'You Have to Be Able to Keep Your Cool'

He’d been operating for nearly 36 hours straight and desperately needed some sleep. Now, Dr. Curtis Tribble was finally off the clock and in bed in his Virginia home.

That’s when the phone rang.

“It was my friend,” Dr. Tribble recalled. “He said, ‘Curt, I know you’ve been up for 36 hours and haven’t gotten any real sleep, but I need you here right now.’”

So, Dr. Tribble raced in his car back to the University of Virginia Medical Center to attend to a woman coughing up pools of blood.

He instructed doctors to get her in the operating room immediately — then dug up an obscure picture he had saved in his files.

“I looked at it and knew,” he said. “I said, ‘This is what we’re going to do to save her life.’”

The woman survived her congenital anomaly, and the story sticks with Dr. Tribble nearly three decades later.

The Daily Coach caught up with him recently to discuss taking action amidst uncertainty, keys to performing under literally life-and-death circumstances, and the process of forgiving yourself after failure and disappointment.

This interview has been condensed and edited for clarity.

Dr. Tribble, thanks a lot for doing this. Tell us about your childhood and some key lessons from it.

My parents met in college. I guess they couldn’t keep their hands off each other because I came along as their first kid a little while after that. My dad went to medical school at Vanderbilt, and that’s where I was born.

In my dad’s era, everybody had to do a kind of disjointed training, and guys in his generation had to spend time in the military. What it resulted in was I didn’t go to the same school two years in a row until I was in high school. We lived in every state in the Southeast except for Alabama. I don’t look back on those years all that fondly. It felt like every time I figured out where we lived and what our address was, we had to move again. But most people who have endured all of that end up developing some degree of adaptability and resilience from it.

What ultimately led you to become a thoracic and cardiovascular surgeon at the University of Virginia? 

I went to high school in Columbia, S.C., then to a small school called Presbyterian College. I wasn’t that keen on school but graduated as the valedictorian and decided I’d go to med school. I went and ended up working in the same hospital at Vanderbilt that I was born in. I thought I might be a general doctor but, early on, decided surgery was a better fit for me. It was about working on things and building things.

People interview all over the place and try to figure out based on limited knowledge where they want to be. I interviewed in New England and at a bunch of Southern schools, but my last interview was at the University of Virginia. I’d never been to Charlottesville, didn’t know anything about Virginia. I flew in here at night and it was dark, but I woke up the next morning, looked out the window and saw the Blue Ridge Mountains. I thought I wanted to come here.

Want to shift to some of your beliefs and mental performance philosophies. You like to play music in the operating room. What’s the reasoning behind that?

We go into some pretty high-stakes situations. Trauma, aneurysm, transplants, everything in between. You can get rattled by that kind of stuff, and some of the things you were hoping to be in control of can get out of control, a patient problem or a machine problem or whatever. You have to be able to keep your cool and keep on keeping on.

First and foremost, I always try to bring music where I wouldn’t be the only one who likes it. I try to find stuff or get other people to bring in what they like. I personally like music that I can hum, though.

Years ago, I got to thinking about an operation as movements in a symphony. Before we get into the nitty-gritty of the operation, we’d have something lively. In the middle part, we’d have something a little more sedate. As we finish up, the heart’s working again and we’ve completed the crucial parts, and we just have an hour or 90 minutes of closing everything up. Sometimes, you can use some energy at the end of a long day. We’ll play something more lively. We need some Leonard Skynyrd on now.

The music is a way of providing a feeling for a room, and sometimes that needs to be calmer, quieter, more placid and get us totally focused on what needs to be incredibly precise. We’re hoping to not have distractions. We’re hoping it brings energy instead of taking it away.

You mentioned that when you step into certain procedures, you encounter a great deal of uncertainty. Are there main questions you try to ask or what’s the key to bringing stability to a fast-moving, chaotic situation in your eyes?

At times, you just don’t know what to do. You want to look it up in a book or ask a friend or call somebody, but you just don’t have time. You simply have to do something.

There’s a story I read about some European soldiers in World War II who were in the mountains during winter, and snow was all over the place, to the point the mountains had become impassable. They didn’t know which way to go. Supplies were dwindling, morale was dropping. Then, one of the folks says, “Look! I found a map! I know the way out. This is it. We’re going down!” They started walking through the snow down the side of a mountain. It was a long haul that took a day or two. But they made it. When they got down, somebody asked, “How did you find that map?” The soldier said, “I didn’t have a map. We were all going to die up there, and I knew our only hope was to go.” He had to make a decision and just go with it.

At times, you’re looking at somebody’s heart that stopped. You’ve got about four options and can only do one of them. You’ve just got to say, “This is what we’re going to do now. You, do that. You, go here. You, stand here, give me that knife.”

The concept of the insanity of indecision is real. You might have several things that are equally attractive to do or to say or to plan, but you’ve got to choose one. You just have to go with it.

Are there instances where you’ve been unsuccessful or failed with patients and what’s your process to move on from regret?

The first thing you need to do in essence before you can forgive yourself and do the emotional work is to do the intellectual work you owe to yourself, to the patient and to all of your future patients.

Nobody’s perfect, so as a practitioner, as a learner, as a teacher, we have to learn how to manage failure. It’s inevitable. To me, I like the idea of remember and forgive. What I mean by that is I think you have to do the intellectual work first before you can get to the emotional work of forgiving yourself.

My idea about approaching that I actually thought of from an ethical standpoint. I can justify ethically being an imperfect human being and starting with that reality. That gives you permission to do things that at times are imperfect and not shoot yourself because of how things went. You must have a strategy for dealing with that. In my mind, it’s that you’re always going to learn from everything you do, not just things that didn’t go well. For many things, whether it’s swinging a baseball bat or performing surgery or general human interactions, you’re not going to get it right 100 percent of the time. You can hope all you want or prepare all you want to try to be as close as you can get, but we’re humans.

The first stage of deserving forgiveness from whomever it is and yourself is you try to learn what happened. I used to dictate notes into a phone or dictate even a letter to myself. My secretary would type these up, and I’d look at them and try to translate them from pig Latin into English. It’d often lead to other things. Sometimes, I’d look stuff up. Sometimes, I’d ask my friends or ask my mentors. Two of my brothers are also surgeons, so I’d talk to them about it. I love to find people who I know are smart but I can also trust to give good advice and feedback, even if it’s, “You dumbass, why did you do this?”

There’s the mental side of stuff, and then there’s the emotional. Things are easier when they go really neat and harder when they don’t. You have to have a way of dealing with that, and I think an important part is thinking about what you learned, what you can do differently and the general ethics of action. Throughout a career, you gain wisdom and experience and a greater depth of understanding. Every situation you’ve dealt with in the past makes you a little better.

You’re a big believer in the need for optimism among surgeons and leaders in general.

If you walk into a room and the scene is dire and you convey something with your look, your tone, your words, your voice, your body language that you think we don’t have a chance, that feeling is going to be pervasive and infectious.

Even if you think the chips are down and the chances are slim, you have to say, “We’ve got a chance,” no matter how close to being dead they might be. If they’re not dead, you have to say, “I want everyone here to believe that we can do this. If every one of us does everything we can think of as well as we can, and we work together, we at least have a chance.”