Stand Up Straight

By Vanessa Hortian, DO, MS, LAc

It was as though the world stopped in preparation for this instant. All I heard was, “Stand up straight.”

Scene
Although somewhat cliché for a general surgery writing contest, please bear with me as the scene is set in an OR during a laparoscopic cholecystectomy. As an intern, I held the camera and received ongoing constructive criticism about how close to zoom in and how much to move. Nonetheless, I accepted my fate. The scrub tech graciously offered me the camera and bestowed it upon me at the case start, and I became the receiver of incessant feedback about my driving skills.

Fast forward to near the end of the case. This is the anticipated moment when the intern breathes a sigh of relief as the camera duties are finished, hopes the attending suffers mild amnesia regarding the camera skills or lack thereof that were demonstrated during that case, and waits eagerly for the question. Then, it happened. My attending asked, “Vanessa, do you want to close skin?” I answered with a resounding and confident, “Yes, absolutely,” and assumed my position. This was my moment to regain any semblance of credibility. I ran through all the details in my head that I would need to effectively close skin at a trocar site, including suture material and name, needle driver size, etc. Surgical success stands on preparation, so in my head, I was prepared. I received the loaded needle driver and Adson forceps from the scrub tech, felt the pressure of everyone staring at my hands, reached in to grasp the skin edge with the Adson in my left hand, and ensured the needle tip would enter the tissue at 90 degrees via my right hand.

Cut!
Correction: via my right wrist, because all top surgeons know that suturing is all in the wrist.

Take Two
Regardless, I was set up to throw my best first throw. It was as though the world stopped in preparation for this instant. All I heard was, “Stand up straight.” Confusion ensued on my part, and I wasn’t sure if it was my Armenian grandmother speaking to me from her grave or if it was my attending. I realized it was my attending, and before I could compute why he was looking at my posture and not looking at the seemingly near-perfect first throw I was about to make, I quickly stood up straight, reconnected my head to my body—a disconnection that all too many of us do—and realized how unstraight I was standing. Enter the Oprah “aha moment.” I thanked my attending for his observation and the case, and finished suturing.
End Scene

To some, this aha moment may seem inconsequential. To me, it was a poignant moment that served as the springboard for this piece. Therefore, when asked one thing I would change about surgical education, I would institute a physical training program that includes both intraoperative ergonomics and lifestyle-based functional mobility modules to develop resident physical strength and awareness both inside and outside the OR. As to the “why” for this idea, allow me to elucidate.

My path to surgery has been anything but traditional, yet it is precisely this path that provides the foundation from which I can serve as a surgery resident who understands awareness and its implications in facilitating a successful career. After serving as a peer counselor and health educator during my undergraduate studies at Rutgers University, in New Brunswick, N.J., I worked after graduation to create a unique therapeutic milieu at Elmhurst Hospital’s first holistic inpatient psychiatric unit, in Queens, a borough of New York City. I then pursued certification as a yoga instructor and personal trainer, which exponentially increased my appreciation for the roles of body and mind in healing. 

While involved in National Institutes of Health?funded clinical research at Columbia University’s Rosenthal Center for Complementary and Alternative Medicine, in New York City, I developed a deep interest in integrative medicine and pursued a Master of Science in Acupuncture. I became a National Diplomate of Acupuncture, established a Manhattan practice, and am currently a licensed acupuncturist in New Jersey, New York, Pennsylvania and South Carolina. Based on my commitment to academics and integrative medicine, Memorial Sloan Kettering Cancer Center’s Integrative Medicine Service sought me out as its first-ever Education Coordinator. I then decided that augmenting my biomedical knowledge would allow me to provide more comprehensive care. I completed an accelerated post-baccalaureate program, graduated with Sigma Sigma Phi Honors from Edward Via College of Osteopathic Medicine, in Spartanburg, S.C., and am now honored to serve as a PGY-2 general surgery resident.

I outline my academic and professional journey not to list accolades, but rather to highlight precisely why my aha moment was so transformational. Reflecting on that day in the OR, several lessons were revealed. My attending did care about more than just my hands, and he realized the importance of surgical body mechanics. It was humbling because if I, with years of training in these modalities, still needed a reminder to “stand up straight,” then most of my fellow residents would benefit from teachings about awareness, functional mobility and ergonomics. From that moment, I have become committed to serving as a catalyst regarding body awareness in the surgical world. My observations have yielded a lack of knowledge and awareness from colleagues about proper body mechanics, both inside and outside the OR, and the resultant potential for/reality of repetitive stress injuries, increased burnout rates, decreased overall and technical efficacy, and decreased quality of life. On an optimistic note, I have observed sincere interest regarding learning and implementing movement, particularly related to improving surgical performance.

Additional support for increasing physical awareness in surgical education comes from two of the four osteopathic medicine tenets. The first states the person is a unit of body, mind and spirit, and the second states structure and function are reciprocally interrelated. Interestingly, Edward D. Verrier, MD, FACS, provided a lecture at the American College of Surgeons Clinical Congress in Washington, D.C., in October 2016, that supported the need for surgical education evolution. Dr. Verrier outlined a myriad of surgical practice changes, but without commensurate surgical education changes. He made recommendations via a thought-provoking comparison of training elite athletes and master surgeons. This perspective supports instituting not only physical training in surgical residency, but an overall paradigm shift toward incorporating training aimed at the interrelatedness of mind and body in training elite individuals.

In closing, I express extreme gratitude for a platform from which I may demonstrate my passion for this work. In that vein, to the minds, hands, vertebrae, muscles and joints of my fellow residents, esteemed attendings, and all other colleagues who wish for a long and prosperous surgical career—whether it’s Bob Marley who motivates you to “Get Up, Stand Up”; your grandmother who pinches your ear until you are Eiffel Tower?tall; your yoga teacher who suggests “Mountain Pose” for chakra alignment; or your attending invested in your growth as a surgeon—please “stand up straight.” It turns out that Grandma was right all along.

—Dr. Hortian is a PGY-2 surgical resident, UPMC Pinnacle, Harrisburg, Pa.