The Humble Surgeon

Cutting into someone’s body requires a certain amount of braggadocio. Everyone wants their surgeon to be confident. There’s no room for simpering vacillation, even though you know much more than the patient how badly it can go. You have to be willing to live with risk and own whatever happens on the table, whether you directly caused it or not. 

But the reality is, part-time surgeons can’t afford braggadocio. There probably aren’t many of us out there, precisely because we are in the rare position of living with a constant handicap. When you work with your hands, cognition only goes so far: there is a degree of proficiency gained by sheer hands-on experience, and in that I will always fall short. I have heard cataract surgeons say they feel it when they take a two-week break—I take breaks that last twelve months. I might be lucky to do as many cases in a month as full-timers do in a week.

And so I find myself walking in this place of conscious humility. I recognize that my surgeries radically improve my patients’ lives, that complications are still the exception, that it is probably good to maintain skills that I invested so much training in. But I routinely struggle with dread and anxiety when operating days approach, and at times those feelings seem to outweigh the pleasure of operating, or spill too much into my home life.

And of course, surgeons don’t like to talk about their fears of complications. Discussing our fallibility is really not done. Someone once said in residency, having a complication is like losing your virginity—you want to get it over with, but you don’t want to get a reputation for it. 

But what I am learning is that it is possible to walk in this place and allow it to make me a better surgeon and person, rather than let it cripple or paralyze me. It’s hard to describe, even harder to do, but I am grasping it more over the years. 

One aspect of walking well in this place is learning how to handle anxiety. It starts with recognizing it, particularly when it spills out in subtle ways like dreams at night or bad moods at home. I then ask myself whether it is pointing me towards any helpful action, and if not, I pray to choose to let it go. What that actually feels like is choosing to believe in God’s sovereignty. In his sovereign goodness, he uses mistakes to help me learn much more effectively than I would have otherwise—or he uses unideal outcomes to work something more important in my patient’s life—but whether I see the reason or not, the fact remains that ultimately, I can’t control everything. And that is okay because I know the God who does. 

Another aspect is learning to measure my empathy. My mind would enter so much into the imagined sufferings of my patients, sufferings directly caused by me, that I would be unable to sleep. Why couldn’t I have a job where a mistake resulted in, say, an incorrectly made cup of coffee, rather than blindness? But I’ve come to realize there is an empathy that is healthy, that leads to compassion and kindness—and there is an empathy that is unhealthy, that conflates and distorts reality. The reality is, all of my patients are informed of the risks they face. The reality is, other jobs bear just as difficult responsibilities. The reality is, I don’t know what my patients’ sufferings entail—nor am I required to bear it for them without boundary. I try to reign in my imagination and pray for them instead, because God is the only one who does know and see their experiences, and he is fully able to bear them.

Sometimes God surprises me. This week, I was struggling with some subconscious anxiety. The night before my surgeries, something nearly magical happened while I was tucking in the kids. It was as if I could suddenly see how precious each of my children were, in a way that pierced through the haze of routine. Each of the kids were particularly sweet in their own way: Esme in her chubby hug and request to be kissed, Ellie in her open talkativeness, Eric in his slow smile, Elijah in his wriggly enthusiasm. I just felt simply that God was telling me, this is worth it. Whatever happens in your work because of the choices you’ve made, this is worth it. And I slept well that night.

Whenever I think about this, I think about Jacob, who encountered God and left with a limp. A limp, but a name. And I think, well, if being a humble surgeon means I have to live with a stronger sense of purpose for what I do, a consciousness of weakness that keeps me from pride or makes me more willing to listen or learn, a constant reminder of my limitations and God’s character—then maybe it’s not a bad thing. 

O Love That Wilt Not Let Me Go

“My hymn was composed in the manse of Innellan on the evening of the 6th of June, 1882, when I was 40 years of age. I was alone in the manse at that time. It was the night of my sister’s marriage, and the rest of the family were staying overnight in Glasgow. Something happened to me, which was known only to myself, and which caused me the most severe mental suffering.

“The hymn was the fruit of that suffering. It was the quickest bit of work I ever did in my life. I had the impression of having it dictated to me by some inward voice rather than of working it out myself. I am quite sure that the whole work was completed in five minutes, and equally sure that it never received at my hands any retouching or correction. I have no natural gift of rhythm. All the other verses I have ever written are manufactured articles; this came like a dayspring from on high.” – George Matheson

I have a fondness for hymns (which are great for teaching children; I have BSF to thank for that) and their stories. Our church sang the Robbie Seay Band version of O Love That Wilt Not Let Me Go on Black Friday and it became the song that stuck with me through that whole period.

George Matheson was born in 1842 in Glasgow, graduating first in his university class in classics, logic and philosophy. Towards the end of that time he learned he was going blind; his fiancée at the time left him, saying she could not go through life with a blind man. He went on to study for and enter ministry as he had resolved to do, with the help and support of his sister, as by his early twenties he had gone completely blind. In 1866 he became assistant pastor in Innellan, where he wrote several works and became a theologian of some repute.

Matheson wrote this hymn in 1882, on the evening of his sister’s marriage, alone while the rest of the family had gone away. Perhaps he saw the dark years stretching out before him without his companion and helper. Perhaps the wedding reminded him of his own failed engagement. He never did marry, but in 1886 moved to Edinburgh, where he became minister of a church for thirteen years.

O Love that wilt not let me go,

I rest my weary soul in thee;

I give thee back the life I owe,

That in thine ocean depths its flow

May richer, fuller be.

O Light that followest all my way,

I yield my flickering torch to thee;

My heart restores its borrowed ray,

That in thy sunshine’s blaze its day

May brighter, fairer be.

O Joy that seekest me through pain,

I cannot close my heart to thee;

I trace the rainbow through the rain,

And feel the promise is not vain,

That morn shall tearless be.

O Cross that liftest up my head,

I dare not ask to fly from thee;

I lay in dust life’s glory dead,

And from the ground there blossoms red

Life that shall endless be.

When Trouble Comes

“I live to show his power, who once did bring my joys to weep, and now my griefs to sing.” – preacher George Herbert

“For it is you who light my lamp; the Lord my God lightens my darkness.” – Psalm 18:28

For three months earlier this year, I went through a period of emotional depression. I have always had a perennially optimistic disposition, and I am not only not very emotional, but tend to be easily critical of people who are. Dave is equally optimistic and even less moody (he is in a bad mood maybe once a year). Needless to say, this was quite a novel experience for both of us.

The whole thing happened very gradually. Without really knowing how it happened, I came unquestionably to a place where I found myself living with constant sadness and depressed feelings I could not shake. At heart I was lonely and homesick. I think we had strategized for this move for so long, then been so caught up in the logistics of settling in, that I had never really allowed myself to say that I was sad. I missed my parents, my friends. I missed the culture back East. I missed my old sense of self. 

It all sounds kind of inane, almost childish, but it was very real in my feelings, whatever my head thought, and for once in my life my feelings would not be overruled. I cried every day. I never felt like eating much. It felt like a big effort to connect with anyone. I didn’t feel like talking. It was hard to receive advice. I felt insecure about how people perceived me. I recall standing off to one side at a school party one morning, next to the stroller with the younger two, feeling like here I am yet I don’t belong and I don’t feel anyone cares. I remember Ellie coming up to me and giving me a hug while I struggled not to cry. 

I remember Dave asking what he could do one night, while I was lying in bed crying. I asked him to hold my hand and not say anything, and that helped more than anything. I didn’t want any words; I just wanted to feel I wasn’t alone. The fact was, I had lost a part of my life and myself, forever. No rightness of decision or future promise could change that, and no one on either coast could really understand how it felt. And it was something I had to feel, not analyze. It was something I had to walk through in an acutely solitary way, yet it helped to hold someone’s hand.

The most helpful practical advice came from my sister, who sent me an excerpt of When Trouble Comes by Philip Ryken. He talks about how it helped him to keep up outward routines when he was feeling down—to exercise, eat something healthy, be present with his kids, go to worship, share with close friends, ask for prayer, and pray himself. I did those things and in retrospect it undoubtedly helped.

But the main thing that helped was pressing into God. Maybe some people feel at these times like God is distant, but I never felt him closer. Who else truly understood me? Who else had been there through every other change in my life? Who else saw every tear? Only God. 

God showed up for me in the most unexpected of places. One time it was in Leviticus 8. I was reading in a café during lunch break at work, and suddenly I felt like every word about Aaron was about me—being washed with water, clothed carefully, set about with precious stones and a holy crown and anointing oil—it was all some love poem from God, to me. I could have done some inductive analysis about how the office of high priest pointed towards and was fulfilled by Christ who then imputed that to me—but what came through wasn’t cerebral at all. It was just a feeling, a feeling speaking into my feelings, and there I was, crying in public over Leviticus (a first).

Another unexpected place was in a sensory deprivation pod during a balance float (another first). I was praying, which those days meant praying my feelings because I didn’t have much else to say, and I felt filled with an unmistakable sense of security, that my identity was both fully seen by and deeply secure in Christ. I hadn’t even wholly realized until then how insecure I felt about who I was here. Again, it wasn’t some kind of self-generated rationalization: it was a conviction of feeling being given to me, and more than anything, it felt like a release. Coming out of that period happened as gradually as it started, but that moment was as much a turning point as any.

I don’t know if I will ever go through a period like that again—I sort of hope not—but part of what I take away is that emotional low points, sometimes beyond one’s ability to outthink or control, can be a normative part of the Christian life. I will also take away small kindnesses, from close friends and family, Dave and the kids. A God that can speak over and into feelings. The comfort of wordless presence. 

Having It All, Part 2

“For his sake I have suffered the loss of all things and count them as rubbish, in order that I may gain Christ.” – Philippians 3:8

Every so often I think through the matter of career versus family again. I posted about this six years ago when leaving academia to enter what became a relatively ideal private practice gig, where I was able to work short days, maintain good surgical volume, and have my own cohort of patients. All while working two days per week with a good salary. Benefits of working in a non-competitive, high-need area.

Needless to say, the career landscape is different here—intentionally finding jobs that allow us to prioritize marriage and family has involved taking a lot more career hits. Dave, who was a rising state-wide superstar in public health, only considered jobs that did not involve a long commute, which seriously restricted his options in a relatively specialized field. He’s had to step out of the limelight in some ways and maintain flexibility with job changes. I have found two part-time gigs with amazing flexibility, but have lost surgical volume, autonomy, and having my own patient cohort to varying degrees.

The decisions to take these hits feels different this time around. Six years ago, it felt like a watershed moment. Looking back, the elite academic environment I habituated prior to that was a bubble in which pushing myself to do everything I could to excel was simply assumed. I was constantly surrounded by the ultra-intelligent and insecure about my own abilities, haunted by anxiety and driven by the need to prove myself, to everyone else but also to myself. Coming out of that was nothing less than transformative.

I’ve since realized that ultimately, the answer to how one balances career and family is one with no clear, practical right or wrongs. You can work for the right and wrong reasons, just like you can stay at home for the right and wrong reasons. 

For me, the process has been a progressive realization that the time I spend with the kids while they are young makes a real difference; that the physical, mental and emotional energy I have when I work less releases me to invest in my marriage, my health, in friends and ministry in a way that feels eternally-purposed and personally fulfilling. Somewhere along the line, it stopped feeling like I was giving something up to stay at home, and more like I was giving something up to go to work.

It’s not a process that is totally without angst. When we don’t have great childcare, it’s really hard to work, to be one of many ophthalmologists my patients could be seeing, instead of the only mom that my kids have. Working itself is a walk in conscious humility—not being as immersed in the field as my full-time colleagues sometimes feels like a functional handicap. I have to be willing to ask for help, to not have the same status or office space. Being a part-time surgeon carries its own dilemmas and difficulties.

But overall, considering this question of whether one can “have it all” feels different than it did six years ago. It seems even more fundamentally like the wrong question to ask. For one thing, it’s a query without comparable outcome measures—maybe career success can be measured by publications, promotions, grants, committee and talk invitations—but how does one measure success as a mother? Churning out obedient kids who go to Harvard? Or who go into ministry or missions? Feeling less guilty when you leave the house? Being able to breastfeed, or make school parties?

Parenting, of course, isn’t about achieving self-oriented outcome measures, just as career shouldn’t primarily be about that either I suppose, and so this question actually misses the point. As a believer, life is not about getting what I want, or what I feel I am due, or what compares well to someone else. My desire is not to have it all, but to follow faithfully; my hope is not in career or family achievements, but in the person of Jesus; my decisions are not born of calculation, but of my relationship with Him. And in that relationship, every decision I make for Him is a privilege and joy.

I think this is why Paul can say what he does in Philippians 3. He rattles off a perfect resume—like the Jewish version of “owner of a startup valued for billions” or “all my kids got into Stanford”—and has the gall to say, I count all of that as literally excrement, compared to gaining Christ, compared to knowing and becoming like him. Did that mean he never leveraged his education, eloquence, or pedigree for God? No. Did that mean he never worked in his field of training to earn a salary? No. But he was clear on what life was about. He was clear on what mattered in the end. Be like me, he says. If you’re going to calculate, do it this way. Keep your eyes on what matters.