Last week, I was  on a ski vacation  at a trauma surgery conference. Every year, trauma surgeons from around the country gather at a ski resort for a week of science sharing, friendship building and skiing. Now let’s set the record straight…I am an advanced beginner.  I ski mostly greens and blues. I can stay on my feet, but not gracefully. My husband convinced me to ascend the side of the mountain that promised a nice easy blue run, but despite the hundreds of dollars I have invested in ski school over the years, I was not steady on this run. Suddenly, a steep descent that was well traveled (read: iced over) became my demise. I lost my footing. I slid. For a long way. Down the side of the mountain. One ski tumbling down the slope, another remained on my foot. Poles flailing. I headed towards the trees…falling off the side of the mountain; uncleared; a dangerous drop off. Life flashed before me. Time stood still. What probably took three seconds to transpire felt like an hour. Then silence. I stopped. Curled up on my belly. Ski boots planted in the side of the ravine to keep me from falling further. Heart rate was probably 150. Scared. Winded. It took me quite a while to get my skis back on and get the rest of the way down the mountain, but I did it. And while I was nervous about the next run, I had the picture of the summit in my head…and on my phone. The view. The silence at the top of the mountain. The crisp, white, crunchy snow; the crystal blue sky. The risk to return to the top of the mountain and try again…it was worth it!

Over the past few weeks, I have heard this word a thousand times…risk. “Is it worth the risk?” “The risk is greater than the benefit.” “It’s a big risk with a potentially big reward.” “That sounds risky.” If you play the odds in Vegas, you understand a little about risk. You can win a giant pot of cash…if you can stomach the chance you could lose. As parents, we gradually increase the risks we allow our children to take…riding their bike down the street, then around the block, then across the neighborhood. We calculate the chance that something bad could happen to them; that they would know how to respond. Over time, we decide that cultivating their independence is worth the risk. In medicine, we have risk calculators. We plug in the data…the patient has diabetes, they are old, they are in kidney failure now…We try to inform our patients, and ourselves, about the risks of surgery. And believe me…sometimes the risk is large! Is it better to operate…or not? And in our own little minds, we calculate the risk of thousands of tiny trials every day…can I beat the yellow light? Can I still make it on time if I run through the drive thru for coffee? And sometimes, broader risks enter our worlds…is the job opportunity worth the risk of moving the family?

But all risk is not created equal. Some risk is personal. Some is on behalf of those we love. Some is for those we are responsible for. The personal risk is the easiest…if I lose…then only I lose.  For my husband and children, risk can change their lives…for better or for worse. A move can provide opportunity at the cost of distance from family; allowing more freedom can translate to personal independence and long term growth. And for my patients, risk can save their life…or cost them their chance at recovery.  Generally, we are horrible at truly understanding risk. We miscalculate the degree of risk we think we are entertaining. We have unfounded fear. We take risks where we shouldn’t and hold back where we should take a chance. (See: Freakonomics; see also: Adam Grant)

 

When I talk to patients and their families about a procedure or surgery, I hold up my hands in front of me, palms up, and alternate them up and down like a scale, tipping the balance one way…then the other. I use the words “risk versus benefit” as I make this gesture. And while this is a pretty good way to practice medicine, I think it turns out to be a lousy way to live life. You see, if I am constantly doing the palm balancing game with decisions of my investment in others, I end up always erring on the side of minimizing my emotional/time/energy/financial investment in a relationship, taking the sure thing, the tiny risk…but sadly, that brings only the tiniest reward. If instead, I risk some mental energy into a friendship, some emotional energy into the marriage, some time into parenting, some money into the hands of someone who needs it more, some spiritual surrender to my own weaknesses…the reward nearly always out measures the one I derived in my head. When I change my mentality to understand that some of the life risks I take will not just reward me, but reward someone else…then the risk is minimized when I can see that the reward is multiplied beyond myself.

So when it comes to a tough surgery, I will play the palm balance game, but when it comes to relationship investment, resource investment; if someone else stands to gain, I think the palm balance rules shouldn’t apply…and it’ll be worth the risk.

Disclaimer: My viewpoints are not necessarily reflective of my employer, or any local, regional or national organization that I belong to. As a matter of fact, I pretty much just speak for myself. Please keep that in mind.