In the zone

One of the great joys of being a surgeon is the feeling of being in the zone.

“Flow” has been described as a state of complete absorption that is both immersive and enjoyable, resulting in loss of one's sense of space and time. Achieving flow is often colloquially referred to being in the zone. Named by psychologist Mihály Csíkszentmihályi in the early nineties, the concept has been widely referenced across a variety of fields though the notion has existed for thousands of years under other guises, notably in some Eastern religions. [1] Flow happens for some of us more often than others, and you may have to be looking for it to appreciate it.

Surgery has often been compared to an athletic performance as author David Foster Wallace says of a gifted athlete, “…they can be totally present: they proceed on instinct and muscle-memory and automatic will such that agent and action are one.” [2] This too is how gifted surgeons function. This is being in the zone in a nutshell.

For me, being in the zone transcends physical pains and hunger, and it may occur in a very difficult revision case as often as in a primary case when the operating room team is firing on all cylinders. The preoperative plan unfolds with clarity, and the gods are with you. I am immune to the forces of distraction that would make a normal person stop and let self-doubt question the surreal task at hand. My whole team works in unison, and we are on the same page. Everything seems to develop in a preordained order even if, and sometimes because, the case is challenging.

When asked by a trainee how I chose to be an adult reconstructive orthopedic surgeon, I’ve sometimes had difficulty describing my path to this career in words. Research into job satisfaction and happiness concludes that people who enjoy their profession (1) like their coworkers, (2) know what is expected of them, (3) feel that they make a genuine impact, (4) are proud to work where they do, and (5) feel recognized [3]. In addition, the most satisfied workers often describe being in the zone at work. When I reflect on my own decision to pursue a career as an adult reconstructive surgeon, all these reasons resonate. But, finding a profession where I could be in the zone was the hook.

As my distinguished editorial colleagues at our sister journal, the Journal of Arthroplasty, point out, it is critical to attract new surgeons to the field of arthroplasty care [4], [5]. Inspiring young men and women to pursue careers in medicine, orthopedic surgery, and adult reconstruction requires communicating the rewards of our profession.

Recent research [6], [7] concludes that we should do a better job making such information available to our residents. In addition to logistical, academic, and research opportunity information highlighted by Young et al. in this edition of Arthroplasty Today [6], we also need to share intangible aspects of our profession that may be helpful in decision-making about job choices. As we better understand how to communicate career advice to our trainees and they ask if they will fit into our world, what better litmus test than to ask them when they feel they are in the zone.