Wu Wei and the Anesthesia life

In my academic time, it was said that anesthesiologists came in two types; doormats and land mines. I was, by nature, a land mine, and suffered the fate of the land mine; I blew up. Early on in my career,  then co-faculty mate and now co-author, Andy Kofke watched me throw a chair through a wall in frustration over bad ICU care. (It didn't help me or the patient...) My colleagues over the years knew that my frustration was just, but they also knew (which I didn't) that my emotional response was not functional. And so, emotionally spent after some years, I wandered out to private practice, and the solace of a bigger paycheck.

By comparison, the doormats of my day were pathetic puny creatures, who did what they were told to do by the surgeons, right or wrong, and hid behind the "blood-brain barrier" (that's the ether screen or sterile drape separating anesthesia from surgery for the uninformed). They would frequently take out their frustration by bullying their subordinates/trainees or would be detached from it all; "it's just a job, man." They marched through their days in quiet desperation. Many of them are still doing so.

Between doormat and land mine there is a third way. It is Wu Wei. Wu Wei is an ancient Taoist concept.The literal translation is "do nothing," although a better translation would be "Don't force matters." If it seems trite, it is only because the concept is so ingrained into our awareness by countless new age imitations, who don't quite get it right (and neither will I here, in these few words).  Every contented senior anesthesiologist understands Wu Wei, although virtually none know that it is called that by the Taoists. I stumbled upon it as a realization (rather than just an intellectual concept) quite by accident a decade ago. Wu Wei is not simply "going with the flow." Wu Wei is to be aligned with the nature of things; it is to be as the dripping water wearing away the stone. It is yielding when pushed, and advancing when the way is clear. It is to flow with events, and to gently guide them when appropriate. For you golfers out there, the golf grip illustrates the principle of Wu Wei; too tight and your swing sucks, too loose, and your club goes sailing.  To attempt to force events out of their natural tempo and order only brings frustration and disharmony - stress.

You know when you have it right when you are in a state of grace. When the anesthetic "feels good" and it seems and looks effortless. When the circulator looks at you and says, "you make it look easy,' dude you're one with the Tao... Supervising residents (or CRNA's) never goes well until one attains something like Wu Wei. My best colleagues and professors had it; the light firm touch, calibrated to the needs of the pupil or nursing colleague. Many of my future entries will, in one way or another, be about attaining this state of grace during different phases of a case...or career...or life.

Now, when my surgeons start to rant and fuss about slow turnover times, I tell them about Wu Wei and encourage them to go gently. It never works, for they are surgeons. But it always helps me to remember that barking, frustrated surgeons and slow turnovers are part of the natural order... and I smile and remember who I was.