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The Secret of Gritflowness

OR Surgical 
September 3, 2021


John Boockvar, MD, is one of the stars of the Netflix docuseries Lenox Hill, the show named for the historic hospital on Manhattan’s Upper East Side where he cares for patients suffering from glioblastoma multiforme (GBM), the most aggres­sive form of brain cancer. It’s why Dr. Boockvar’s career has been filled with moments of pro­found gratitude from hav­ing the opportunity to save lives and dark moments in dealing with inevitable death.

“Every surgeon, the saying goes, has their own graveyard they visit on occasion,” he says. “But it’s all part of my job. And when I’m not sure if I can go on anymore, I remember one simple thing: Inhale. Exhale.”

Dr. Boockvar fully embraced the potential of mindfulness in medical school — long before the concept was mainstream. He created the term “Gritflowness” to describe the combination of grit, flow, and mindfulness needed to reach his desired state of mind. Dr. Boockvar will share more about how to incorporate “Gritflowness” into your OR and everyday life during his OR Excellence conference keynote session on October 13.



Grit involves deliberate practice and single-mind­ed drive to master a skill. For example, Dr. Boockvar spent endless hours in cadaver labs dur­ing medical school practicing new surgical tech­niques on his way to becoming one of the best neu­rosurgeons in the world.

Mindfulness is being fully present in the moment, without worry of past events or future possibilities. It’s an essential skill for managing the inevitable stress of everyday life inside and outside of the OR. Flow state is the cul­mination of grit and mindfulness.

“At its core is finding my flow state, which is the place where I think without thinking, operating on autopilot, and trusting my training and my instincts,” says Dr. Boockvar. “It’s where I do my best work, and where I need to be if I want to save lives without my mind and my anxiety get­ting in the way.”

You don’t need to per­form high-risk proce­dures where the balance between life and death is in your hands to benefit from Gritflowness.

“Whoever you are, whatever you do, the principle is the same — negative mindset only makes situations worse, and poise and composure frequently carry the day,” says Dr. Boockvar. “The next time you’re faced with a task you find daunt­ing, just stop, breathe and find your flow. The rest will follow.” Regardless of whether you work in the OR, gritflowness is a crucial tool to help mitigate the stress of daily life, according to Dr. Boockvar. “Dwelling on past failures or thinking about all the responsibility we’re given and feeling like we have little control over situations are the daily challenges to mindfulness,” he says.

Dr. Boockvar incorporates mindful moments into surgical time outs to create a sense of group calm before his team begins highly complex procedures. He asks his colleagues to focus on their breathing and be present in the moment. “We check the patient and confirm the details of the operation, but we also need to check on the well-being of the staff,” explains Dr. Boockvar. “The mindful time out introduces the concept of mindfulness to members of the team, and hopefully inspires them to begin training, even for just a few minutes a day.”

That training can begin with the 4-7-8 breath — inhaling through the nose for four seconds, holding it for seven seconds and exhaling slowly through the mouth for eight seconds. It’s a simple but impor­tant first step on the path to mindfulness, according to Dr. Boockvar: “If you do it for two minutes a day, you’re well on your way.”

Join Us at OR Excellence

Join Dr. Boockvar for his OR Excellence conference keynote session on October 13 from 10:35 a.m.- 11:35 a.m. ET. Register today for early-bird pricing through September 20.

This article originally appeared in Outpatient Surgery Magazine.

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