharmila Dissanaike and asked her if she would be willing to write about the topic for wellnessrounds.  To my delight she agreed!



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The recent #Ilooklikeasurgeon phenomenon reminded me that times do indeed change – albeit slowly. The peak of this phenomenon happened to coincide with my talk at the American College of Surgeons on “Mindfulness for Stress Reduction and Burnout Prevention”. If you had told me 10 years ago that I would one day deliver this brief lesson in stepping off the treadmill for a few moments, I would have said you were crazy. Surgery was only for the tough, and the tough don’t need breaks (or so we thought). As a woman surgeon, it was even more important to me that no chinks show in the armor, and being a trauma surgeon proved an easy way to solidify my “street cred” despite being a 5”2’ little brown woman with long hair.

So it has taken a while for me to feel confident enough to broach such a “soft” topic in a public surgical forum. Obviously age and (a little) wisdom has probably helped, but there is also a tangible change in the prevailing culture of surgery as exemplified by the #Ilooklikeasurgeon movement and other similar initiatives; where calling for help is no longer an (automatic) sign of weakness, and the surgical community has accepted that the good old days (or bad old days, depending on your perspective) are well and truly over. The next generation of surgeons is currently being greeted with much hand wringing and wailing and gnashing of teeth, for how could a group of kids raised in this limited workhour era possibly achieve the heights of excellence that the “old school” surgical residents achieved? Since the switch to 80-hour workweek happened exactly midway through my residency, I have the privilege of a foot in both worlds, and while I agree that our training paradigms do have to change, I am not yet ready to concede that the golden age of surgery is well and truly behind us. Partly, this is because of the audience that gathered for the session at ACS. What stunned me even more than the opportunity to speak on mindfulness was the full house that gathered for this session, and the enthusiasm and interest generated by a wonderful audience of men and women of all ages, and in nearly equal proportions – it embarrasses me to admit that I had expected to be speaking to a handful of younger female surgeons. Instead, I met the 65 year old broad-based general surgeon who came because he recently lost a younger orthopedic surgeon colleague to suicide – by stabbing himself through both femoral arteries, with surgical precision of course. I met several Governors of the College, who were in the classic “grey haired” demographic, and yet optimistic and enthusiastic about the future of surgery, and the improvements to be had by focusing more on our wellness – that “healing the healer” would have tangible results not just for our own wellbeing but also that of our families and our patients, and was thus an obligation, not an option. I met young surgeons a few years out of residency/fellowship who had already recognized the need for maintaining their own mental health in order to remain functional for as long as possible in order to maximize the productivity to be gained from their long training – working less was certainly not on their priority list. There was clear recognition of the systemic problems that drive a lot of surgeon frustration with ensuing burnout – bureaucracy, being treated as interchangeable expendable cogs in a machine, electronic medical records and endless paperwork topping the list – and yet there was also an acknowledgement that adjusting internal cognitive factors was at least as important for wellbeing as it was to try and change some of the external factors.

The methods I teach are focused on building resilience and capacity – characteristics that are both innate and learned, which can be developed and expanded through meditation and other techniques. One of my favorite analogies is that a spoon of salt in a cup of coffee renders it immediately unpalatable; the same spoon in a river or swimming pool would not be noticed. The spoon of salt represents the unavoidable daily irritants in our lives – the cases that run late, the scrub tech who doesn’t know what instruments you use, the colleague who lets you down in a key meeting. The cup of coffee of course is us – or at least, where most of us start. Instead of spending our lives either trying to avoid all these frustrations (which is futile) or becoming upset when they happen, mindfulness can increase our capacity to be with them fully, accept them for what they are and yet respond thoughtfully and effectively instead of blindly and automatically reacting with anger or frustration (which usually only causes us more trouble in the long run). Over time, we develop an increased capacity to handle irritation without it placing us in a perpetual bad mood, and increased resilience to bounce back from the inevitable traumas of life, both personal and professional.

So why teach mindfulness to surgeons, when there are plenty of other things I could be doing that would probably be more directly beneficial to my career? Because I do believe that the biggest waste of potential is to take a motivated young person, put them through the grueling training to be a surgeon, set them out on a career that is of such benefit to society, and then allow them to flounder and become discouraged 5 – 10 years later, quickly discarding those hard-earned skills as they turn into full time administrators, wound care docs or some other alternate career path. Not that there isn’t value to these professions of course, and some people do realize at a late stage that they are better suited to another path – in which case all of these are excellent choices. But too often it is one bad outcome that leads to a malpractice suit, or some other event that proves just too difficult to handle, that completely derails an otherwise excellent surgeon and this lack of coping – the lack of capacity, and resilience – leads to a complete abandonment of what should be an intrinsically rewarding career.

If mindfulness, meditation and other strategies can help even one surgeon regain a wider perspective and avoid this outcome, then it will have been a worthwhile endeavor.


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Dr. Dissanaike is a general surgeon with primary focus in trauma, burns and critical care, and a Professor at the Texas Tech University Health Sciences Center in Lubbock, TX. She serves as Medical Director of the Level 1 Trauma Center and Co-Director of the regional Burn Center. She has an interest in ethics and humanism, and is on the ethics committees of both the American College of Surgeons (ACS) as well as the American Burn Association.

Last Minute Halloween Costumes

Today’s discussion in the OR lounge was about Halloween costumes …. Great ones we’ve seen in the past and last minute options for procrastinators.  I thought I’d pass on a few ideas!

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 An all white outfit (WBC), an all red outfit (RBC) and  – if there is a small person in your trio – purple for a platelet.


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BDU (camouflage) shirt with black pants = upper GI

Black shirt with BDU pants = lower GI.


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And a few more ….

Go as the game “Operation”


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Create a simple costume to go as an Immuno-goblin

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Staphylococci and Streptococci (best done as a pair!)

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Identity Thief

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Please use the comments to add other great costumes you have seen or worn. Even better, send photos for next year’s update!  HAPPY HALLOWEEN!


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Don’t Lose your Wedding Ring!

“I can’t go home.”


“I’ve spent the last 3 hours with the folks in the laundry room trying to find my wedding ring, but I think it’s really gone.”

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One of the lesser-known hazards of working in a hospital is that you have to take your wedding ring off to scrub for procedures.

I started with tying my rings into the drawstring of my scrubs … then moved to the “watch band” method.  I use my badge lanyard now – which I think may be the most secure solution yet.

IMG_0432Even though I’m happy with my solution, I thought it might help to poll my colleagues to see what they do.  After looking at their responses (below) , I realized that the most important thing is to develop a routine – i.e. do it the it the same way every time. And, while you are at it, make it a ritual to remember and be thankful for the support you have at home!

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1. Tie it to your scrub pants.

“Tie it to my scrub tie”

“I tie it on my scrubs with about 5-6 surgical knots.”

“I tie it in my scrubs. I tried the necklace thing but found it too cumbersome.”

“Take it off. Tie in drawstring of scrub pants. When changing, never set it down. Finger-drawstring-finger. 46 years without a hitch.”

“I tie it to one of the ties on my scrub pants, that way it doesn’t fall off when I untie… and I check it on my finger like I check my pager on my hip.”

“Tie watch, wedding and college rings in drawstring of scrub pants.”

“Tie it to my scrub ties with a square knot (after losing my ring 3 months after my wedding). Does require some planning if you need to hit the head quickly between cases!”

“Tie it onto your scrubs. Can’t get your pants off without getting your ring.”

“When tying your pants, do the bow. Then double knot it through your ring. As of today, has worked for me for 33 years.”


2.  Put it in a pocket

“ I used to tie mine in my scrub ties, but that got cumbersome and I was afraid I’d toss it by mistake. I toss it in my back pocket, which seems not terribly secure, but it works for me. ”

“Back pocket – also lost a ring a few years after my wedding. Now going on 28 years with the same ring.”


3. Put it on your watch band (which then goes on your scrubs, on the desk, in your locker or in your loupe box)

“The best may be to put it on your watch band and tie your watch to your scrubs. That way you would know it was there.”

“Put it with my watch in my loupe box. I wear loupes for every case so that works. If you don’t… it may not be as effective.”

“I tie it to my watch and leave it in the locker!”

“Put it on my watch band.”

“Put it around watch band which I tie to scrub pants drawstring while scrubbing.”


4. Put it on a chain or lanyard

“I used to tie it on my scrubs but lost it one night in L&D. I got home and noticed it was not on my hand, went back to L&D, and found it under the couch but since then I got a silver neck chain with an easily accessible latch that I thread it through right before tying my mask.”

“After losing several watches tied to my scrubs I wear wedding band, engagement ring and bootie for each child on chain around my neck.”

“Necklace. I always wear the same one.”

“I wear mine on a necklace when I scrub. Got a nice one that I trust will not break. 7 ½ years so far….”

“Necklace that my wife bought me for this very purpose. Tried putting it in the scrub pocket, but inevitably it would end up on the floor in a dirty OR”


“Colleague put hers on necklace, but technically doesn’t meet OR dress code (although it was a long chain, hung inside her scrubs).

“I clip it on my ID lanyard.”

“Use a necklace made for this.”

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5. Put it in your wallet

“I have a key case with a zip compartment for coins and ring – though I must admit I am on wedding ring number 2 (I suddenly had to jump into a case to help with bleeding – the ring went into my scrubs pocket and that was it.) Fortunately my wife made my second ring herself – am taking extra care.”

“Place it inside my wallet, which then goes into my back pocket.”


6. Put it in your loupe box

“I put it in my loupes box with my watch and regular glasses – but I wear loupes for every case. Over the years, I’ve had to go searching through dirty scrubs too many times when I forgot to every attach it any way to my scrubs again!”


7. Pin it to your scrubs

“Hang it from the over-sized, decorative pin that your wife gave you.”

“I use a safety pin on my bra strap. You may have to change scrubs, but I’ve never had to change the former!”

“I always pinned it to the front of my scrubs, but the real motivation to not lose it was to envision the slow and painful death I would face if I did!”

“Diaper pin on the outside of scrubs where the back part of pin passes behind your bra strap so pin must be removed to get scrub top off.”


8. Wear something other than the “real” ring

“I wear a comfort band to work instead of my fancy ring.”

Wear silicone rings or other cool alternatives

“Bought a back up (I lost mine 16 years ago, but mine had never been in outer space like yours.)”



9. Leave it at home

“I leave my ring at home on OR days.”

“No ring on OR days.”

“Leave it at home.”

“Lost two; leave at home on OR days. If I lose another, I’ll replace on the sly… :-) 17th anniversary Saturday.”

“Always left it at home.”


10. Find a different but creative alternative.

“Duh. Loop it thru your belly ring.”

“Get a ring tattoo”

“I had parts of my ring used to reconstruct earrings, so I guess you could say I wear mine on my ear.”

Use A carabiner – can clip to lanyard, necklace or leave in locker.

Use unique solutions like the RingCling

Tie it to your shoe.


11.  Don’t worry about it.

“If you’re my husband, you lose it and don’t look back. At least he still loves me. :-)”

“I lost two and gave up.”

“No longer wear one after losing my third. Gave up.”

“I’m not very successful with keeping my wedding bands. But I don’t care cause I’ve got the same loving guy for the past 43 years!”

“After two diamonds and three bands – and a first name basis with Alan, owner of the antique jewelry store near me – I just don’t fret too much. It’s the love, not the gold, that counts.”


And as I final note…

“If so many people have lost rings, where do they all go?”

“They go join the lost orphan socks of the world.”

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It’s the First Day of Medical School – What Should I Do?

I’ve written before about what to do before medical school starts, how to study in medical school and strategies for succeeding in the basic sciences. But how do you put this information about organizing your studying and your day into a system that works?   Everyone will have variations on how they do this, but there are some fundamental principles that apply to all.


Don’t get behind

From day one, the material matters and, from day one, it is voluminous. If you get behind, it’s really hard to catch up.

Study, don’t just read and reread.

You have to actively engage this material and review it (multiple times) to really learn it. You are no longer studying for a test, you are studying to take care of other people. The SQ3R method is used by many students, but there are other systems as well. What is important is to develop a system that works for you.  One tool used by many students is Anki, software that allows you to create electronic flashcards to review key points.

Tips on active studying from UCSD

Tips on active studying from the University of Utah

 Use going to class as time to “study”

One of the important components to active learning is to review the lecture material before it is presented.  This is the opposite of what most of you experienced in college, but it’s key.   Survey the handouts or slides and make a list of the important points to be covered. Stay actively engaged.

p.s. You can’t learn medicine if you are on Facebook in class.

Create a summary page for each lecture

Include the big concepts, and key points. Include specifics that are stressed by the professor, but avoid listing all the details. You may choose to hand write this, but most of you will come up with an electronic format and will organize the class notes, and your summaries using One Note, Growly or an equivalent software. Although your personal notes are fine on the cloud, don’t put copyrighted material or your professor’s slides where other people can see them (it’s illegal).

Begin with the end in mind

In the long term, what you are learning (yes, all of it) will be applied to taking care of patients. In the slightly less long term, you will be tested on this information on the USMLE Step 1, a high stake exam and the first part of your medical license.   Although some dedicated time to study for Step 1 is important, having a system to really learn the material in your basic science courses is by far the best way to do well on this exam.

Don’t sacrifice sleep.

If you don’t sleep you don’t learn as well. Organize your schedule so you get at least 7, but preferably 8 hours of sleep every night.

Eat well, play hard and stay connected.

Clay Goodman,MD the Associate Dean of UME at Baylor, tells our first year class that the first year of medical school is a 60 hr/week job. They need to get up in the morning and “go to work”, using the afternoon and evening to study. He then points out that if they work 60 hours and sleep 56 hours (8 hours a night) they still have 52 hours to work out, spend time with family and friends and do whatever else they want.


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So, what should you do the first day of medical school?

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Here’s what your schedule might look like…

The night before – pack your breakfast for the morning break and lunch for the next day. Review any posted slides – survey them to understand the “big picture” and use them to start your summary of the lecture. Write down what you don’t understand from the slides (yes, at this stage it may be every line… but that will get better!).

7am – wake up (If you prefer morning workouts, you can get up earlier and workout before class)

7:30 Grab a piece of fruit or a smoothie if you don’t like to eat an early breakfast. (If you are ok with it, eat the full breakfast now, but whatever you do, don’t skip breakfast)

8-12 Attend class – Stay engaged. Take notes, make sure the questions you asked yourself in the review are answered, raise your hand and ask questions if they weren’t. Eat your breakfast or a snack at the 10 am break.

12-1 – Lunch with your classmates. Play foosball, talk, or just eat, but take a real break.

1-5 Study. One hour of studying for each hour of class is about right for most people.   This may need to go until 6 or 7 if you have afternoon labs.

7 – Workout and then make and eat dinner. Working out is an important part of self-care. Exercise is essential to decrease stress and also will help you avoid the “freshmen 10”. Your dinner should be healthy, not processed, and definitively not Ramen noodles. Make sure you have fruits and/or vegetables at every meal.

9-10 Look over tomorrow’s lectures and start your summary pages for those lectures. Once you are a week or two into this, you’ll be adding in reviews of material from previous weeks on a schedule.

10-11 Read a novel, watch TV, decompress.

11 Go to sleep!

You are starting on one of the most amazing journeys any human being can have… enjoy it! Don’t forget to keep a journal and take photos (but not of patients). The first time you actually interview a patient, put on your white coat, hear a heart murmur or take a test in medical school are just that … the first time. Write about the experience.

Let me know in the comments what other advice you have for the students starting medical school this summer!



Letters of Recommendation: Advice for Faculty

It’s the time of year when fourth year medical students have decided on their specialty and are working on their applications to enter the NRMP match.   It’s also the season that faculty are asked to write letters of recommendations. With approximately 17,000 medical school seniors applying, there will be around 100,000 letters of recommendation written this year!


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If you have had the benefit of sitting on a residency committee to evaluate and rank applicants, you’ve read these letters – and you know that they matter.   If you haven’t had that experience, it will be important to seek advice on how to write these important letters.  Seek help from other faculty with more experience or review the great advice posted by the University of California- San Francisco and the University of Illinois Urbana-Champaign.

A few other points that may help:

  1. This year, for the first time, faculty will have to upload these letters themselves. You can have a “designee” (your assistant, for example) do this for you – but it cannot be someone in the Office of Student Affairs. Make sure you get started early so it doesn’t become an issue as deadlines approach! The help desk at the AAMC is wonderful, but it’s going to be a problem if you wait until the last minute!
  1. Proofread. Twice. This is the first year that the Deans in your school won’t be able to look at your letters.   No one means to make mistakes…. but in years past, I’ve found letters with the wrong names, the wrong gender and grammar that only sort of made sense.   Needless to say, for the Program Directors it raises a question about whether your letter is legitimate.
  1. Instead of having the students worry (think back…. you worried, too), let them know when you plan to upload their letter. Regardless – make sure they are uploaded by September 1st.


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On behalf of all the students you are helping, and all the departments who rely on your letters to help match students to their programs – thank you!!


Resilience, Grief, and Remarkable Wisdom

My heart breaks for Sheryl Sandberg’s loss of her husband … and I am so grateful for her honesty, her wisdom and for the effort it took to share her journey. As I read her post on Facebook today, I realized that all of us in medicine could benefit from her thoughts as she ends sheloshim, the Jewish 30 days of mourning for the loss of a spouse.

One of the things that is so hard to teach in medical school (and all other health professions) is to honor the resilience of those we accompany on their journey through times of struggle and loss.  It is so hard to let go and realize there is nothing to “fix” in these situations. Far more important than trying to convince our patients, their families or our friends that it will be “better” or that there is “hope”… we need to commit to just being there with them, and walking with them on this very human… but incredibly hard journey.

“I have learned that I never really knew what to say to others in need. I think I got this all wrong before; I tried to assure people that it would be okay, thinking that hope was the most comforting thing I could offer. A friend of mine with late-stage cancer told me that the worst thing people could say to him was “It is going to be okay.” That voice in his head would scream, How do you know it is going to be okay? Do you not understand that I might die? I learned this past month what he was trying to teach me. Real empathy is sometimes not insisting that it will be okay but acknowledging that it is not. When people say to me, “You and your children will find happiness again,” my heart tells me, Yes, I believe that, but I know I will never feel pure joy again. Those who have said, “You will find a new normal, but it will never be as good” comfort me more because they know and speak the truth.”

Thank you for your wisdom, Sheryl.   We will hold you in the light.

Rabbi David Wolpe: What Sheryl Sandberg’s Post Teaches Us


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“We are all just walking each other home.”  Ram Dass

Fast, Easy Healthy – A Couple Cooks

One of the keys to wellness for medical students, residents and physicians is to cook. Sorry, but it’s the truth. Eating nothing but fast food, pizzas at conferences and “free” food in the hospital is just not good for you!

I developed the “pizza rule” years ago for myself and my trainees. It’s important to cook food at home … but who really has the time? I realized that we had to find recipes that took less time to cook than it takes to order a pizza.

This week I discovered A Couple Cooks– a great website by Sonja and Alex, a couple who taught themselves to cook together and now share their recipes and ideas for others.


Enchilada skillet


Tropical Mango Salad with Creamy Cilantro Dressing and Grilled Shrimp


Lasagna Stuffed Zucchini