Fear and Trust in the Operating Room: A Cancer Surgeon's Story

December 2, 2015

“It was magical. Everyone in that operating room peacefully did their jobs and we felt love for the patient and one another,” recalled Dr. Peter Johnson about a Christmas Eve surgery on an elderly cancer patient. “She brought us cookies to thank us for being there for her on Christmas, which set such a harmonious tone. Here was a very, very sick woman who wanted to us to know how grateful she was, who showered us with love as she suffered. No one in her company that day missed that irony. From that point, that foundation of love, the operating room was a place of hope and serenity, with a spirit like none I had ever felt before.”

Dr. Johnson is the medical director of gynecologic oncology at Aurora Medical Group in Wisconsin, and one of the top cancer surgeons in the nation. He was one of the first in the country to use state of the art robotic-assisted surgery to treat gynecologic cancer. He pioneered many patient care techniques and has authored and been featured in numerous studies about successfully treating cancer and enabling reproduction. He has helped thousands of women not only to survive cancer but also to go on to become loving mothers, by treating their cancer with sensitive approaches that allowed them to have children. He has been licensed to practice in five states for nearly two decades. Today, Dr. Johnson helps train medical students as a clinical professor at the University of Wisconsin School of Medicine and Public Health, one of the top physician training institutions in the U.S. He has been married for 25 years, is the father of a grown son, and may someday be a grandfather.

Peter Johnson was, by his own admission, a jerk. About a year before the Christmas miracle surgery he had a claim filed against him for being an emotionally abusive mentor to resident doctors under his watch at the teaching hospital. Resident doctors are typically in their mid-20’s or older, have obtained their medical degree, and are continuing their education with formal specialized training under an experienced supervising doctor. Dr. Johnson was in charge of a team of residents. The complaint against him capped years of behavior that alienated colleagues and brought future doctors to tears and to their knees as he berated them during their education and training. At the same time, he helped female patients to realize their dreams, to lead rich lives, and to bear children after they had been told by other physicians to not expect much more than a few more months to live. With one hand Dr. Johnson was crushing souls and with the other he was saving them.

“I did not know any better,” reflected Dr. Johnson. “I was trained by physicians who were abusive, exacting, and unforgiving. The theory was this: if you were trained under fire, then when it comes time to perform on your own and something goes wrong in the operating room, you have the wits and calm to keep it together and fix the problem.” This approach to medical care and to surgery in particular has long run through the halls of the finest medical schools and training hospitals in the U.S. It has for decades been common practice to demand interns and young doctors to perform under extreme stress by creating overwhelmingly stressful training situations. “The problem is that I never told any of my students why I was so harsh on them. I never communicated that I cared about them and about all those they would heal in the future. Young men and women under my tutelage unnecessarily suffered, tragically suffered, because I did not voice my concern, love, and respect for them. I was teaching behaviors that made people ugly human beings.”

“I also was a hypocrite. I would enter a patient’s room and turn into a sensitive doctor who understood my patient’s pain. I was kind to patients and medical students and harsh on residents. And, even with patients my approach was less effective than it could have been. My voice was saying ‘a’ and my energy was saying ‘b,’ and patients picked up on that. Residents and others saw this Jekyll and Hyde routine and were dumbstruck by it.”

The complaint culminated years of Dr. Johnson’s belittling behavior toward those under his sway. Ultimately he was accused of hitting a resident in the operating room. “I did not hit anyone. However, I had created such a negative environment that the perception that I could hit someone was legitimate. I cussed, I yelled, I put people down, so it was natural to think I could have hit someone.” His reputation led to the charge that left Dr. Johnson’s superior no other choice: he had to undergo a thorough review of his behaviors and would be fired if he had another complaint filed against him. At that point, Peter realized he had gone too far.

He had also gone too far at home. The night before his son took his driver’s license exam, Peter used the same approach he had with interns and residents at the hospital. He created a practice environment so harsh that the actual driving test would seem like a walk in the park. He yelled at his son, deriding him for mistakes made in practice turns and backups, rendering an atmosphere of pure fear and sadness. “Now I see why the residents hate you!” yelled his son as he climbed out of the car. “I never told him I did that because I loved him and wanted him to succeed,” said Peter.

“Fear consumed me. Every decision I made could be life ending. Every student I taught was entering this same world, where the result of a job well done or poorly done is life or death. I feared complications from surgery. I feared professional humiliation. I feared losing my practice. I feared being broke. I feared that I was going to miss something that could kill someone.”

Doctors generally function from a deficit based mentality: they focus on what is wrong. They constantly look for a problem, for what ails patients. Sickness is something no one wants; doctors are always seeking to find and to eliminate what is causing illness. This clinical approach serves patients well – as the focus is on finding and fixing a problem – but it does not work well in other parts of your life. When constant fear and looking for what is wrong spills over into your relationships with others, the world around you suffers. This clinical approach to life leads to unhappiness and a lack of true fulfillment.

“It took almost losing my job to wake up. A mentor and colleague, Dr Jim Katz, told me the world had changed, and I needed to polish myself. I needed to make better eye contact with people. I needed to change the way I spoke to people. I needed to discuss potential issues with people before I blew up at them. Another friend gave me books by Thich Nhat Hanh who shared pearls of wisdom about peace and acceptance. In this time period I really questioned who I was and how I was. The final “aha” moments came at the Abundant Living Retreat where for four straight days I worked on understanding what drove me and how my behavior impacted others. I continue that work today, every day.”

“I remembered that early in my career I was told by a mentor that, ‘When I quit screaming at you, you better worry, because that means I don’t care about you anymore. I want to stress you out so you are tough and ready for the worst.’ When I compare that thought with the serenity in the operating room last Christmas Eve, I realize how ludicrous it is.” Dr. Johnson came to know that care is not best voiced in a scream. It is best voiced in a caress.

“I needed to teach the art of medicine and not the science of it. Anyone can learn to be a clinician. But if you have a cold heart and dispassion for mistakes you are not a healer. The art of medicine is magical. Authentically and openly communicating with patients and colleagues that you truly trust and care about them, and giving positive support to every member of a team lifts the entire state of a hospital and a community. I see that everywhere I look. We all saw and felt it on Christmas Eve.”

The importance of trust, understanding, and kindness is not taught in medical school. There are no surgery classes in the world entitled “Compassion, Serenity, and Peace as the Ultimate Healing Tool.” But Dr. Johnson knows firsthand the difference operating –literally and metaphorically – in this state makes. He has traveled a long road to loving himself and those around him. “I am on a committee that is analyzing the efficiency of our surgical services. We have 30,000 employees and 2,000 physicians. Our studies so far reveal that our most cost effective doctor is a 58-year old orthopedic surgeon. I asked him why he thought he was so successful. He told me he operates his practice as a team. There is no overbearing captain. They all work together. They cross the lines of each other’s jobs and do what needs to be done. Nothing is beneath him, or anyone else on the team. Their culture is trusting, loving, kind, and supportive. They work well together because they care for each other.”

“I don’t want to be mocked as this ‘new agey’ doctor who went to a retreat and found what matters, where I tell people how to love each other to make the world a beautiful place. Instead, I lead by example. I now tell people how they handled a situation beautifully, how they showed tremendous compassion and leadership. I have come to be a much better person because I acknowledge and embrace my fears; I don’t hide from them or let them drive me to anger or collapse. I now show others it is okay to do the same – to share their fears – by sharing mine. I kindly but honestly tell people what I feel and let people know they are valued and appreciated. I realize that one person – even the person who may have been suffering the most, like our Christmas Eve patient – living in a state of trust, love, and compassion has the power to elevate the state of the world.”


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