I have had the privilege of being a vascular surgeon for the last 28 years. I have had the opportunity of joining a specialty in its infancy and growing with it from primarily open surgery to a preponderance of minimally invasive endovascular care. It has been a wonderful experience but has required re-envisioning my care and role …

Excerpted from my application to graduate school

This was an early formulation of my desire to ‘give-back’ to a profession that has given me such a wonderful life. This blog not only lets me clarify my thinking but allows me reciprocity. Today I want to take a long belated moment to thank my mentor. 

I have spent the last few weeks exploring gift rather than commodity economies, reading the excellent work of Lewis Hyde, The Gift. And in that reading, I think I have a much better understanding of what surgery has given me and what I am trying to return. We all know commodity or market economies; it is the one that is all around us. It is where everything has a value. Gift economies are more ancient representing the practices of much smaller societies. Gifts “are a class of property whose value lies only in their use and which ceases to exist as a gift if they are not constantly consumed.” Simple example, the ugly tie from your mother-in-law when it remains in the drawer is no longer a gift; it is an unused thing; if you wear once or even if you re-gift it, it remains a gift. Another salient distinction about gifts is that it establishes a ‘feeling-bond’ between people. Sale of commodities has no comparable synchronous exchange of feelings. When did you have particularly warm and fuzzy feelings towards your car dealer? More to the point, the idea of an empathetic exchange that I spoke about the last blog is a form of gifting providing worth to practice. The careful reader will note that value is different from worth. Value, the basis of commodity exchange relies on a comparison and balancing of equity. Worth refers to “things we prize and yet say ‘you can’t put a price on it.’ But I digress.

I chose vascular surgery because the principal attending physician was an excellent surgeon and a mensch. A glorious combination for a surgeon and who showed me such a beautiful adjacent possibility. I spent five years as ‘apprentice’ in service to his vision and our patients before I was ready, as a journeyman, to practice on my own. That was when the real labor began as I learned mastery of my field, providing excellent care to my patients and shepherding residents and fellows rather than just instructing them. Here is what Hyde writes: 

Most artists are brought to their vocation when their own nascent gifts are awakened by the work of a master. That is to say, most artists are converted to art by art itself. The future artists finds himself or herself moved by a work of art, and, through that experience, comes to labor in the service of art until he can profess his own gifts. … with gifts that are agents of change, it is only when the gift has worked in use, only when we have come up to its level, as it were, that we can give it away again. …transformative gift cannot be fully received when it is first offered because the person does not yet have power either to accept the gift or to pass it along. … A gift that has the power to change us awakens a part of the soul. But we cannot receive the gift until we can meet it as an equal. We therefore submit ourselves to the labor of becoming like the gift. Giving a return gift is the final act in the labor of gratitude, and it is also, therefore, the true acceptance of the original gift.

I understand better the underlying emotional drivers of my giving-back. It lies in my gratitude for the gift given to me; it signals that I believe my labor to be deserving of the gift has been met and that I am completing a virtuous circle, putting the gift back into my community a little greater for my individual contribution.