James Naples is assistant professor of otolaryngology-head and neck surgery at Harvard Medical School. He is an adviser to Harvard medical students and residency program director.
Each year right about now, with the sunny start of term long past, it dawns on my students and residents that surgery is not just about perfection and precision; it is also frustrating and fraught with compromise. Each winter I reflect on something that happened to me at their age and stage.
For an entire year, early in my training as a surgeon, I struggled to perform even the simplest procedure. I woke up early and stayed late. I willed my skills to get better. They didn’t. I performed countless simulations and repetitions. I sought advice from senior surgeons. Nothing felt like it made any difference.
I had the surgical yips.
My head had gotten in the way of my hands. My problem was not a lack of effort or potential. The problem was my mind: I could not bridge the gap between imagined perfection and messy reality. Surrounded by God-like professors projecting infallibility, I couldn’t grasp that even in surgery, good enough has to be good enough.
What happened is a lesson in leadership — and life that I’m glad I learned early.
Sports fans know all about the yips. It’s when elite golfers, pitchers, cricketers or darts players, say, become unable to sink the short putt or let go the dart — for no apparent reason. Pitcher Daniel Bard told the New Yorker of thinking in terror: “I don’t know where the ball is going.”
It was just like that for me. Each morning of training, my body would tighten. The operating room turned into a courtroom, and I was on trial.
Even when things went well, the self-doubt never felt that way. A win — I spotted and dodged a blood vessel — was a zero, something any idiot could do. A slip-up — needing help to control bleeding — I’d etch onto my mental scorecard as a fundamental failure of aptitude and character.
It didn’t occur to me that both were ordinary — necessary — steps on the road to mastery; and few senior surgeons pointed that out.
In professional sports, the yips can end a career or mean millions of dollars lost. The stakes are high. In surgery, the stakes felt higher. Every move seemed as though a life was on the line, even though in truth, as a trainee, a senior surgeon always has your back.
Relief came when I switched rotations. One team of senior surgeons was traded for another. I met Dr. E. His approach was acceptance, not arrogance.
Dr. E had no preconceived ideas about my skills. As we scrubbed for surgery (where all the real conversation happens), he asked if I’d ever done a mastoidectomy: Had I, in other words, ever drilled the bone behind the ear to take out diseased cells from its hollows? I said I had not.
“Good,” he replied, as if he’d hoped for that reply. “There is only one rule: Do not hit the facial nerve.” That can cause the face to droop. “That’s it?” I asked, probably sounding confused and naive. “Yes; all other mistakes are fixable,” he said.
In three minutes (the recommended scrubbing time), he related his own struggles during training and how much they had taught him. He was authentic and specific; warm and open. He told me of the errors he’d made — mental and technical. He spoke as if these things had happened yesterday, and I felt his shame.
This was the first time I’d heard a senior surgeon admit to making mistakes. Surgery is filled with expert technicians who project perfection. Struggle of the mind is rarely discussed. Young people rising through the ranks are not taught how to manage the psychological stress of the operating room.
Dr. E normalized my situation: He created the psychological safety I so desperately needed to keep going. I became comfortable with being uncomfortable. I learned that there are some mistakes that must not be made, but that most are easily remedied and crucial to learning. Finally, my head got out of the way of my hands.
I’ve reflected a lot since then on the confidence I drew from the belief and compassion of one mentor.
For an elite gymnast or soccer star, Dr. E’s role might be filled by a sports psychologist. Since there is no surgeon-psychologist, I try to take on some of this role with trainees. I encourage them to share their fears and doubts. We discuss the differences between the fluid reality of the operating room and the artificially perfect scenarios conjured by textbooks and the tall tales of attending surgeons.
The yips refers to a spiral of self-doubt in certain high-pressure situations demanding great physical precision. But is it really so narrow? What thing worth doing — in our jobs, families or communities — is not susceptible to the folly of perfectionism? With honesty and empathy, we all can help others find peace with fallibility and cross the treacherous bridges that freeze them along the way. The principle “everything else is fixable” can apply to so much of life.
As my trainees struggle to reconcile what they dreamed with what they face, I pay forward what I learned from the yips: that great, compassionate and creative surgeons are vulnerable and imperfect. We all are, and that is okay.