For this neurosurgeon, Greek philosophy has a lot to offer health care l Expert Opinion

How many of these phrases do you recognize?

“ … life is not fair and you will fail often.”

“The world breaks everyone and afterward many are strong at the broken places.”

“Luck favors the prepared.”

Adm. William McRaven said the first. Hemingway wrote the second. The last is a contraction of Seneca, a Roman philosopher. “Luck is what happens when preparation meets opportunity.” They are modern reflections of Stoic philosophy, which is all around us. Being from a somewhat military household, I found it easy to embrace the Stoic tradition of health care.

At about the same time as Stoicism was described in ancient Greece, Epicurus described a nearly opposite approach to finding happiness. Naturally, Stoics and Epicureans remain suspicious of each other, so I was at first pretty reluctant to read How to be an Epicurean by Catherine Wilson. The book was going to challenge my Stoic sensibilities and I wasn’t going to like it. I was taking a risk by reading it.

Stoicism is protective and keeps us on task in health care. A patient dies, but she’s not a family member. We all did our best, but the patient still did poorly. A deeply invested nurse may cry in a broom closet for 10 minutes, but she comes out to finish her shift. A doctor walks out of a difficult discussion and moves on. Reflection is dangerous. It pollutes the rest of the day. Keep calm and carry on, another Stoic martial encouragement, this one for British citizens in 1939. Compassion and empathy are not included in Stoicism’s foundations.

For Stoics, happiness is doing good, not feeling good. Emotions are a disease to be stamped out. We cannot avoid suffering, so we harden to it, to our witness of it, controlling only our reaction to it, sometimes even embracing it in a quest for a virtuous life. And pleasure, oh pleasure. Pleasure is to be avoided or certainly minimized. These features are useful, but after 30 years in health care this detachment feels a little inhuman sometimes.

Epicureanism demands that we embrace humanness, to seek happiness from the pleasures of friends and affections, earth and work, just not too much, only enough that we will not regret it the next day, Epicurus recommends. I began to warm to him, his writings more approachable than the Stoics’.

Now I’m not saying that the time to emote is during a critical portion of surgery or in the midst of a complication, for example. Not at all. These scenarios demand deliberate, sometimes intrepid action, some “Dumbledore business,” to quote one person politely. But maybe there’s a place for something in health care that isn’t stony scientific detachment.

I’m a technical guide for patients, but also a personal one. A woman suffers from a herniated disc. It’s important to know that she cannot ride her motorcycle or work in her garden. Disease keeps her from these pleasures. Personal connection is more than history, exam, scan, plan. There is no moral dissonance in applying science and skill in service of restoring pleasures to patients.

But what do I do with the emotions that I inevitably feel? Stoics demand that I contain and bury them deep like toxic waste. I compress them into some dark, cobwebbed corner of my mind, not to deal with later, but to deal with never, so that I can move on to the next patient, the next task.

Without light and air they should wither, but they are not zinnias or marigolds. They are mold, and the dark corner is the perfect place for them to fester and toxify. Light and air cleanse, but that is scary. I’ve no fear of dissecting a brain tumor or slipping a titanium screw down a tube of bone surrounded by vital structures, so why does allowing emotions light feel so uncomfortable? Because I’m a Stoic, and it feels — unprofessional, but I’m getting better.

I’m making room for a softer Epicurean approach. Just recognizing, naming and framing an emotion has a cordoning effect. It’s not as if I’m hiding anything anyway. We all read each other by verbal tone, physical gestures, facial expressions. Maybe it is OK to permit emotion, to understand and embrace my own and others’ sorrow and joy, suffering and relief. That’s empathy. Stoicism serves me well, but I don’t want to be bound by it anymore. Epicurus can serve me, too.

Patrick Connolly is Penn Medicine Clinician and neurosurgery chief at Virtua Health. The opinions expressed in this article do not represent those of the University of Pennsylvania Health System or the Perelman School of Medicine.