Bruce Lee, Wu Wei, & The Art of Surgery

The greatest carver does the least cutting.

lao tzu 

Can bruce lee teach you anything about surgery? That, like anything else, depends on the person being taught. Enter the Dragon, his last movie, opens with Lee having just pinned and tapped out his opponent. The scene changes. We find Lee in a monastery, on a lovely hill,  branches swaying in the wind, birds singing in the background, all very zen, when Lee begins to wax philosophical

 

Enter the Dragon was a cultural phenomenon. Released a few months after Lee’s untimely death, theaters were sold out everywhere. For many Westerners, it was their first introduction to Asian culture and philosophy, and for everyone it was the start of the martial arts phenomenon. Dojos opened every­where. Kung fu movies became the routine at cinemas, and Lee became a household legend. But more than anything else, the movie was a vehicle for Lee’s philosophy on life and the martial arts. Lee refers to the mindset a mar­tial artist must have when fighting, but his observations apply to any human endeavor including, and especially, surgery. Lee understood that mind, body, and action are intimately linked, and with that understand­ing he achieved a level of mastery that has rarely been paralleled in any of the physical arts.

Lee was a student of philosophy, and in particular Taoism, the ancient Chinese tradition that emphasizes living in harmony with the Tao. The Tao, by its own definition, cannot be named or described, but you can think of it as the absolute harmony or energy that runs and creates the universe. Some might call it God. Lee’s phrase “not hitting” hints at one of Taoism’s most important princi­ples, wu wei, which can be roughly translated as “non-doing” or “non-action,” or with the paradoxical expres­sion, the “action of non-action.” It’s a state of being where your actions are unforced and in perfect harmony with the world around you. To be really good at anything you have to have the skill set, but then you also have to be able to get out of your own way. Have you ever noticed how mas­ters of any disci­pline seem to practice their art effort­lessly while ama­teurs struggle by doing too much? That’s wu wei. Lee developed Jeet Kun Do – a martial arts “style with no style” as he referred to it, to reflect his understanding of wu wei, a response only to the moment and the opponent in front of you, like surgery should be – a response only to the moment and patient in front of you. Just this.. . 

There is zen in a master surgeon’s instrumentation and technique. With the beginning surgeon, the actions are forced. Cuts are too deep, or not deep enough at all. The angles are unnatural; the anatomical planes of the surgical field are seen but not seen. With the master surgeon, the action is unforced. It yields like wa­ter. Nor is it borne out of self or the ego, only exactly what is needed for the moment. Fighting against instru­ments or the anatomy wastes energy and time. When one softens and lets go, things come to a natural end. There is no instrument. By doing nothing every­thing gets done. That is wu wei.     

In surgery, the anatomy and not the surgeon must be respected. The surgeon simply alters the balance, doing as little as possible, and the wonder that is the living, breathing, and self-healing human body does the rest. Small maneuvers done at the right time have greater impact than complicated maneuvers, and cer­tainly any maneuver done at the wrong time. The Tao reminds us that “only those who know when enough is enough ever have enough.” Good surgeons know when enough is enough. We’ve all had cases where we wish we had stopped when things looked good. A little more, and you’ve nicked a vessel, or the patient can’t tolerate anesthesia any longer. There is wisdom in know­ing when to stop, in a procedure, after a proce­dure, and, sometimes, before you even do the proce­dure, and that comes not just with experience, but with reflection and self-awareness. It’s human nature to want to do more and achieve perfection. But perfection is an illu­sion. In the mind’s eye, there will always be some­thing better. . .

The above was a selection from my book, Zen in the Art of Surgery (A Manual for Surgeons) which you can buy at Amazon. I often assigned my residents and fellows movies, books, and field trips that (seemingly) had nothing to do with surgery and medicine, but (in reality) everything to do with surgery and medicine.