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The Dartmouth
April 16, 2024 | Latest Issue
The Dartmouth

Guo: Ruptured Aneurysms

I wait for the noise to die down in the crowded lecture hall. The clock turns 7, and I step out from behind the podium, activating my presentation. Holograms fill the stage, 3-D faces rotate and swerve amongst the surgical residents in the audience.

The faces are beautiful, symmetrical, statistically averaged. Their expressions shine with laughter, marked by straight teeth and twinkling eyes. But the faces morph: Foreheads wrinkle, eyes sadden and movement slows until only a line of faces pocketed with age decorates the stage behind me.

“What is beauty?” I ask.

The faces disappear, one by one, replaced by a brain hovering above me.

“Beauty is the symmetry of neural organization.”

The brain is sliced midsagittally to separate the two hemispheres.

“Beauty is the rise and fall of gyri and sulci, the arborization of the cerebellum, the precision of structure and plasticity of function. It is a cut that slices through the grey and sucks away tumors, allowing for another chance at life.”

The two halves of the brain fall away from the stage, replaced by an emergency waiting room.

“Beauty is the ease with which good news is delivered, the resulting relief and the boost in confidence. It is the finesse with which deaths are conveyed, the moment you, as a physician, claim responsibility and boomerang back after failures.”

The emergency room shatters. I pause.

“But you know all of that. You have been residents for years now. It is not my job to tell you what you already appreciate as your passions. I have been asked today to speak to you about beauty. I thought long and hard about appropriate topics in medicine — the birth of a baby, the restoration of movement after trauma, the return of memory despite age. These are beautiful, grand moments, moments that should be treasured and archived. But, today, I will speak to you about another kind of beauty — a beauty rooted in wholeness.”

A quote flashes above me. “I stumbled across this quote by Hugh Mackay 44 years ago, when I was 16 years old:

“I actually attack the concept of happiness. I don’t mind people being happy, but the idea that everything we do is part of the pursuit of happiness seems to me a really dangerous idea and has led to a contemporary disease in Western society, which is fear of sadness. We’re kind of teaching our kids that happiness is the default position — it’s rubbish. Wholeness is what we ought to be striving for, and part of that is sadness, disappointment, frustration, failure; all of those things which make us who we are. Happiness and victory and fulfillment are nice little things that also happen to us, but they don’t teach us much. Everyone says we grow through pain, and then as soon as they experience pain they say ‘Quick! Move on! Cheer up!’ I’d like, just for a year, to have a moratorium on the word ‘happiness’ and to replace it with the word ‘wholeness.’ Ask yourself, ‘Is this contributing to my wholeness? and if you’re having a bad day, it is.”

I let the quote sink in. “Maybe you disagree. Maybe, for you, happiness is beauty. But maybe, just maybe, it’s not.

“When I was an undergrad decades ago, no one sat me down and recounted the routineness of practicing. Few explained the occasional banality of patient interaction, often marked with utter frustration and sporadically with exciting humor. Some of you, I’m sure of it, chose to pursue medicine for the prestige, the money, the stability of your career. A handful of you chose to pursue it for the patients, for the opportunity to do good by healing one person at a time. There is no right reason behind pursuit. I thought for years that I wanted to pursue medicine because of the latter, for the opportunity to change at least one person’s life.

“But, as a senior in college, I spoke with a fourth year Stanford MD/MBA student, who worked at the same healthcare consulting firm I did before med school. He spoke about his reservations toward the healthcare industry, the inability to enact systematic changes at such a microscopic level. ‘If I were the top provider in the country,’ he said, ‘and I treated x number of patients, how much value would I have added to society compared to the second top provider or tenth or even hundredth? Not a lot. Not a lot at all.’ I wondered about this for a long time before applying to medical school, finally quelling my doubts when acceptances rolled in and I officially committed. But the doubt resurfaced in residency after I lost my first patient during a routine surgery. Was I fit to be a physician? What could I possibly add to society that another physician couldn’t? To quote Mackay, I was having a ‘bad [terrible, heart-wrenching] day.’

“We were — and are — told that complications happen, that we can’t always control our patients’ decisions and therefore their lives. But, in the operating room, I was and you are in control. I believed after I lost my first patient that I was responsible — that it was my rudimentary technique and inaccurate incisions that ruptured the aneurysm.

I pause. “Two days later, I had to perform another aneurysm repair. Two days to ‘move on’ and ‘cheer up,’ to mourn for my patient and his family, to regain confidence in my skills as a surgeon and my decision to pursue medicine.”

I walk back to the podium. “I won’t talk you through my recovery process; I’m sure most, if not all of you have fallen into the rabbit hole of self-doubt and then resurfaced whole, as evidenced by your presence here today.

“There is a beauty in medicine, in the cycle of diagnosis and treatment and care. But it is a system not without flaws. I hope that each of you finds beauty in your craft, in the idiosyncrasies of your patients and, especially, in the wholeness of self that results from your experiences and the wholeness you impart on others.”