American College Of Surgeons - Inspiring Quality: Highest Standards, Better Outcomes

Insights from a Surgeon from the University of Florida College of Medicine

Gilbert R. Upchurch, Jr., MD, FACS, Chair, Department of Surgery, University of Florida College of Medicine, discusses the need for preparation to combat the COVID-19 virus in areas that haven’t yet seen significant cases, and also the need to prepare to “get everything back to normal.” He writes, “While the emotional and fiscal toll will be significant, based on all I know about human resolve, we will show ’grit,’ as we always do.”

As a nonnative of Florida, Nancy and I experienced our first “Category 5 hurricane is coming” alert this past fall. In addition to waiting in extremely long lines at the gas station and suffering shortages at the grocery store, I remember having to take everything from outside our home that could serve as a projectile and move it inside. We spent days preparing for a storm that never came. After a week of anticipation, the hurricane moved toward the Atlantic Ocean and never hit Gainesville. Spending multiple days preparing for the storm, we likely all suffered silently from “anticipatory grief” as we prepared for the worst, even though it never arrived. In hindsight, getting over this grief took time and possibly was why it took us the rest of the fall/winter and into spring before we got everything back to normal.

Unlike the hurricane, unfortunately I believe this pandemic likely will hit us. At present, we once again find ourselves suffering from anticipatory grief as we prepare for the pandemic without knowing when or how hard it will strike. Clearly, we are actively preparing and will be ready. I am convinced that everyone in the department of surgery will do what is required, no matter how big or how small.

Having said that, we also need to prepare to “get everything back to normal.” It’s likely we all will be affected by losing someone to this disease. While the emotional and fiscal toll will be significant, based on all I know about human resolve, we will show “grit,” as we always do. Grit is defined variably as: growth, resilience, intensity, and tenacity. Psychologist Angela Duckworth, PhD, describes grit in multiple areas, including athletics, education, military training, science, and business, in which people persevere despite adversity. They persevere because of a belief in something bigger than themselves that matters in the long term. In this instance, we clearly believe that it is our duty to help others as health care providers. The work we do caring for patients, training the next generation of health care providers, and performing research that moves the standard of care forward isn’t only bigger than ourselves, it transcends our lifetime.

In an era in which we are inundated with negative articles focused on health care, let me suggest you read a recent scoping review, first authored by Tyler Loftus, MD, a former resident, fellow, and soon-to-be-faculty member at the University of Florida, and enriched by perspectives from surgeons across multiple specialties and academic ranks. Building and strengthening our own grit and optimism serves as a method to prevent burnout and actually improve performance, especially in times of crisis.

Methods for cultivating grit to improve performance are well described in many social and natural sciences, but not so much in medicine. Dr. Loftus suggested the following five methods to improve our grit: First, maintain increased levels of positivity. As humans, we try to avoid the negative more than we try to attain the positive. The literature suggests that one needs to be three to six times more positive than negative. We need more focus on the positive!

Second, pursue major challenges that match personal skills. The best way to help in the battle against this disease is to spend time focused on helping others who may have it or are at high risk for it. Volunteer to make masks. Go serve as a scribe. No job is too small when you are helping. My Dad volunteers at a place where they hand out food every week to 120 needy families in a small town in North Carolina. He can barely stand or walk and says now he is “in charge of hugs.” While I don’t suggest you hand out hugs, I do suggest that, like my Dad, you help as best you can.

Third, engage in deliberate practice to improve personal skills. Most great athletes envision making the shot before it goes through the goal or hoop. Envision yourself helping others and then go out and do it. I keep seeing myself in the trauma/acute care surgery clinic or rounding. Don’t be surprised if I show up.

Fourth, persist in hard work over time, recognizing that effort often can count for as much as talent. There is a lot of data suggesting that grit is important in achievement. In a group of Ivy League undergraduate students, grit correlated with higher grade point averages, ironically even in the setting of lower SAT scores. We all can give of our time with effort.

Fifth and finally, pursue a higher meaning and purpose in your work and life. As corny as it might sound, we all started down this path of being health care workers with the same goals: to rid the world of pain and suffering and to help others. Reflect on why you became a health care worker during this time of assault, as well as in the time following when we will be returning to normal. Use this “new normal” to reprioritize the things that are important to you and “become a better you.”

Access the article referenced here in The American Journal of Surgery.

I know most people don’t read past the third line of any communication, and believe you me, I get it, as my attention deficit disorder is just as bad as anyone’s. However, if you did read this and you find it useful as it serves as a brief pause from your anxiety and grief, drop me a line. I am happy to keep doing it. I want us all to be better on the other side of this pandemic. In fact, I know we will be better, because we all have a little “Rooster J. Cogburn” in us: that is, “True Grit.” Namely, we are all willing to do what others won’t: putting ourselves in harm’s way in order to help.

Go Gators,
Gilbert R. Upchurch, Jr., Chair, Department of Surgery, University of Florida College of Medicine