NOBILITY IN SMALL THINGS

Reflections from an esteemed physician.

Cardiothoracic surgeon Smith, who performed a coronary bypass operation on Bill Clinton in 2004, makes his book debut with a forthright memoir about his roundabout path to medicine and the commitment and accountability inherent in being a physician. When the pandemic shut down elective surgeries from March to May 2020, the author, chief cardiothoracic surgeon at Columbia Presbyterian Hospital, wrote 59 daily email updates to everyone in his department. Hoping “to inform and reassure, and—possibly—to inspire,” he found himself sharing “surprising extrospection and intimacy,” a project he continues here. An awkward, accident-prone child, Smith endured many hospital stays. Though comfortable in that environment, he did not feel compelled to follow in his grandparents’ steps to become a doctor. After graduating from Williams College, he worked as a lineman, earning his first post-college degree from the Framingham pole climbing school. Graduate study in biology took him to Dartmouth, but he soon decided on medical school instead. During his residency, he was drawn to surgery because of its challenges. “Every year,” he writes, “a surgeon is doing more surgery, more difficult surgery, and doing it better.” However, he was undecided about a specialty until he scrubbed on a cardiac surgery case: “I was hooked and never looked back. It was bold and complex, there was risk, every stitch seemed to matter, and feedback was immediate. Get it right or the patient might not leave the room alive.” Besides recounting many medical cases (Clinton’s led to unforeseen complications) and reflecting on hospital culture, Smith reveals the social anxiety leading to “autonomic storms” that beset him for decades. “Social life became a minefield,” he admits, until he devised strategies to help him cope. The author underscores a physician’s responsibility to the patient. Certainly, surgeons must face “the personal impact of bad outcomes,” but, he asserts, should not seek to minimize that risk to maximize their own wellness.

A candid picture of a surgeon’s life.