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Triumph, tragedy and the pursuit of happiness: A journey of self-awareness

2020; Elsevier BV; Volume: 71; Issue: 5 Linguagem: Inglês

10.1016/j.jvs.2020.02.003

1097-6809

W. Charles Sternbergh,

Optimism, Hope, and Well-being

This is not going to be your typical presidential address. For me, the most impactful presidential addresses were those that were personal: Clem Darling1Darling III, R.C. Looking forward through the past and changing me to we in the evolution of team-based vascular care.J Vasc Surg. 2019; 70: 347-357Abstract Full Text Full Text PDF PubMed Scopus (3) Google Scholar and Julie Freischlag's2Freischlag J.A. Of strategies and chances.J Vasc Surg. 2014; 60: 1686-1689Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar Society for Vascular Surgery (SVS) addresses, and Spence Taylor3Taylor S.M. Vascular surgery, self-awareness, and the University of South Carolina School of Medicine Greenville.J Vasc Surg. 2013; 58: 1106-1114Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar and Tom Huber's4Huber T.S. Professionalism and the work-life balance.J Vasc Surg. 2014; 60: 1072-1082Abstract Full Text Full Text PDF PubMed Scopus (9) Google Scholar Southern Association for Vascular Surgery presidential talks come to mind. They all spoke from the heart, and in revealing a bit about themselves, made their topic compelling. So I ask for your indulgence, as I share with you some of the triumphs and tragedies in my own life, in a personal quest for contentment, understanding, and fulfillment. Lessons learned, aha moments, a journey of self-discovery, all in the pursuit of happiness. Much has been written about the importance of self-awareness, but what does such a self-evident phrase really mean? The Oxford dictionary suggests this: “conscious knowledge of one's own character, feelings, motives and desires” (Fig 1). Let that sink in for a moment. While a quick glance might leave one with the impression that, surely, most folks know themselves, I believe that mastery of self-awareness is rare. Many people don't have great self-awareness, and the irony is glaring; folks just don't know what they don't know about themselves. Looking back, I wasn't blessed with great self-awareness in my formative years—quite the opposite, actually. Here is a great example: Convincing myself that my choice of college and medical school had nothing to do with the fact that my father had attended the same institutions. I really believed, and forcefully tried to convince any who would listen, that there was no connection. Perhaps I wanted, and others around me, to see myself as my “own person,” one who would not be influenced by my parents, or anything else. Wow! Talk about a “lack of self-awareness” whopper. It's my supposition that, in the pursuit of true happiness and deep authentic contentment, a good grasp of self-awareness is essential. So, I'd like to share with you a handful of events that have impacted my development of better self-awareness. It was the late 1990s, and I was 3 years out of my fellowship training, working at the Ochsner Clinic in New Orleans. We had been fortunate to be a trial site for the earliest minimally invasive endografts for aortic aneurysm repair. Given that we were very junior in the pecking order of site primary investigators from around the country, we had no illusions about getting a piece of the clinical trial data for presentation. But I thought, how about an economic paper about the costs of this new technology? While cost papers are now omnipresent in health care delivery, this was not a topic that was explored much 20 years ago. My working hypothesis was that EVAR [endovascular aneurysm repair] was going to be less costly than open repair, given the radically reduced length of stay. The trial sponsors agreed with this proposal, and hired an independent economic consultant to pull the cost data from the trial sites around the country. The summary data were FINALLY delivered to me the afternoon before the SVS abstract deadline. I was floored to find that my hypothesis had been completely wrong; AAA [abdominal aortic aneurysm] management with EVAR was actually much MORE costly, primarily because the endograft cost was more than 50% of the total hospitalization cost. I knew immediately that these data were abstract gold, and spent the rest of that evening writing. Now is where it gets interesting. The abstract was highly ranked by the program committee, and initially placed as the second podium presentation of the opening plenary session. But then we received word that, at the direction of the SVS president, our abstract had been removed entirely from the program. Notably, the SVS president also happened to be the national primary investigator for that trial, and a shareholder of the sponsoring company. But this was before the age of conflict of interest disclosures. While we were successful in getting our abstract back on the program, the patient-level data and cost methodology were suddenly “no longer available” from the sponsor's consultant, at the bequest of the sponsor's marketing department. Anyone old enough to be at the SVS meeting 20 years ago will likely remember the drama. The invited discussant for the paper was, interestingly, the SVS president. We were accused of fabricating the cost data during the discussion. The aftermath included an effort by elements within the SVS leadership to block publication of the data in the Journal of Vascular Surgery. I was “highly encouraged” to withdraw the manuscript. But the accusation that we had fabricated data cut me to the bone. Integrity is everything to me. So I took this very personally. The epilogue of this story speaks for itself. After very rigorous review and multiple discussions with Wayne Johnston, the Journal of Vascular Surgery co-editor, the paper was published.5Sternbergh III, W.C. Money S.R. Hospital cost of endovascular versus open repair of abdominal aortic aneurysms: a multicenter study.J Vasc Surg. 2000; 31: 237-244Abstract Full Text Full Text PDF PubMed Scopus (126) Google Scholar Later that year, three consecutive editorials were published in the Journal of Vascular Surgery expressing concern about competitive interests, potential problems with industry-supported research, and finally a mandate for formal conflict of interest declarations.6Rutherford R.B. Johnston K.W. Potential problems with industry-supported clinical research.J Vasc Surg. 2000; 31: 1076-1086Abstract Full Text Full Text PDF Scopus (28) Google Scholar, 7Johnston K.W. Rutherford R.B. Failure to disclose competitive interests.J Vasc Surg. 2000; 31: 1306Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar, 8Johnston K.W. Hertzer N.R. Rutherford R.B. Smith III, R.B. Yao J.S.T. Joint council guidelines for disclosure of conflict of interest.J Vasc Surg. 2000; 32: 213-215Abstract Full Text Full Text PDF PubMed Scopus (5) Google Scholar And our paper ? Yes, the data were accurate, and ultimately reproduced by multiple other authors over the last 20 years. What life lesson did this provide for me? Believe in yourself. And although I didn't realize it at the time, this episode helped me along the path of self-awareness, providing a concrete example of understanding the “conscious knowledge of one's own character.” While a triumph like this can provide opportunities for personal growth, tragedies lay bare the challenges of life. Sometimes our lives are forever changed in a blink. I was just 9 months out of fellowship training when my son Jared suddenly died under tragic circumstances. He was a month away from his third birthday. It was a grief that cannot be imagined. I literally did not think the sun would rise the next day. Coping with the death of a child is one of life's very greatest challenges. Despite a great deal of emotional “work” to process this loss, there remained a weight, a heaviness that I could not really understand. In retrospect, I did not have the self-awareness to access it. Many years later, I was finally able to locate that heavy weight in my emotional backpack (Fig 2). To lighten that load, a counselor suggested that I write Jared a eulogy, just from me to him. It took me 18 months to make it happen. I'd like to share portions of that with you:Almost 20 years since you have been gone. Taken away in an instant. No opportunity to tell you, show you how much you were loved. You took your last breath in my arms, but you could not hear my cries, or feel my heart break.It is a father's responsibility to protect his children. I was not there to protect you that horrible day—and have never completely been able to “go there,” and imagine your pain, confusion and wondering “where is my dad?”Many years later, alone on the dock at Ono, sitting at your plaque, I felt your love so strong, your understanding, that allowed me to forgive myself. Thank you Believe it or not, I'd like to segue to Brad Pitt, one of the worlds sexiest guys, who has dated, wedded, and/or bedded some of the most beautiful women in the world. He recently spoke about some of the challenges in his personal life which profoundly resonated with me.The fact is, we all carry pain, grief and loss. We spend most of our time hiding it, but it's there, it's in you. So you [need to] open up those boxes.9Buchanan K. The planets, the stars and Brad Pitt. The New York Times, Sept 4, 2019Google Scholar A central part of self-awareness is being about to locate, access and process your feelings (Fig 3). As a head-directed person, that's frequently been a challenge for me. It took me almost 20 YEARS to process the reality that I was FEELING guilt about my son's death, holding onto it, despite the lack of any culpability. And processing, exorcising that deep hurt was a big deal. I feel lighter. More self-aware. And perhaps a bit farther along that path in the pursuit of happiness. Friends, what pain, grief, loss, or sadness are YOU holding onto? Leaving it unprocessed in YOUR emotional backpack creates heaviness, and that weight is an impediment to finding the peace, contentment and joy that you deserve. As vascular surgeons, we excel in cerebral, thought-directed activities, but are frequently challenged when it comes to accessing and processing our feelings, especially ones that are painful. I urge each of you to look inward, and embrace the challenging emotional work of processing those hurts that many of us carry. There is no more important action you can take for augmenting self-awareness, in your personal journey of self-actualization, pursing happiness and contentment. The second most difficult challenge in my life was that of divorce, a cataclysmic event that many of us have faced, but rarely discuss. The reasons for the dissolution of marriage are protean and unique to every couple. For me, I finally came to the realization that I had been living between anger and despair for a long time. I had been working harder and harder trying to “make my wife happy,” hoping that would improve our marriage. And I ultimately had an aha moment, realizing the fundamental error in my thinking: It is not possible to “make” someone else happy (Fig 4). We all are ultimately responsible for our individual happiness. It was like a great weight had been lifted from my shoulders. I was toiling at an unattainable goal. I would be told later by friends that this dynamic had been so clear to them for a very long time. So why did it take me so long to realize it? When you are in the middle of an emotional vortex, one cannot see what may be so obvious to those around you. Joint custody with twin 3-year-olds and a 12-year-old daughter. It. Was. Hard. I lost 10 pounds in the first 2 weeks of separation. Juggling child care and call responsibilities. Being lonely. It took a toll on my ability to function professionally. My clinical productively fell, and my academic pursuits were shelved. There was just not enough bandwidth. But it was undoubtedly the right decision, for me and my children. A year later, I met Tasha, my soulmate. In our 15 years together, she has demonstrated extraordinary love and devotion, with sacrifice that few women would bear. Foregoing the chance to have her own children, she was “all in” with one of the most challenging and underappreciated jobs of all, that as a step-mother. Our children Whitney, Annie, and Will are thriving in no small part to her mothering, providing love, care, and attention. I am so incredibly proud of them. Who they are, and HOW they are, is an enormous blessing. Family and faith are everything to me. But I would be remiss not to brag on Tasha's influence on me. Simply put, I am the best version of myself with Tasha. There are not sufficient words to describe my love, admiration and gratitude. Thank you, sweetie, for being in our lives. So let me take you to another moment in my life, at the 2007 winter meeting of the Vascular and Endovascular Surgery Society, the last run of the last day of skiing. It could not have been more cliché. After stating “last one to the hot tub is a rotten egg,” I fell and suffered a nasty midshaft spiral tib-fib fracture. At the local hospital in Steamboat, the orthopedic surgeon was summoned, telling me I needed emergency surgery, and would be out 6-8 weeks. Despite having major narcotics on board and still in remarkably severe pain, My response was this: “But I have 12 cases on the schedule next week!” So let's unpack that for a moment. Did that response demonstrate great self-awareness? Not so much. But it did expose a classic Baby Boomer characteristic: a mantra of work ethic as duty above all else. Damn the torpedoes, full speed ahead! And yet, the world did not end when I could not do those cases. In reflection, this episode reminds me of one of my mentors, Dr Robert Smith III. I was fortunate to work with him during my fellowship training at Emory. He exemplifies the traits of humility, integrity, and wisdom. And to boot, he is a master technical surgeon. More than 20 years ago, he gave an address to the Georgia Vascular Society reflecting on his years of practice. In his talk, he provided a number of “self-evident” truths relevant to vascular surgeons. One of those was this:I never met a vascular surgeon who said on their deathbed, I wish I had done more aneurysms. Such wisdom, and discussed decades ago, before there was much question about work-life balance. Too often, Americans seem to live to work, while in many other parts of the world, they work to live. As vascular surgeons, we are driven and ambitious, and too many of us, myself included, have fallen in the former group. We boomers have plenty to learn from gen Xers and millennials who, in my opinion, have a heathier approach to work-life balance. That being said, I truly feel blessed to still enjoy what I do professionally. As vascular surgeons, we are fortunate to be in a position to make a real difference in people's lives. That satisfaction, and the genuine gratitude of our patients, still puts a smile on my face. I'm quick to point out to medical students and trainees that vascular surgery is one of the very few surgical specialties that provide longitudinal care and connection with patients. For me, that connection is a great part of my job satisfaction. The Sunshine Support Group is a grassroots organization in New Orleans that provides community support for patients with kidney failure. It is run by my patient Wilbert Williams and his wife Barbara. Through the years, I've helped save his leg and keep his fistula functional. He had asked me to come to one of their events for years, but I was always too busy. This year I made it. . . and the remarkable thing was HIS appreciation of my attendance. Sometimes we become so busy that it is easy to lose sight of these moments of humanity, our deep connection with our patients and their families. Don't skimp on those interactions, as they will bless you more than you may imagine. So w hat makes us happy and content (Table)? While there are thousands of articles addressing this question, you may be relieved to know that I'm not going to quote any of them. I believe that the answer is a uniquely personal one, and probably dependent to a degree on your age and gender. Necessary components for many of us may include family, faith, companionship, love, intimacy, professional satisfaction, leisure activities, stewardship, altruistic acts, good health, exercise, and financial security.TablePotential components for happinessFamilyFaithCompanionshipLoveIntimacyProfessional satisfactionLeisure activitiesStewardshipAltruistic actsGood healthExerciseFinancial security Open table in a new tab But what is the right “mix”? What things in our lives should have more priority? It is unique for each of us. Only the self-aware person is equipped to make these critical choices. Attaining genuine happiness and contentment doesn't just “happen.” As in a good marriage, it takes sometimes difficult emotional work, the ability to be real with yourself, peeling back those protective emotional layers, allowing vulnerability. Realizing this goal is not possible without knowing yourself. So I'd like to leave you with a reminder about the definition of self-awareness: “conscious knowledge of one's own character, feelings, motives and desires.” I ask you to carefully consider how much true conscious knowledge you have of yourself in each of these categories. Genuine self-awareness will help you along life's realization of peace, contentment and happiness. My friends, don't postpone joy! Because life is not a do-over. Carpe diem.