Surgery, Passion, and the Medical Student

Not long ago, during the course of an interview for surgical residency, a medical student asked me how I determined which person would make the best candidate for that position. I reflexly responded to the student's question, but my response set me to thinking about the answer I gave. The answer was not one you or I might give after serious reflection. I did not enumerate those qualities that distinguish a superior surgeon: ie, high intellect, excellent hand-eye coordination, steady temperament, sound ethics, good moral character, and a large fund of medical knowledge. Rather the answer was one I suspect surgeons of all specialties could agree on with some unanimity. My answer to the medical student's question of what I sought in a person seeking a surgical residency, was, passion.

Surgery and all of its subspecialties grew out of a need “to see” disease, to understand it, and to conquer it. The men and women who developed surgery were talented, driven, and they uniformly sought excellence in their profession. It may be said that their “hearts were touched with fire.”¹

Because of a perceived passion for excellence, the public holds surgeons in high regard.² The privilege of performing a surgical intervention within the human body has attracted the best and brightest of our youth for generations. A surgeon, with rare exception, truly loves the practice of surgery. A surgeon will render operative care to the best of his ability, to the least of our society, day or night, regardless of the hours worked or patients seen. Most surgeons are dedicated to life-long learning. They read extensively and pursue postgraduate courses to maintain surgical excellence.

A statement by Justice Oliver Wendell Holmes in a powerful 1884 Memorial Day address encapsulates a life in surgery. “I think that, as life is action and passion, it is required of a man that he should share the passion and action of his time at peril of being judged not to have lived.”¹ To share the action and the passion of an operating theater is to experience life in brilliant focus. The pedestrian concerns of social station, economic advantage, and employment status are swept away in the grand drama of working in God's temple. A man or a woman is never the same after having been exposed to the purity of purpose found in an operating room.

The passion for a life in surgery begins by “wanting” to be part of that experience. The desire and the wanting comes through in an interview.

Many changes, though, are occurring in medicine. The influence of technology is being felt in all areas of the profession. Communications, computers, and access to vast databases are enabling physicians to manage disease as never before. A veritable stream of information is now readily available from previous hospitalizations, histories of illness, physical examinations, operative procedures, laboratory values, and X-ray studies that enhance the clinician's ability to understand the critical events leading to a person's medical disorder.

With the aid of video, audio, and tactile interfaces, a physician can now be integrated into this information stream in a manner unfathomable just a short time ago. In a sense, time and space can be dissolved. Surgeons can perform interventional procedures on patients remote from the operating room. Indeed, the patient can be in an adjoining operating room, in the next state, or in space. It does not matter; it can be done.

Powerful currents are at work, however, that threaten the integrity of medical practice. Declining reimbursement, longer work hours, increased patient load, and the “monstrous horrendum” of managed care have shaken the pillars of medicine.

Moreover, economic times have been relatively good. The world has not recently experienced a major war. The society of the United States has prospered, but our society has seemed to become more detached, more dispassionate. There are those who say that the political events of our day “define us down.”³ To excel does not seem to be as important as before. Our national figures and media seem to be more concerned with “parsing” information than examining the heart of it. The totality of a concept or of an experience does not seem to be as important as what the meaning of is, is.

But the totality of an experience is important. Passion in wanting to pursue a life in surgery is important. Surgeons, already established, can describe the feeling, but passion, as suggested by Justice Holmes, is best imparted by “contagion.”¹ Feelings do beget feelings, and great feelings beget great feelings. Our actions, our commitment to excellence, and our commitment to a life-long study of surgery can be imparted to our students by example. The “wanting” to become a surgeon can be nurtured and developed.

I have heard more than one surgeon comment with pride when a resident or trainee exhibited passion for surgery. I know that I, and those who I know best in graduate medical education, hold this quality most high.

Make note, the passion for surgery and the true wanting to become a surgeon can be observed during an interview process. Passion and a pursuit of excellence constituted the “fire in the hearts” of our surgical forebears. And as it was then, so is it now.