In the Zone: A Day in the Life of a Pediatric Cardiac Surgeon

In this interview, Dr. Bacha, Chief of the Division of Cardiothoracic Surgery at NewYork-Presbyterian/Columbia, provides a glimpse into what it is like to perform open heart surgery on children every day, and what it takes to excel in such demanding circumstances. Having previously served as the director of pediatric heart surgery programs at Children’s Hospital in Boston and the University Hospitals of Chicago, Dr. Bacha has had many years of experience in learning how to be at one’s absolute best, day in and day out, when a child’s life is on the line.

Q: You describe something you consider indispensable to being a successful surgeon: the ability to be “in the zone,” as you put it. How would you describe being “in the zone?”

Dr. Bacha: Being “in the zone” means maintaining complete focus, concentration, and equanimity so that nothing distracts you from the task at hand. And this has to be done under any circumstance. It means being able to control your emotions so you can focus exclusively on the patient’s heart surgery. It means leaving your problems, whatever they may be — spousal, financial or whatever — at the door in the OR. It means not losing composure no matter what else may be going on.

Q: Why is this important?

Dr. Bacha: Being able to be “in the zone” really differentiates a successful surgeon from one who isn’t as successful. If you have a patient dying before your eyes, a limited time to do an operation, and the clock is ticking, are you able to hold it together and do the right thing? Or do you compensate by falling apart, or yelling or lashing out at your colleagues? In the field of pediatric cardiac surgery, emotions are especially magnified because we are dealing with a child’s life. Going through years of training is not enough; I have seen doctors who have had impeccable training and who are extremely ‘book-smart’ but who break down under pressure in the operating room. If you’re not able to control your emotions, you can’t function at a high level day after day after day.

I teach my residents that the tougher and the more acute it gets in the OR, the slower you should get. Because the adrenaline is flowing, you are usually not slower, but in fact achieve a sort of middle range where you are not hasty in your decisions and actions. Remember that a surgeon has to be physically proficient as well as intellectually. That is, you can be the smartest surgeon in the world, but if that stitch is not placed perfectly, the patient will die no matter how smart you are. Another thing I teach my residents is that the best teams handle emergencies in an orderly fashion, such that if an observer was watching the team work from the outside, he wouldn’t be able to tell that an emergency was going on.

Q: Was there ever a time you could not stay in the zone?

Dr. Bacha: A few years back, my wife and children got stuck in Lebanon in a war situation. They were at my mother’s house, and bombs were falling, and I was terribly worried. That was the one time I could not uncouple myself from what was going on, and I could not go into the operating room, and therefore canceled my cases.

Q: How do you maintain your equanimity – do you have any particular practices that help you stay balanced?

Dr. Bacha: I don’t meditate or do yoga or other practices in particular, no. I do have a stable family life, and I think that’s a big part of it. I think I am lucky because I have found it not too difficult to remain balanced. Other things are harder for me, but I grew up during the Lebanese civil war, with a lot of mayhem around me, so maybe I learned to have some innate order.