Let's face it. The price we surgeons pay is not just economic. That's what we mostly complain about. That's what you hear about, read about. But it's harder than that. Much harder. The real price is often physiologic and emotional. It goes to the human soul. I was 64 years old in 1990 when it hit me. I had been in surgery for 45 years, beginning as an operating room corpsperson, an operating room technician, in the US Navy in World War II. I used to boast about caring for war casualties; I must have been stuck by needles a thousand times. Nothing could hurt me. I was immune. I recall it was a Thursday, Thursday of a Labor Day weekend, and I wanted to get away early. I was driving north beyond the Golden Gate Bridge to spend the long weekend with my family at Lake Tahoe when the California Highway Patrol pulled me over and ticketed me for illegally driving in the commute lane. As I drove on afterward, having inconsolably and ineffectually exhausted all my excuses with the officer, I wondered if perhaps I was losing it. It was not like me to make such a stupid mistake, having traveled this same road hundreds of times. I had been inordinately tired for 3 months, I noted. But I had taken on night-and-day emergency department calls at 2 hospitals to defray the horrendous college tuition for 5 children. So what if I’d lost a little weight, couldn't sleep at night, and had no appetite. Fatigue is an episodic way of life with surgeons. Being tired was nothing new; it comes and goes with the territory. I had also noted a dark dysuria at times, mostly after my tennis game at a new club I had joined. So I ignored it; thought it was dehydration.
Neely JC. Life Depends Upon the Liver. Arch Surg. 2007;142(6):503–504. doi:10.1001/archsurg.142.6.503