Reflections on Mortality Part 1: Worry and Planning (9/25/24)

 

(As I review this in July 2025, I am breaking this down into three segments to make it more digestible!  Since now being diagnosed with Parkinson’s disease, in retrospect, many things make more sense.)

 

 

"I am an old man and have known a great many troubles, but most of them never happened. Worrying is like paying a debt you don't owe. I have spent most of my life worrying about things that have never happened."

Mark Twain

 

I have a tendency to worry, although I would like to deny that it is actually “worry”.  I’d prefer to call it something like “planning” or “being prepared”. I at times envy people who seem to go through life without a concern for the future, for the possibilities.

 

I often, maybe almost always, find myself concerned with the “what if”, to the point that it steals the joy of the moment.  This past year, while on a trip to Croatia, conscious of my tendency to worry, I purposefully planned to practice mindfulness and focus on the moment.  Well, that worked to a degree, but also left me “mindful” of the things that could go wrong!  What if I had an accident with the rental car?  What if we missed the ferry…?

 

This tendency to worry has developed over time from a mix of influences. I am a first born.  My mother worried (also a first born). I am highly goal oriented and was a bit driven to succeed (or afraid of failing). Some of this was influenced, maybe honed, by a fundamentalist Baptist upbringing, with its do’s and don’ts. And to cap it off I became a surgeon.

 

Being a surgeon, at least for me, was partly defined by “planning for the worst” (i.e. worry).  I was trained to be prepared for whatever might happen.  I anticipated the nightmare scenarios, and had plan A, B, C… mentally mapped out, both for the operating room and throughout the recovery period.  Doing surgery meant there would be complications.  It comes with the territory when you take people who are relatively “well”, paralyze them, put them on life support, cut them open and rearrange their insides, and then try to bring them back to a condition better than what they started from.  Things go wrong!

 

Why?

 

I lost much sleep over this short question!  Did I do something wrong that caused Mr. Jones’ postoperative infection?  Could I have done something differently that would have prevented Mrs. Smith’s stroke during surgery?  Was it my fault?  

 

I think this accumulated burden of worry over the years contributed to my declining health which I first grappled with in my early 50’s; overweight, impending diabetes, high blood pressure, high cholesterol.  Of course, my lack of sleep, long hours at work, being on call, eating junk food, lack of exercise, etc. all contributed as well.  That led to my encounter with lifestyle medicine, which changed the trajectory of my life, and probably has spared me from years of medication, maybe a heart attack, early disability from diabetes, and other unhappy scenarios.

 

This tendency to “plan for the worst”, as burdensome as it was, also did have its positive side.  It did help me through some difficult patient situations in the operating room.  It also helped me set up and run an operating room in a hospital in Honduras (see the blog Thoughts from Honduras).  And it helped me as I led multiple medical mission trips oversees where we often faced the unusual (but if I “planned” correctly, not the “unexpected”).

 

It was this accumulated burden of worry that contributed to my decision to retire from surgery in 2017.  There were many other factors as well.  The introduction of the electronic medical record was very burdensome.  I resisted the shift of medicine to a factory mentality focused on productivity at the cost of diminishing the relational connection with the patient. I refused to have a hospitalist do my pre and post op care, which would have reduced me to a technician that cranked out the numbers (and bills), and resisted the pressure to work faster and spend less time with patients. I wanted to personally talk with each patient and their family before and after the procedure, which meant more “down time” for the OR crew.  And I was developing arthritis in my hands, leaving them aching, especially after “driving” the endoscopes for several hours.  It was time to change, to lighten that burden of worry.