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How Surgeons Stay Focused for Hours

Practitioners at Montefiore Health System have honed strategies to push through long


Nov. 16, 2016 10:27 a.m. ET
Organ-transplant surgeons have skills most of us can only dream exactly. One,
concentrating for hours straight, is something we can aspire to.
Transplanting a liver can take eight to 10 hours. Surgeons are on their feet the whole
time, hunched over the operating table. They minimize breaks for the bathroom or
refreshments. And they need frequently to be on call, ready to perform an operation
whenever an organ becomes available.
Members of the abdominal-organ transplant team at Montefiore Einstein Center for
Transplantation, in Bronx, N.Y., have carefully honed strategies they use inside the
operating room, and away from the job, to push through long surgical procedures. Some
techniques are simple, like wearing comfortable shoes. Others stem from an awareness
that implanting a new organ can save a patients life.

You get into a zone when you are operating, says Milan Kinkhabwala, chief of
transplant surgery at the center, part of the Montefiore Health System. Your mind is so
focused on what you are doing, you are not aware of time.


Transplant surgeons, whose work includes stitching minuscule blood vessels together,
minimize their distractions. No one checks cellphones in the operating room during




surgery. The surgeons often wear loupes mounted on eye glasses to magnify their work,
which limits their field of vision to a few inches.
Dr. Kinkhabwala likes to play music in the background, which he says helps reduce his
stress and fatigue. His playlist, which can run for more than 14 hours, consists mostly of
nostalgic tunes such as The Girl From Ipanema and Raindrops Keep Falling on My
Head, songs he says his surgical team enjoys, too.


Jay Graham, a 40-year-old member of the Montefiore transplant-surgery team, says he

used to suffer from neck and back pain as a result of spending hours hunched over the
operating table. The pains have gone away since he started practicing yoga for an hour
each morning, he says. Dr. Graham also eats a vegan diet and runs as many as 30 miles a
week, which he says keeps him in physical shape for his job.
Many of the surgeons wear clogs or sneakers designed to ease the strain of standing for
hours. I have super-tight support stockings and I can stand for 10 hours without being
tired, says Sarah Bellemare.
Dr. Bellemare, 44, generally skips lunch during a marathon surgery. If there is a lull, she
might step out for some water. But usually she prefers to keep going until the operation
is finished.


Patients put their lives in our hands and we feel very responsible to them, she says. Dr.
Bellemare is married to Dr. Kinkhabwala and the couple is raising two young children.
Members of the Montefiore transplant team typically perform at least one long surgery
a week. On other days they do shorter operations and see patients in the hospital or at
their offices.
Most transplants use organs from people who have died, in which case the organ must
be retrieved and used almost immediately. The Montefiore surgeons retrieve the organs
themselves, flying as far as Texas and Florida to remove it from a cadaver and returning




it to the New York hospital. There, other surgeons are waiting to implant it in the
The team also performs live-donor transplants of livers, which is more complex. One
group of surgeons removes segments of liver from a healthy donor. A second group
removes the diseased liver from the ailing patient and implants the new liver graft.


Dr. Kinkhabwala, 53, came to Montefiore 10 years ago to set up the organ-transplant
center. The team consists of six surgeons, ranging in age from late 30s to early 60s.
Montefiores one-year survival rate for adult liver-transplant patients is 93%, compared
with the national average of 91%, according to the Scientific Registry of Transplant
Transplant surgery cant be a young persons game, because it requires a lot of
training, Dr. Kinkhabwala says. On the other hand, you dont want someone tired and
Transplant surgeons have a short shelf life, says Dr. Kinkhabwala. A typical career
runs from the mid-30s to mid-50s, when some practitioners start taking on lessdemanding surgeries or transition to research or teaching, he says.
Studies have shown rising levels of stress and burnout among physicians, especially
surgeons. An analysis of research on the topic, published recently in the Journal of the
American College of Surgeons, found that burnout rates among all doctors ranged from
37% to 53%, with surgeons close to the top of the list. Burnout often involves feelings of
depression and alienation and leads to sharply reduced job satisfaction.
Stuart Greenstein, 61, has been a transplant surgeon for 30 years. He specializes in
kidney transplants, which typically take four or five hours. And he credits his faith as an
Orthodox Jew and the bonds he establishes with his patientshe stays in touch with
them and attends family eventsfor his ability to still do the job.
Attasit Chokechanachaisakul, 37, says his faith as a Buddhist and daily meditation help
him keep calm under pressure. If a surgeon finds himself in a bad situation in surgery,
you have to be very calm to be able to cope, says Dr. Chokechanachaisakul.
Juan Rocca has a more conventional approach to keeping focused during long surgeries
a shot of espresso. While he tries to limit breaks for other reasons, sometimes in the
middle of the transplant, I come back to my office and have another shot, the 43-yearold surgeon says.
Write to Lucette Lagnado at