‘Grit matters in vascular surgery’

Gilbert R. Unchurch Jr. closes out his presidential address at SAVS 2021

“This is what happens to you when you show grit: You end up being elected president of the American College of Surgeons.”

Those were among the words delivered by Gilbert R. Upchurch Jr., MD, in his presidential address at the Southern Association for Vascular Surgery (SAVS) annual meeting in Scottsdale, Arizona, in late January. He was talking about the singular achievements of Julie Ann Freischlag, MD: vascular surgeon; the first, and to-date only, woman president of the Society for Vascular Surgery (SVS); and, now, the American College of Surgeons president-elect.

Upchurch interviewed Freischlag to help inform the argument he put forth in his address: that “grit matters in vascular surgery.” She figured among a trio of female vascular surgeons with whom he spoke about grit last year as the cultural currents around diversity, equity and inclusion issues shifted.

“She said, ‘When I interviewed for surgery resident, I was the only woman interviewing at most everyplace I went,’” he told the SAVS gathering. “‘When I took the job at [Johns] Hopkins, I was the fourth woman to be a department of surgery chair in the country. I was the first woman president of the Association of VA Surgeons, the Society of Vascular Surgery and the Society of Surgical Chairs.

“‘Learning to speak out just by being the only female in the room was an art I learned early. I strengthened my grit as the number of female vascular surgeons increased.’”

“Her story is really amazing,” Upchurch added. “I applaud the grit she has shown over time.”

Upchurch aimed to use Freischlag’s story to help convince vascular surgeons of every stripe that the characteristic of grit was central in the practice of their specialty. For grit, he had told an audience made up of surgeons both in the room and many more attending virtually, is the antithesis of burnout.

“Regardless of our struggles, we’re all obligated to make vascular surgery better for our trainees and future vascular surgeons, as well as our patients,” he said.

Earlier, Upchurch had told attendees he initially looked set to draw lessons on grit from a scene in the 1969 western movie, “True Grit,” starring John Wayne as lawman Rooster Cogburn. In that scenario, Cogburn is seemingly doomed yet resolute as four adversaries are arrayed against him.

“So, what is it about this scene that inspired me to think about vascular surgery?” Upchurch asked those watching. “Well, I’d say that here you’ve got one on four. Besides the whiskey drinking and occasional foul language, it’s this: In vascular surgery, armed with a scalpel, a few wires, a graft and a few stents, we take on nearly the impossible. We take on patients when success is completely stacked up against us. Patients are still self-mutilating, they’re still smoking, many of them are obese, and yet there we go, riding one-on-four, just like John Wayne. I just think: Vascular surgery—you must have to have true grit.”

Yet, upon further examination, Upchurch would find true meaning in the character of the 14-year-old Mattie Ross, played by Kim Darby, who had hired Cogburn to help avenge her father’s murder.

Indeed, part of the initial impetus for his talk was the work of Angela Duckworth, PhD, a professor of psychology at the University of Pennsylvania, contained in the book, “Grit: The Power of Passion and Perseverance.” Her work defined grit, he said—specifically as passion and perseverance for very long-term goals.

“I was really excited about giving a talk about John Wayne and True Grit,” Upchurch said. “But it turns out, actually—after one of her TED talks—I had it all wrong. And especially given the issues that we’ve had around diversity, equity and inclusion, I pivoted my entire talk.”

He then proceeded to outline five methods vascular surgeons could use to develop grit: The tools of realistic positivity; of major challenges matching skillsets; of deliberate practice to the order of 10,000 hours to achieve mastery; of hard work; of higher meaning and purpose.

“We all have challenges and failures and traumas—what happens to you when you actually have the patient die on the table, even though you did the exact, right operation?” Upchurch said. “How about when a patient wakes up after a carotid endarterectomy who came in asymptomatic and has had a stroke? How do you feel after that? Do you want to surrender, do you want to quit vascular surgery? Do you move towards the persistence, strength and growth? Because this happens to all of us, right? We all have failures.

“How do we get to that peak performance and achieve success? This is the really good question. And the answer: What causes this shift—all of these bad things that happen to us in vascular surgery and in life, because this is not just about vascular surgery? How can we shift from this sense of attrition and failure, to be being positive in our peak performance? This is what causes this shift: grit, resilience and optimism.”

“Hopefully I’ve convinced you that grit matters in vascular surgery,” Upchurch concluded. With the weapons contained in the grit toolbox, he said, vascular surgeons can treat the ailments that can stalk them: burnout, apathy, implicit bias and indifference. “We all need a little more Mattie Ross in us.”


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