A life lesson in the operating room

Recently, there was an issue in my O.R. No, the surgery went well. The patient was healthy and tolerated the procedure just fine. And, yes, we had the proper equipment and it all functioned perfectly.

This was another kind of issue, something that I had not encountered before. It turned out to be a life lesson. My team and I were getting started in the O.R., for a fairly routine day. A fellow, Joe, rotated in to give one of my team members a quick break. I’ve known Joe for several years, but he hadn’t helped out in my room before. We welcomed him, and as is my custom, I brought Joe up to speed on how I ask each team member to name three things they are grateful for before we begin.

I noticed out of the corner of my eye that Joe did not seem his usual self that day. He seemed quiet, harried, or perhaps even angry. I couldn’t get a read on what was going on. I’m aware that the people who are assigned to give O.R. teams breaks have drawn the “short straw.” I imagine they feel out of sorts, like a substitute teacher assigned to a new, rowdy classroom every 20 minutes. I noticed Joe clenched his jaw under his facemask, as I recounted the items my team members had said they were grateful for.

They said easy things, like “I’m grateful it’s Friday” or “I’m happy I’m not on call this weekend.”

Joe shook his head without looking up at me. He finally muttered, “I can’t think of anything at all to be grateful for today.”

There was a pause. The team looked at me. Sure, sometimes one of us has a hard time coming up with something, but we can usually tease it out. But that day, something about Joe’s demeanor told me not to push. I let it go gently and told him what I was grateful for that day, and we went on with the case.

A few minutes later, Joe left our room to give another team a break down the hall. But that encounter stayed with me. A couple weeks later, I saw Joe in our hallway. His countenance hadn’t changed. If anything, he looked more tense, more withdrawn. I entered the O.R. while he was still in the hallway.

Worried we might have a case of deja vu, I said, “You know, I’ve been thinking. Days will come up when any one of us could be having a rough time. And on those days, it’s hard for our team members to know what we may be going through.”

“So,” I continued, “if someone on our team is having one of those days and they don’t want to name three things they’re grateful for, it’s OK. Instead, why don’t we each name three things about that person that we are grateful for?”

My usual team just looked at me quizzically and nodded. And then Joe slumped in to give a break. We greeted Joe and I asked him if wanted to share anything he was grateful for. In the same breath, I said that we would be glad to name three things we were grateful about him, if he chose to abstain.

“No pressure,” I smiled under my mask, hoping he would look up at my eyes. He didn’t. He just shook his head and said,

“No, not today.”

So, I proceeded without skipping a beat: “Joe, I’m grateful for how caring you are to each patient you encounter throughout the day. I’m grateful for your knowledge of medicine so you can safely help everyone do well. And, I’m grateful that you came to work today to help others be able to take their breaks and lend a hand.”

Each member of my team stepped up in kind, and named three things they were grateful for about Joe. “I’m grateful you come in early every morning to help set up the room,” one nurse said. “I’m grateful you bring in those yummy donuts when it’s someone’s birthday,” another said.

As the last person made the rounds, Joe glanced up at us, nodded quietly and mumbled a soft, “Thanks.”

Last week, my team and I were told that Joe died. He had been diagnosed with a serious illness a few months before. After a moment of silence, with a lump in my throat, I spoke: “I’m grateful that Joe knew we cared about him,” I said. Every member of my team nodded.

Blessings, Joe. You will be missed.

Starla Fitch is an ophthalmologist, speaker and personal coach.  She blogs at Love Medicine Again and her upcoming book, Remedy for Burnout: 7 Prescriptions Doctors Use to Find Meaning in Medicine, will be available this summer. She can also be reached on Twitter @StarlaFitchMD.

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  • Clare Feinson

    If my personal space were violated in this egregious and hurtful way, I would be pretty surly myself. Why did you keep pressing even after Joe made it quite clear that his problems were personal and he was not interested in sharing? You didn’t care about him, just about forcing him into your mold. I’m glad it made you feel good, but I doubt it helped him.

    • Lisa

      I think the author’s team members offered ‘easy’ things they were grateful for is indicative of the fact that this practice is not taken all that seriously and can even be hurtful. I’ve worked in situations where these sort of exercises are engaged in. The more serious workplace issues such as workload and pay were never discussed. Ugh…

      I wonder if Joe was working after a serious diagnosis because he had too. He might well have not wanted to disclose anything because of the danger that he would find himself unemployed.

      • JR

        When I was reading this, I couldn’t help but expect the reveal to be an employee angry at being dragged into religion at work.

        The only time I’ve ever given “thanks” was during prayers with family as a child, so it gives me the heebee geebees to imagine someone doing this at work. Even worse that it seems to be done in the ER while a patient is unconscious and waiting for surgery as the article seems to suggest.

        • Lisa

          Interesting. I’ve read my surgical reports. They have mentioned a time-out, which was described to me as a chance to stop and make sure every one involved is on the same page, that they are doing the right surgery on the right patient. The reports haven’t mentioned sharing by the OR staff.

  • SarahJ89

    This would so drive me crazy. It feels really patronizing and kindergartenish.

    • guest

      Concur. Have a colleague who recently received a cancer diagnosis and I’m sure this crap would have pissed him off too. And me too!

  • ErnieG

    I hope the lesson Dr. Fitch learned is to realize that coworkers and employees may have private issues outside of work that need to be respected. The “exercise” of listing things to be grateful, while useful in private settings, really should have no place at work. Let’s face it, some people have it bad, and there is no reason to expose it. All those things in the news– it happens to people. Joe may not have seen this “exercise” as a way for his coworkers to recognize his worth, but rather a stressful interaction. In the future, if you notice a coworker is “having a bad day,” it may be best to ignore it (unless it is impacting their ability to perform their job); It may be more than enough to say something closed ended in private- “It seems you are having a bad day. It is not my business, but whatever it is I hope it is nothing serious, or if it is, I hope you get through it,” If you know them a little better, perhaps adding “if I can help you, let me know,” then walk away.

    • lithium_tungsten

      With all due respect, for some reason, I can see how your suggestion could be viewed as just a lip service. Dr. Fitch really cared (clearly, enough to have observed Joe and his demeanor long enough), in ways that exceeded merely mouthing the usual words that we have all heard from one another far too often and too liberally (“let me know if you need anything”).

      Your last suggestion — walking away — also doesn’t offer much hope to a person in need, especially since what they also need is your sincerity if you really hope that your offer of help will actually make them feel better; after all, if you truly want to help, you would hope that they know that you are serious about offering said help. I just don’t see how walking away fits into this picture. Saying the words loosely and not meaning it would only hurt a vulnerable person deeper — and you also risk conveying this attitude if you walk away.

      How often we do fail to take someone up on their offer because they’ve heard “lmk if you need anything” too many times, and know that it’s not really true – that they can’t truly ask them of anything? that it’s just an empty promise?

      I’m all for the sincerity that Dr. Fitch offers, even if it means a bit of a more unusual work practice. Like I said in my above post, positivity can only help, not hurt.

      • ErnieG

        Everything is about context. My suggestion about walking away is to give the person being talked to an out–perhaps “walking away” was intended more as a way to let that person out wihout a need to create drama or a situation.
        I am also very against the idea of sincerity=caring=respect. I deeply believe that the best way to “care” for co-workers and employees is to give them space in their private life, respecting what they are. I am a physician, and I have talked to many patient’s about bad things done do them, and many bad things can happen. I don’t presume that each one of them wants me in their personal business any more than is necessary to treat or diagnose them. People are complex creatures with strange emotions. Respect and dignity trump any “sincerity”– this is a very important distinction lost on our society that eats up celebrity apologies.

      • SarahJ89

        Actually, Dr. Fitch demonstrated the very opposite of caring in that she singled out a staff member in a most unprofessional manner. If she had anything to say she should have said it privately. But honestly, she seems so insensitive, ham handed and clueless I’m sure silence would be a better course of action.

  • JB McMunn

    How times have changed. When I was an intern nobody gave you a break, the attending couldn’t care less about how you felt as long as you held the hooks right and cut the sutures the way he liked, and I was grateful if I got through the day without someone taking a bite out of my hiney.

    Now it’s an encounter session. I hope everyone had good self-esteem and that some deserving mediocrity got a medal for “best posture”.

  • Renee Porte

    This is so sad. I am chronically ill and was dying for a while there, now trying to figure out the rest of my illness. If I were in a room and heard people say they were thankful for Friday and such, I would be disgusted. It would make me feel so much worse and probably ruin my day every day for the rest of my life.

  • safetygoal

    I find it quite odd that the comments that precede mine are so negative. It is my belief (and I am not a religious person) that finding things to be grateful for are paramount to centering one’s self. If someone has nothing to be grateful for, even when terminally ill, THAT is sad. Having an “attitude of gratitude” has been shown to be a mood lifter. Dr. Fitch, you seem to understand this. It’s too bad the rest of the folks on this thread do not.

    • Lisa

      What I object to is such exercises in the workplace.

      I highly recommend reading “Bright-sided: How Positive Thinking is Undermining America,” by Barbara Ehrenreich.

    • JR

      I can’t find it at the moment, but I read a study that said that patients who do not feel positive, but pretend to be positive to benefit others, fair worse then those who feel negative and admit to feeling negative.

    • JR

      This isn’t the study I read – but the two studies references were similiar in that “faking” positive feelings actually hurts rather than helps.

      http://myheartsisters.org/2012/04/05/faking-smiles-unhealthy/

      • safetygoal

        I never would advocate for “faking” positive feelings.

        • SarahJ89

          But having your boss insist upon putting everyone through a childish exercise like this is pretty much guaranteed to bring up that very effect. Can you see the difference between your own (and my own) private practice and a silly, inappropriate forced exercise on the job?

    • guest

      You do realize people might be at different stages of grieving after being diagnosed, don’t you? I’m sure if I were in denial or anger or feeling hopeless I wouldn’t have much to be grateful for either.

    • SarahJ89

      safetygoal, I totally agree with you–as a private practice to be conducted in one’s private life. But this kind of superficial forced exercise that fails to respect the boundaries of people who have no choice but to pretend to go along is the opposite of promotion of a good attitude. This is work. You know, the place where many of us go to leave our personal problems at the door so we can focus on our jobs?

  • Hornblower1810

    Dr. Fitch,
    You might want to re-read your earlier post regarding “Don’t let your patients treat you like a doormat”. Particularly the statement, “One of my goals is to help doctors be happier in their day jobs. This does not mean you put on a fake smile, and grin and bear it through your day. What it does mean is you consciously set your boundaries for what you need. Stick with them and let others know. Because the truth is, you teach people how to treat you.”
    Perhaps Joe was trying to set his boundaries.

  • lithium_tungsten

    I’m also surprised at all this negativity in the commentary. I’ve decided that people will just always find things to pick at.

    For instance, think of an opposite situation: If everyone had just trudged into work every day, barely grimacing a smile at each other and merely picking up the usual tools of their trade and diving straight into business, only to find out one day their colleague died, and no one cared to ask him how his day was, or push the envelope a little (is it any surprise that an unhappy person doesn’t want to openly, freely, liberally disclose what’s making them unhappy? Sometimes you just have to ask! ) — the situation would have been truly tragic and dreary, and certainly everyone in the commentary would have asked, “Why didn’t and couldn’t you guys care more? Shame on you.”

    Dr. Fitch is merely illustrating how, by pushing the envelope a little — because she cared, despite ultimately finding out that Joe truly did not wish to partake or reciprocate — at least some positivity was shared and experienced amidst a difficult life or situation.

    And who knows, maybe this totally made a difference in those dreary last few days/weeks of Joe’s life. To say, “oh this would have irritated me, so you shouldn’t have done this to Joe”, is itself arrogant and presumptive. We shouldn’t chastised someone for being positive – the alternate that is suggested when we do so is far from ideal.

    • SarahJ89

      Honestly, she really didn’t sound as if she cared about anything but pushing her approach on someone else. This isn’t nitpicking, this is simply the desire to maintain professional boundaries. Crawling up each other’s butt is not the only option to grim diving into business. I come from a human services background where the staff supported one another daily in doing difficult work. This sort of exercise would have been perceived as intrusive and meaningless, leading only to hypocrisy.

  • guest

    Sorry, Starla, you sound like a pest. If I were Joe I would have reported you for harassment to med staff. Adults are not under obligation to play these games, particularly in an OR where we are all trapped and cannot run away. I know your heart was in the right place but this piece just makes you seem quite clueless.