Finding My Rhythm: Healing, Leading, Becoming

In many complex cases, patients undergo multiple procedures on the same day — often requiring two surgical teams from different specialties. That was the case one morning as I walked into the OR. I was still a Fellow, assisting my Chair as well as a second surgeon. The latter was relatively new to our institution but came with an impeccable reputation. He had even operated on a former President.

I was eager to learn from him.

The first part of the procedure proceeded smoothly. My attending — meticulous, disciplined, and a gifted surgeon — left the operative field pristine. Then he stepped out, turning the case over to the second attending. I prepped to assist again, expecting the same level of calm, confident execution.

What followed, I’ll never forget.

Within minutes of beginning the second procedure, the operative field filled with blood. Chaos erupted. Voices rose. Instruments clattered. Control slipped away. The tension in the room was immediate and electric.

And then — just as suddenly — the bleeding stopped.

Order returned. Suction cleared the field. The vessel, it seemed, had been found and clipped. I breathed out, reassured. Maybe this had just been a fluke. In fact, I began to admire how skillfully the surgeon had regained control.

Until it happened again.

The bleeding returned, fast and furious — arterial and unrelenting. The source was elusive. The anesthesia team called urgently for more blood. I did what I could to help — clearing the field, holding retractors, staying steady — trying to help him find a path out of the storm again.

Eventually, he did. Another vessel, another clip, another fragile calm.

And then it happened again.

Three times in a single case. Three catastrophic bleeds. Three narrow escapes. By the end, the patient had received multiple liters of blood. He survived — but only because of resilience, luck, and grace, not surgical precision. I walked out of that OR shaken, frantic, and deeply disturbed.

This patient had trusted us. Trusted me. And though I hadn’t known it at the time, we had allowed him to be operated on by a surgeon who, while clearly talented, was also reckless. He got into trouble by his own hand — not once, but repeatedly — and only barely managed to get out of it.

The next day, I walked into my Chair’s office and shared what I’d witnessed. I told him plainly: I couldn’t, in good conscience, assist with another case involving this surgeon. It felt unethical. Unsafe.

My Chair patted my arm gently. “He’s also a Chair,” he said. “And he has a stellar reputation. These cases are complicated. There are politics involved.”

I was stunned. Had he not heard me? I tried again, in different words, hoping to convey the urgency. Hoping he’d understand the danger.

But the answer was the same: politics.

I left that office feeling crushed. Defeated. Was this the world I had trained so hard to be part of? A world where reputation overrode reality? Where patient safety bowed to hierarchy? What would it cost me — and my patients — to survive in a system like this?

Years later, I found myself in the attending’s seat. I referred one of my oncology patients to a surgeon within our institution. He was well-liked, considered competent, and no red flags had ever crossed my path.

But what I didn’t know — and what I only discovered too late — was that he had no formal training in cancer surgery. He didn’t intentionally ignore oncologic principles. He simply didn’t know them.

That gap in training led to inadequate cancer control. My patient — a woman who could have been cured — experienced recurrence. She ultimately died from a disease that should have been stopped.

I was devastated.

After that, I made a quiet, resolute decision: I would refer all patients needing complex cancer surgery to a trusted colleague — someone outside our institution who I knew understood the principles, who had been trained for these cases, and who would never be cavalier with a life.

The first time I did this, my Chair called me in.

“Why did you send this case out?” he asked.

I explained. He pushed back. “That’s not how we do things here. We have a surgeon for these procedures.”

I nodded. I listened. But I didn’t waver.

I never referred another patient internally for cancer surgery. And to this day, when I offer a referral, my patients know: I am sending them to someone I trust. Someone I would trust with my own family.

The outcomes won’t always be perfect. That’s the nature of medicine. But if a complication occurs, it won’t be because someone ignored basic principles or operated beyond their training.

It won’t be because politics took precedence over patient care.

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That’s how I lead now. Quietly. Unapologetically. With clarity, conviction, and the memory of all the moments I’ve had to choose between what is easy and what is right.

I will not be complicit in a system that sacrifices patients for professional alliances. And I will not stay silent when lives are at risk.

Leadership, to me, means remembering that every patient deserves the best we can offer — even when that means speaking uncomfortable truths.

Especially then.