A Pledge Every Plastic Surgeon Knows…

Maddie was nervous…

Trembling as I swiped the curtain open to preoperative holding room 5. Her mother, crossed legged at the edge of the bed holding her hand, her father perched forward on the window ledge. It is 7am at the 900N Michigan Surgicenter and an 18-year old with a broken nose has been dreaming of this day for 2 years. She injured it playing softball for the state championship team. Her humble parents thought she looked beautiful, but Maddie, originally not bothered, just graduated from High school and is enrolling into the University of Illinois this fall. Her sports career is now behind her and her appearance is taking on more importance.

Maddie couldn’t sleep last night. They got up before the sun and drove 3 hours from Alton, Illinois to Chicago to be on time for surgery.

My morning? Routine, a 5AM run, shower, coffee, suit and tie, a quick review of emails, Maddie’s chart and then the surgicenter. I’ve done this over 4000x in 23 years and one thing never changes, the appreciation I have for the responsibility. They have exposed their vulnerability and trust me to protect it. Similar to many who come from smaller towns, Maddie and her family were particularly respectful. As I walk into the room, they sit up attentively and seem pleased to see me. They comment, “You look nice today, why are you so dressed up?” It is a question I get often. And while each doctor dresses how they feel most comfortable, for me I feel formal attire offers a level of respect for my patients, staff and colleagues. It is my way of preparing and demonstrating this is an important event. I got the idea from Michael Jordan; he would put on a suit before each game. He felt it showed respect for the game, his profession and the fans. I found it meaningful. I have done the same for 23 years.

Maddie’s father asked me how I was feeling and if I slept well. I retorted, “Of course,” which is true. I realize it is all he can do. I get it. It is an attempt to protect his little girl… He wants one last semblance of control. But he has nothing to worry about. The night before surgery I always take it easy, I eat a light meal, don't drink alcohol and get to bed early. While I know I would be just as sharp if I was up all night, as has happened many times in my career, I prefer feeling well rested when I enter the OR.

I put my hands on Maddie’s warm blanketed feet give a little squeeze and ask her if she is nervous, “Yes'' and I volley back, “that is normal… In fact, if you are not nervous, then I get worried.” Which is true… A certain level of fear is expected… But not to the point of panic attack. I then ask Maddie, “What are the 3 most important things to you regarding your nose?” I do this in case goals have changed and it also gets her talking and comfortable. She tells me, “I want the bump removed, the tip smaller, the nose turned up just slightly… Oh and can I have one more.” “Of course.” I say. “I want it straighter.” “Ok, got it.” I make marks on her nose to help diagram what I will do. She asked to look, and my fellow gives her a mirror. She smiles and approves. Mom who is hovering nervously laughs, takes a snap photo to show grandma. I tell mom to expect surgery to take about 2 hours (even though I'm pretty sure I’ll finish in an hour), I let them know I’ll meet them in the waiting room afterwards. And not to worry. I will take good care of her. I’m the father of 3 daughters, and know how they feel, they can trust me.

They seem relieved and thankful. And while I do this nearly every day, I realize this is a once in a lifetime event for them. They are making a big decision, concerns always linger. But if the surgeon is experienced, the procedure and the outcome is almost always better than expected.

However, effectively communicating confidence, authentically without coming off cocky or dismissive is not something natural to most surgeons. And while many surgeons, from trauma to neuro, perhaps are given latitude if they are crass. Confidence blended with empathy mandatorily matters to the success of a plastic surgeon. This I cannot teach. My students either have it or don’t. The plastic surgeon has been given an enormous responsibility to operate on a healthy person and they must commit to doing only what is in the best interest of their patient. It is a mindset that requires discipline, fortitude, and ability to block out all distractions. And while I can teach most residents to adequately and safely operate, the emotional quality (EQ) character traits and the ethical decision-making skills needed to make a great surgeon takes years to develop and most will never achieve it.

I walk out of holding room 5 ready. I am honored, humbled and forever grateful for the privilege to be the one they have chosen. I promise to never betray that trust nor take it for granted.

It is a pledge every plastic surgeon knows…