By Lilah Morris-Wiseman, MD, FACS
“Stepping into the operating room to perform heart surgery on a sick patient, being fully in control of the large team of people who are required to do the procedure, and feeling totally prepared to perform the task at hand is an unbelievable feeling that can barely be described.”
–Renee Hartrz, MD, FACS, Cardiothoracic Surgeon, FACS website “Why do surgeons become surgeons?”
I received a call from my program director after the second time I didn’t show up to work.
“We need to meet,” he told me.
I was a fourth-year general surgery resident on our night trauma surgery team. I didn’t wake up for my shift and I wasn’t answering my phone or pager. I woke up to let the paramedics in, but only became truly aware when there was a needle in my vein infusing dextrose. I had not adjusted my insulin pump schedule to reflect that my days and nights were now flipped, which caused hypoglycemia when my typical higher daytime insulin needs were delivered while I was asleep.
We sat in the hospital cafeteria before my scheduled shift. My program director was kind and supportive. “Do you want me to switch your schedule? I can take you off nights,” he offered. “No, thank you,” I replied, “I’m fine.” I did not need help, I thought. It never crossed my mind that I could have died had no one figured out what was going on or been persistent enough to call 911. “I will fix this,” I assured him.
Surgeons are supposed to be invincible and strong, I thought, and that’s certainly how I thought of myself. Years before, after ending up in the hospital in diabetic ketoacidosis and a new diagnosis of Type 1 diabetes, I still ran 4 marathons and decided to go to medical school. In line with choosing the most difficult route, surgery became a perfect fit.
Truthfully, I’m not sure I had ever considered diabetes as a limitation, or even an influence, in my path. At that moment, sitting with my program director, I realized that I needed to figure out how I could live as a healthy surgeon, wife, and eventually mother, with a chronic disease requiring constant management.
I chose a specific surgical career path that fit with my health needs. Because I have more difficulty managing blood sugar in cases longer than four hours or when my schedule is erratic, I pursued a specialty with shorter, non-emergent cases (Endocrine Surgery). I am able to take general surgery emergency call on a defined schedule.
I learned how to live safely with my disease. I have a continuous glucose sensor with feedback to an insulin pump. If my blood sugar is low in the operating room, my sensor alarms. I have set a backup “auto off” mode so if I have not touched the pump in 8 hours, it will alarm and turn off. I eat a higher protein, low carbohydrate diet that helps me avoid many of the blood glucose swings, and I exercise daily.
Finally, I share my experience. I talk about my diabetes in an attempt to normalize chronic disease in a surgeon. Much of the medical perception of chronic disease relates to disability. In truth, I know several surgeons with Type 1 diabetes. I have surgeon colleagues with neuromuscular diseases who receive monthly treatment infusions. We also hike, swim, and run outside of the OR. A life in surgery is challenging, but for those who can live safely with a chronic disease, it is not a limitation.
Lilah Morris-Wiseman, MD, FACS, is an Assistant Professor of Endocrine and General Surgery at the University of Arizona, Tucson where she is the Associate Program Director for the General Surgery residency. She was diagnosed with Type 1 diabetes at age 22, which prompted her to attend medical school. After graduating from Tulane University School of Medicine, she completed General Surgery Residency at University of California, Los Angeles and fellowship in Surgical Endocrinology at MD Anderson Cancer Center in Houston, Texas. She is grateful to be able to work with her surgeon husband; at home they enjoy hiking and spending time outdoors with their three daughters, ages 16, 8, and 6. She is currently training for her first ultra-marathon.
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