Corner Stitch: The art of surgery in the present moment

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Anna Kinio

As a young surgeon-in-training, and a millennial, the concept of mindfulness and wellbeing perfuses my day-to-day life. Reminders of the importance of “being present” and “taking care of yourself” come from all directions: in newsletters, inspirational quotes on social media and advertisements offering everything from yoga classes to aromatic diffusers. I am as guilty as the next person of falling for this materialistic version of wellbeing, buying the agenda with inspirational quotes that will surely change my life, or signing up for a meditation app that I use religiously for a week before letting it fall by the wayside.

But beyond this superficial and easily marketable concept of mindfulness, I do believe that the art of being present has an important place in our lives, and especially in the operating room (OR). As someone with a constant stream of self-talk, much of it negative, I was forced to address this head-on in my second year of residency. As Henry Ford famously put it—“Whether you think you can or you think you can’t, either way you are right”—and I decidedly thought that I could not. In the OR, I would live in fear of performing in front of my staff. The nerves would start the night before and increase until I was in the OR, shaking and berating myself harshly for performing so poorly, sometimes also playing a script of what I was sure the staff were thinking in my head. Clearly this did nothing to help my surgical prowess, and led to even simple acts becoming tense and poorly executed.

Understanding the concept of mindfulness has traditionally been difficult for the surgical community, which is ironic given the great amount of mindfulness that occurs in a surgical theater. As Carter C. Lebares, MD, director of the UCSF Center for Mindfulness in Surgery in San Francisco puts it: “mindfulness consists of specific cognitive skills including interoception (an awareness of passing thoughts, emotions and sensations), emotional regulation (development of nonreactivity in response to stimuli) and metacognition (conscious awareness of one’s cognitive control processes).”

It is clear that these skills are already being put to use in the OR by many of the attendings with whom we work. They may be recognized as those who are able to obtain the “flow state” where total focus on the present activity leads to complete union with the task at hand.

Beyond achieving this desirable state, the implications of the surgeon’s mindfulness-based skills extend beyond him or herself. The surgeon who can take a breath and calmly deal with intraoperative bleeding will create a better working environment than the surgeon who starts cursing, worrying that his or her patient will die, and barking at the assistant and anesthesiologist, who in turn will start making mistakes. While the studies on mindfulness in surgery remain small, research confirms the positive effects of mindfulness-based training that seems intuitive. Studies show that using mindfulness training can improve executive function scores, increase the speed of motor skills, improve working memory, and lower stress and surgeon burnout.

As for my journey, it continues to be a work in progress, but I am happy to be evolving away from the anxiety-ridden and overly self-conscious version of myself. Lots of practice on my surgical skills has helped, but so has working on being fully present when performing a task in the OR.

For me this is the true value of mindfulness, far from the commercialized idea that we put on a pedestal. I think that, as a specialty, we will only gain value in recognizing mindfulness as a skillset that needs to be actively developed and worked on for a fully balanced surgical training. I know for my part it is a muscle which I will continue flexing every day. After all, the present moment is all we truly have.

Anna Kinio, MD, is a vascular surgery resident in the department of surgery at McGill University in Montreal.

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