Life After Surgery with Jeffrey Saffle, MD

My take on Life after Surgery.

My name is Jeffrey Saffle. I read with interest Dr. Dirk Noyes’ recent essay about his life following a distinguished surgical career. Like Dirk, I am a recovering surgeon of roughly the same vintage:  I was the first R-4 on Dirk’s newly-created surgical oncology service at LDS Hospital in 1980. And while I certainly agree with many of his reflections about the surgical life and its aftermath, I think my take is different enough to permit some comments of my own.

Way back in 1968, I left my childhood home in sheltered, provincial Utah for college at the University of Chicago.  It was a tumultuous time in America:  both Martin Luther King Jr and Robert Kennedy were assassinated that Spring, and the contentious, violent Democratic National Convention was held in Chicago just a few days before I arrived.  I landed neck-deep in the swirling tide of current events and ended up getting a much broader education than I had bargained for.  My initial interest had been evolutionary biology, but a part-time job as a diener in the hospital morgue plus the looming threat of the Vietnam draft helped me to decide on medicine.  I stayed in Chicago for med school, and then returned—thanks to the capricious match—to the University of Utah for residency.

Early in my second year our chairman, Frank Moody, suggested that I look into a nascent and untried technology called “laparoscopy”.  But I was too smart for him.  “That’s a crazy idea”, I told myself, “that’ll never work”.  Instead, I found my initial rotation in the burn unit compelling.  Its new director, Glenn Warden, was eccentric and sometimes outrageous, but also gifted, innovative, and tremendously supportive of his staff, his patients and me. He easily recruited me to a home-grown fellowship of clinical work and research, and my future was decided.  I was delighted to be offered a faculty position after residency, and threw myself into the burn unit whole-heartedly. The injuries were sometimes gruesome, but taking the patients through surgery and rehabilitation was very rewarding, and working with residents and students was educational as well as fun. The culture of the unit was uniquely close, and we worked with the nurses and therapists as a real team.  We did almost all our own reconstructive surgery, and followed many patients for years.  I still have a drawer full of wedding invitations and graduation announcements from former patients.  When Glenn left in 1985 to direct the Shriners Hospital in Cincinnati I covered the unit alone for three years.  Exhausting and demanding—sometimes dangerously so—but I didn’t care. 

I enjoyed academic surgery. Most residents I’ve encountered headed straight to private practice, attracted I suppose by financial rewards as well as the chance to operate without the irksome distractions of research and teaching.  I admit that there’s a healthy dose of pretentious bullshit in academics, but I’m not sure the politics of private practice are any better, especially in the corporate-dominated world that it is becoming.  And while academic surgery is certainly focused on money, it isn’t entirely venal, and there are numerous other attractions.  Research was both enjoyable and enlightening—you can’t write papers without having to read a few—and the ongoing interactions with residents and faculty and regular participation in meetings kept me stimulated and up to date. Helping residents through their first attempts at presenting and publishing was enjoyable, and even if most of them never did it again, I’d like to think it helped their career development too.

And surprisingly, I was able to dovetail my academic career into my other great interest—the natural world. I had always loved nature and the outdoors, and in the early 1990’s my wife Susan and I became interested in birdwatching (nowadays called “birding”), currently a rapidly growing, 40 billion dollar a year “green” pastime.  We’ve been all over the world birding, and whenever I could I capitalized on academic meetings to tack on a couple of stolen days in the field.  Many people cherish their memories of Paris or Rome, but some of our fondest recollections are of places like Zim, Minnesota, Harlowton, Montana, and Hobart, Tasmania.

Through my forties and well into my fifties I stayed on course.  The burn unit prospered, and my quality of life took a big step up in 1988 when I was able to lure Dr. Steven Morris back to be my partner.  This left me time, for more birding certainly, but also to pursue other career aspects.  I was very active in the American Burn Association, and rose through the ranks to become President in 2001-2—the year of 9/11.  I worked on several connected projects:  a national burn registry, burn center verification (in cooperation with the ACS), and multicenter trials.  When the new technology of telemedicine began to emerge, I saw its potential and—having learned my lesson with laparoscopy—I became an early adopter and advocate. All of these efforts gave me chances to travel, to interact with a network of peers, and to write, publish, and present.  And if a few birding side trips occurred along the way, none were the wiser.

But somewhere in my late fifties, things changed.  Put simply, it stopped being fun.  The work wasn’t harder; Dr. Amalia Cochran had joined us as a third partner, so my call requirements were lessened.  But worries about the unit and the patients seemed to stay with me more.  Our outcomes were certainly better than when I started, but they seemed less satisfying, while our complications and infrequent failures preoccupied me more.  A glass which had once been half-full now seemed a third empty.  The physical demands of call and the inevitable all-nighters in the OR were much harder to recover from.  The term “burnout” wasn’t as fashionable or ubiquitous fifteen years ago, but that’s clearly what it was (I was a trendsetter!).  So, in 2009, when Susan abruptly declared “I want to retire and move to Minnesota”, I was very ready to listen.

Susan’s idea was a great one, for a number of reasons.  First, it was time for both of us.  Susan had been forced live through all the ups and downs of the burn unit.  She was tired of sharing her life with such a jealous mistress, and she wanted a change from Utah.   Having supported me so uncomplainingly, she was clearly entitled to determine our next steps.  Moving away let us re-invent ourselves to some extent, and starting our new life gave us something to retire to, not just from.  We picked Minnesota largely by a process of elimination:  climate, politics, lifestyle, and, yes, birding.  We began planning then, well in advance of actual retirement, which I strongly recommend.  That gave us time to consider our decision, and let me begin searching for a new burn doctor.  It took all of three years to find the perfect person in Dr. Giavonni Lewis, who joined us in 2012.  Simultaneously, we spent those years traveling back and forth to Minneapolis. We planned to build our new home, so we shopped lots and architects.  We wanted to be surrounded by nature, and we ended up with 10 acres in little Lake Elmo, Minnesota, about 12 miles from St. Paul, and we couldn’t have been happier. Planning is half the enjoyment, and we had great fun—especially Susan--  looking at furniture and fixtures and all the little details of a new home.