The Cardiac Surgeon's Secret

I performed my first coronary artery bypass graft in 1988 as a fellow under the supervision of a legendary cardiac surgeon named Dr. Arthur Levin. Dr. Levin was known for two things: his extraordinary surgical outcomes and his complete intolerance for anything that deviated from evidence-based practice. He was a purist. If a technique had not been validated in a randomized controlled trial, he did not use it. If a drug had not been proven effective, he did not prescribe it. He was the most rigorously scientific physician I have ever known.

And before every surgery, Dr. Levin stood outside the operating room doors and closed his eyes for approximately ten seconds.

I noticed it during my first month as his fellow. The scrub tech would call that the patient was prepped, the team would be waiting, and Dr. Levin would pause — just outside the OR doors, hands at his sides, eyes closed — for ten seconds. Then he would open his eyes, push through the doors, and scrub in. I assumed it was a focus technique. A centering exercise. A way of clearing his mind before a complex case.

In my second year, I asked him about it. We were alone in his office, reviewing angiograms for the next day's cases. I said, casually, "Dr. Levin, what do you think about before you go into the OR?"

He looked at me for a long moment. Then he said, quietly: "I pray."

I was surprised. Dr. Levin was not religious — or at least, he had never expressed any religious belief in my presence. He did not attend hospital chapel services. He did not discuss faith with patients. He was, by all appearances, a secular man.

"I'm not asking God for good outcomes," he said. "I'm not asking for a steady hand or clear judgment. Those things are my responsibility, and I train constantly to maintain them. What I'm asking for is humility. I'm asking to be reminded that no matter how skilled I am, I am not in control of what happens on that table. I am a participant in something larger than myself, and the moment I forget that is the moment I become dangerous."

I have thought about those words every day for thirty years. Before every surgery I perform, I pause outside the OR doors and close my eyes. I don't know what I believe. I don't know if anyone is listening. But I know that the pause — the ten seconds of humility — has made me a better surgeon than any technique I learned in training. And I know that Dr. Levin, before he retired, had a thirty-day mortality rate for CABG that was half the national average. Draw your own conclusions.