20 Life Lessons from 25 years as a Heart Surgeon

Key Concepts

Persistence, death acceptance, true value, adaptability to change, ego management, overcoming fear of starting, delayed gratification, consistency, body awareness, focused action, active listening, process over outcome, impermanence, possibility mindset, character through adversity, holistic health, daily movement, surrounding oneself with excellence, prioritizing relationships.

1. Death

Dr. London emphasizes that dealing with patient death remains the most challenging aspect of his practice, even after 25 years. He acknowledges the inherent 1-2% mortality risk in even low-risk cardiac surgeries and the profound impact it has on him due to the deep relationships he forms with patients and their families. He views these relationships as a privilege and an honor. His perspective on death has evolved, becoming less frightening as he recognizes its inevitability and the importance of knowing when to let go. He intellectualizes and compartmentalizes to cope, allowing him to continue his work. He has gained acceptance of his own mortality, motivating him to live each day to the fullest.

2. True Value

True value requires effort and is not achieved easily or quickly. In medicine, a great surgeon understands that "good enough" is never sufficient when dealing with human lives. Consistent effort is essential to achieve lasting results.

3. The Only Constant

The only constant in life is change. Complacency is dangerous. Dr. London thrives on being a beginner, believing that resisting learning leads to mental stagnation. Decisions should be made based on current knowledge, but one must remain open to change. Fear should be directed towards remaining stagnant rather than embracing change. "How you do anything is how you do everything."

4. Ego is the Enemy

Ego can be detrimental, especially for cardiac surgeons who are often confident. Confidence is necessary, but ego becomes problematic when one is unwilling to admit uncertainty or seek input from others. Humility is the antidote to ego. Acknowledging uncertainty and valuing others' opinions fosters confidence and ensures the right course of action is taken. It's not about being right, it's about doing the right thing. Ryan Holiday's book, Ego is the Enemy, is referenced.

5. Starting is the Hardest

Starting is the most significant barrier, primarily due to fear of failure. Dealing with fear is temporary, while regret is permanent. Greatness requires embracing the beginner's mindset and being willing to fail. Epictetus is quoted: "First say to yourself what you would be, and then do what you have to do."

6. Hard Now, Easy Later

This principle involves prioritizing difficult tasks early to create freedom and opportunities later. Dr. London overcame procrastination by establishing daily non-negotiable habits. Jocko Willink's phrase, "Discipline equals freedom," is cited. Consistent discipline upfront leads to greater freedom and predictability in the long run.

7. Consistency Breeds Progress

Consistency compounds over time, leading to exponential success. Avoid cramming everything into one day and instead focus on consistent daily effort. "Be good every day as opposed to being great occasionally." Quitting is the only true failure.

8. Listen to Your Body

Pay attention to your body's warning signs with self-awareness and intellectual honesty. Respond to these signals promptly. As a physician, Dr. London emphasizes the importance of listening to patients, as they often reveal their ailments before any tests are conducted.

9. The Work Doesn't Care

Excuses and rationalizations only delay progress. Emotional responses to work consume energy without producing results. The work is indifferent to one's mood or circumstances. "Thinking about the work, talking about the work, reading about the work, making lists and planning about the work, none of those things actually get the work done. Just do the work."

10. Listen More, Talk Less

Be mindful of your words, as they are irretrievable. In moments of anger, pause and take deep breaths. Cooling down emotions before speaking prevents regret. Listening engages you, keeps you interested, and is a sign of respect. There is something to learn from everyone.

11. The Pursuit is Greater Than the Goal

Conditional happiness, based on achieving future goals, is often fleeting. Focus on the process and curiosity as primary motivators. Find joy in the present moment and pursue activities you would do even without external pressures. Maintain passion and happiness now, as the goal's arrival may not guarantee it.

12. This Too Will Pass

Life has highs and lows. Bad times are rarely as bad as they seem, and high points are rarely permanent. Learn from low times, acknowledge high times, but avoid becoming overly emotional in either situation. The sun will always rise the next day.

13. What If?

Transform "I can't" into "What if?" to overcome seemingly insurmountable goals. This shift in mindset creates tangible possibilities and a clear path forward, one step at a time. Dr. London used this approach to pursue his aspirations of becoming a physician and cardiac surgeon.

14. Character is Defined by Losses

Character is defined by taking responsibility and ownership when things go wrong, not by celebrating wins. Actions during adversity reveal true character.

15. Health is Wealth

Physical, mental, emotional, and psychological health are foundational to life. A healthy person desires many things, while a sick person only desires health. Dr. London acknowledges his past neglect of his own health and the importance of prioritizing it to better care for others. Selfishness in maintaining health enables selflessness in caring for others.

16. Move Every Day

Daily physical activity, including resistance and aerobic training, significantly impacts health span and lifespan. The specific modality is less important than the consistency of movement. The benefits are so profound that if it were a pill, it would be highly sought after.

17. Wrong Room

If you're the smartest person in the room, you're in the wrong room. Surround yourself with people who are better and smarter than you to elevate yourself. Recent research suggests that those you look up to and compare yourself to also influence your aspirations. Social media and the internet provide access to experts in various fields.

18. Family and Friends

Family and friends are the most important aspects of life and all that one truly needs. These relationships are the culmination of the other lessons, providing a crystallized vision of what matters most.

Conclusion

Dr. London's 20 lessons learned after 25 years in clinical practice offer a roadmap for personal and professional growth. They emphasize the importance of persistence, adaptability, humility, continuous learning, prioritizing health and relationships, and finding meaning in the process rather than solely focusing on the outcome. These lessons, while rooted in his experience as a cardiovascular surgeon, provide valuable insights applicable to various aspects of life.