Archive for September, 2012

Ten Thousand Knots

September 4, 2012

Hey everyone.  Sorry it has been so long since my last post but now that I have some time, I thought it would be nice to commit some of the thoughts rattling around in my head to “paper.”

Presently I’m at the VA, and it has been quite an experience, but I think I will be glad when I go back to the “mothership.”

One thing that has happened at the VA though, is that I think I am slowly coming to terms with the process of learning to be a surgeon.  I am not going to be perfect every time, and berating myself every time I fall short of that goal is not going to be productive, nor mentally healthy.  The drive to be good for my patients will always be there regardless, but adding on the self-deprecation when my fingers slip tying a knot or I forget to enter an order helps nobody.  Starting my second year, I think it has given me a little bit of prospective; I am far enough from where I started that I can see where I came from, and how far I’ve already come, while at the same time I have an appreciation of how far I have yet to go.

My soccer coach back in high school said that in order to be a good soccer player, you need to get touches on the ball.  Over and over, you had to get those touches.  Juggle it, pass it, touch it.  Learn how it moves over the grass, how it feels on your foot.  He said that whether we had formal practice or not, every day we had to get some touches in on the ball if we ever wanted to be good soccer players.

Well, I wasn’t a good soccer player, and indeed I quit the soccer team early on in my senior year because I saw that the younger classmen were going to be starting, and I’d be spending another season on the bench (My coach, bless his heart, let me keep my jersey even though I told him I was planning to quit.  He was a classy man).  But now I think I finally understand what he meant by getting in those touches.  There is a saying in surgery, that you need to throw ten-thousand knots before you can consider yourself proficient.  The number isn’t what is important.  But it is the idea that it is going to require a daily commitment, for a long long time, to master surgery.  Maybe it will be tying knots at home, or reading in a textbook or looking up an article.  But surgery is an art, and like soccer it needs to be handled every day if you want to have any hope of being good.  The way my attendings tie, the suture seems to obey their will without any conscious thought.  It’s effortless.  They have gotten so good that every little subtle motion, the tension and the feel, it’s all so deeply ingrained in them they think about it with the same consciousness as they do breathing.  And of course I struggle mightily.

But know I understand how it works.  A journey of 10,000 knots if you will.  Scrubbing into cases that I wasn’t interested in used to be a chore, but now I understand their purpose.  Of course nobody is interested in all the cases all the time.  But now I see that every case is a chance to throw some more knots, to handle more suture, to hold the instruments and feel the tissues.  Somehow coming to that understanding has made things so different in my mind.  I can place myself now on the route of how I get to where the attendings are.  It’s a long long way to go but I can see it and that was a big moment for me when I understood that.