In this solo episode of the Scalpel and Sword podcast, Dr. Lee Sharma draws on his personal mountaineering experiences—summiting Mount Rainier, Kilimanjaro, and trekking to Everest Base Camp—to explore deep parallels between high‑altitude climbing and modern medical practice. He argues that the mountain’s ultimate authority demands humility, reminding physicians that expertise does not guarantee outcomes and that biology, weather, and systemic constraints are beyond individual control. Sharma uses vivid physiological observations at altitude to illustrate how the body’s responses become tangible lessons for clinicians. He critiques the prevailing notion of "resilience" that encourages clinicians to simply tolerate intolerable conditions, instead proposing a definition rooted in accurate reality‑assessment, adaptability, and the willingness to turn around when necessary. The episode distinguishes burnout (personal exhaustion) from moral injury (conflict between one’s values and systemic constraints), emphasizing that structural problems cannot be solved by individual coping strategies alone. Sharma introduces the concept of "conflict as a vital sign," urging healthcare organizations to treat staff dissent as diagnostic data rather than pathology. He recounts two contrasting physician stories from the 1996 Everest disaster—John Tasky, who wisely turned around, and Beck Weathers, whose delayed descent led to severe frostbite—to illustrate how decision quality, not outcomes, should be the focus of professional accountability. Concluding with a call for a new professional mantra—"excellence is mandatory, omnipotence is impossible"—he encourages physicians to pursue excellence while embracing humility, preparation, communication, and the acceptance that sometimes the mountain (or medicine) has the final say. The episode ends with shout‑outs to Alpine Ascents International and his guides.
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Hello, my peaceful warriors, and welcome to the Scalpel and Sword podcast. I'm your host, Dr. Lee Sharma, physician and conflict analyst. And if you know me at all, or if you look at any of my social media, one of the things that you know that I really love is climbing. I started climbing way back in 2014 when some friends of my husband said they were going to go climb Mount Rainier. And my husband asked me if he could go and I said, of course you can go. And why didn't they ask me? We went and we trained and ultimately summited Mount Rainier. It was an amazing experience and it set me up for a lifetime of just loving the idea of climbing and the process of climbing as well. And I love hiking and trail running. I think there's something very beautiful about being in nature, but one of the things that you learn very quickly is as much as we love it, we also have to respect it. And there's a phrase that you learn in mountaineering, and the phrase is that the mountain has the final say. I have been to Everest Base Camp. I have summited Mount Kilimanjaro, and also I summited Mount Rainier. And those are extraordinarily different mountains. Different terrain, different technical demands, different altitude, and different risks. But each of them taught me essentially the same lesson. You don't conquer a mountain. You prepare for it. You train for it. You study it. But ultimately, you must respect it. You bring the right equipment and surround yourself with people who know what they're doing. You make the best decisions you can with the information you have, and then nature gets a vote. And very often, that can be the deciding vote. The weather changes, snow changes, your body changes, and conditions that were acceptable an hour ago become dangerous. And sometimes after months or years of preparation, The strongest decision you can make is to turn around. There is a humility built into mountaineering that I think medicine desperately needs because the mountain teaches something physicians can have enormous difficulty accepting. Effort does not guarantee outcome, and neither does expertise. As a physician, one of the things I love about mountaineering is that you experience physiology in an entirely different way. You don't just know it intellectually, you feel it. At altitude, physiology stops being something you memorize for an examination. The partial pressure of oxygen is no longer a diagram in a textbook. It's your breathing. It's your heart rate. It's your pace. It's the headache that makes you ask whether you're simply tired Or whether something more important is beginning. I remember the first time I experienced an altitude-related headache. It was right after we landed in Lukla. You have to take a plane from Kathmandu to Lukla, and you gain about 5,000 feet of altitude in the process. And I'd read about altitude-related headaches, but I'd never experienced one. And I remember walking around Lukla and just feeling this very strange, dull sensation At the base of my skull and just wondering, was that an altitude-related headache? And I did have some Dymox with me in my bag. And so after done walking around, I went back to my bag and took a half a tablet of Dymox. And within half an hour, the headache was gone. It's one thing to read about it. It's quite another to experience it. You become intensely aware of acclimatization. How you breathe, hydration, how much fluid am I drinking, temperature regulation, am I cold, do I need to put on another layer, energy utilization, how am I sleeping, my cerebral function, my decision-making processes. And then of course, unfortunately, there is pathology. Acute mountain sickness, high altitude pulmonary edema. High-altitude cerebral edema, hypothermia, frostbite, dehydration, exhaustion, trauma. The mountain has an extraordinary way of taking concepts physicians understand intellectually and making them profoundly physical. And it teaches another lesson. Physiology does not care about your resume. The mountain doesn't care how fit you are. It doesn't care what your VO2 max is. It doesn't care how many degrees you have. It doesn't care how important you are at sea level. You cannot negotiate with hypoxia. You cannot shame your body into acclimatizing faster. You cannot motivate pulmonary edema away. And you cannot positive-think yourself out of cerebral edema. You respect the physiology, or eventually the physiology makes the decision for you. Nature in all her forms demands humility, and medicine should too. Physicians are trained in responsibility, and that's appropriate. If I'm operating, I'm responsible for preparing well. I'm responsible for knowing the anatomy. I'm responsible for understanding the procedure. I am responsible for recognizing complications. I'm responsible for communicating with my patient. And when something changes, I'm responsible for responding. But somewhere during medical training, responsibility can quietly transform into something else: omnipotence. We begin to believe that if an outcome was bad, there must have been something we could have done differently. And sometimes there was. That's why we review cases. That's why we study complications. And that's why we learn. That is how medicine advances. But sometimes there wasn't. Mountaineers understand this distinction intuitively. You are responsible for your preparation and your decisions. You are not responsible for the weather. Yet physicians routinely hold themselves responsible for the clinical equivalent of weather: disease progression, biology, a patient's response to treatment, a patient's decisions, staffing limitations, Resource limitations, the actions of other people, the limitations of the healthcare system. We are trained to fight all of it. Then we're surprised when physicians become exhausted from believing they were somehow supposed to control things no human being could control. And this is where I think our conversation about physician resilience sometimes goes terribly wrong. Imagine that you're climbing Mount Rainier. The weather deteriorates, visibility drops, conditions become unsafe. Your guide says, we need to turn around. And you answer, no, I just need to become more resilient. So you keep climbing. Nobody in the mountaineering world would call that resilience. We'd call it poor judgment. And yet sometimes that is essentially what we tell physicians. The system is understaffed? Become more resilient. Your inbox is impossible? Learn better time management. You're chronically exhausted? Try mindfulness. You cannot provide the care you believe your patients need because of structural limitations? Here's a wellness module. None of those interventions is inherently bad. I believe in resilience. I believe in mindfulness. I believe in taking responsibility for our own well-being. But resilience cannot simply mean increasing someone's tolerance for an intolerable environment. Mountaineering offers us a much healthier definition. Resilience is the ability to assess reality accurately, adapt to changing conditions, make difficult decisions, and continue toward what matters. And sometimes continuing toward what matters means changing the plan. Sometimes resilience means pushing forward, but sometimes it means waiting. Sometimes it means asking for help. And sometimes it means turning around. Turning around is not necessarily failure. Sometimes turning around means you understand the mountain. This is also where the distinction between burnout and moral injury becomes so important. Burnout may ask, how much longer can I carry this? Moral injury often asks, What happens to me when I repeatedly cannot practice according to what I believe is right? Imagine telling a climber, you are responsible for reaching the summit, but we're going to reduce your oxygen, take away some of your equipment, increase the number of people you're responsible for, shorten your turnaround time, change the route while you're climbing. And then, if you don't reach the summit, we're going to bring you into a meeting and ask, what could you have done differently? It's absurd, but physicians practice inside the healthcare equivalent of that scenario every day. And then we locate the problem inside the physician. Burnout screening, resilience training, meditation. Time management strategies. Again, these things may help, but they cannot fix a structural problem masquerading as an individual deficiency. Sometimes the physician doesn't need to become better at climbing. Sometimes we need to acknowledge that the climbing conditions have become unsafe. And this is one reason I believe conflict matters so much. At my company, Lentil Health, we say conflict is a vital sign, not a disease, because conflict is information. Imagine you're on a climbing team and someone says something isn't right. You don't silence that person because they're disrupting team cohesion. You pay attention. Maybe they're wrong, but maybe they noticed the weather changing. Maybe they saw instability in the snow. Maybe they're developing altitude symptoms. Maybe they just noticed something you didn't, but their discomfort is data. Healthcare organizations need to learn to treat conflict the same way. When physicians, nurses, trainees, or staff repeatedly say, We cannot keep doing this. That isn't automatically negativity. It isn't automatically resistance to change. And it isn't automatically evidence that those people lack resilience. It may be a vital sign. Something in the environment may be changing. If we suppress the conflict without examining what created it, We may eliminate the warning while allowing the underlying danger to continue. That's why I say conflict is the doorway. It is an invitation to ask, what's happened here? What has changed? What are people being asked to carry? What is within our control and what isn't? And what needs to change? Before we continue climbing, I want to end with a story, actually with 2 stories. 2 physicians, both were on Everest in May of 1996. Both were clients of Rob Hall's Adventure Consultants, and both survived one of the worst disasters in the history of Everest. One was John Tasky. An Australian physician and former army officer. On the morning of May 10th, Tasky was climbing toward the summit. But the expedition was behind schedule. There had been delays. There were bottlenecks. And the clock was moving. Tasky, Luce Kaczynski, and Stuart Hutchinson looked at their conditions, looked at their progress, And made a decision. They turned around. Think about what that means. Months of preparation, years of dreaming, thousands of dollars, the summit of Everest somewhere above you, and you turn around. They didn't wait for the mountain to force the decision upon them. They listened to what the mountain was already telling them. And they survived. But there was another physician on that expedition. His name was Dr. Beck Weathers. Beck was a pathologist from Dallas. His story was different. High on Everest, Beck developed severe problems with his vision. He stopped climbing. His senior guide, Rob Hall, instructed him to wait until Hall returned from the summit. So Hall could help him descend. So Beck waited, but the conditions changed. The climbers above him were delayed. The weather deteriorated. And the system upon which his plan depended began to collapse. Eventually, Beck attempted to descend with others. Then came the storm. He became profoundly hypothermic, severely frostbitten. At one point, his fellow climbers believed he was going to die. He was left on the mountain. And then something extraordinary happened. Beck Weathers woke up. He somehow stood, and this physician from Dallas, his hands and face catastrophically frozen, staggered back toward camp. He survived. Eventually, he was evacuated from Everest by helicopter. But the mountain had taken an enormous price. His frostbite injuries were devastating. And this is where, for me, this story stops being simply a story about Everest. Because while all of this was happening in May of 1996, I was in Dallas. I was a 3rd-year OB-GYN resident doing my gynecology rotation at Medical City. And one day, I was in the operating room, When we were told that the plastic surgery team had brought in a physician who had suffered catastrophic frostbite on Mount Everest, they told us he was a doctor. They told us he'd just been on Everest. And I remember hearing about it, being in the operating room suite while the plastic surgeons debrided the frostbitten tissue from his face. But that was all I knew. I went back to residency, back to operating, back to taking call, back to learning how to become a physician. And it wasn't until approximately 20 years later that I put the pieces together. That physician was Beck Weathers. I was in the OR suite that day with one of the survivors of the 1996 Everest disaster. Without understanding the story I was witnessing. And there is something almost poetic about that to me now, because at that point in my life, I was learning medicine. I was learning how to operate, how to solve problems, how to push through fatigue, how to take responsibility, how to keep going, how to become the person everyone expected to have an answer. What I hadn't yet learned was something the mountains would teach me years later. There are things that skill cannot control. Years later, I would go to Everest Base Camp myself. I would summit Kilimanjaro. I would summit Rainier. And eventually, I would understand something I could not possibly have understood as that third-year resident standing In the operating room suite in Dallas. The mountain has the final say. And sometimes medicine does too. I don't tell the stories of John Tasky and Beck Weathers because one physician was wise and the other was foolish. Their stories are much more complicated than that. That's precisely the point. 2 physicians, same expedition, Same mountain, same storm, very different circumstances. And their stories force us to confront something physicians have enormous difficulty accepting: expertise does not eliminate uncertainty. We enter medicine believing that if we prepare enough, study enough, work hard enough, and care enough, We can somehow guarantee the outcome. We can't. And when the outcome is bad, physicians often do something that mountaineers are specifically trained not to do. We confuse the outcome with the quality of the decision. A summit does not necessarily mean you made good decisions. Turning around does not necessarily mean you failed. And a patient not responding does not necessarily mean a physician failed. The better question is, given what I knew, the conditions I faced, and the resources available to me, did I make the best decision I could? That is responsibility. It is not omnipotence. Physicians cannot continue carrying responsibility for the weather. We cannot control biology. We cannot control every patient decision. We cannot control every staffing shortage. We cannot control every resource limitation. We cannot control every outcome. But we can prepare. We can pay attention. We can respect physiology. We can recognize changing conditions. We can speak when something is unsafe. We can listen when someone else tells us something is unsafe. We can preserve our agency. We can ask for help. And we can refuse to confuse perseverance with wisdom. Mountaineers also have a phrase, The summit is optional. Getting down is mandatory. Maybe medicine needs its own: excellence is mandatory. Omnipotence is impossible. This isn't an excuse for mediocrity. It's almost the opposite. It asks us to pursue excellence relentlessly while maintaining enough humility to recognize the boundaries of human control. Because whether we're standing in an operating room or at 18,000 feet, nature doesn't care about our credentials. Biology doesn't care about our expectations. Physiology doesn't care how badly we want a particular outcome. Nature, in all her forms, demands humility. Our responsibility is not to control the mountain. Our responsibility is to meet it with preparation, skill, attention, communication, courage, and humility. To know what belongs to us and to recognize what belongs to the mountain. And sometimes, despite everything we know, everything we've done, and everything we desperately want, the mountain has the final say. It took me 20 years to realize the physician who was there in the Medical City operating room that those plastic surgeons were trying to save. It took me even longer and a few mountains of my own to understand what that story had to teach me. Maybe accepting the limits of our control isn't giving up. Maybe it's one of the deepest forms of resilience there is. And maybe the lesson isn't that we need to teach physicians how to keep climbing. Maybe we need to teach them something harder, how to pursue excellence without believing they control the mountain. This is Scalpel and Sword. Remember, conflict is a vital sign. It's not a disease. And as always, if this podcast resonated with you, share it with a friend, share it with a colleague, Share it with an administrator or somebody at your institution. I would like to have a personal shout-out to Alpine Ascents International, with whom I have climbed all 3 of my mountains, and I thank them for their guidance and expertise and for helping me learn these lessons myself. And a special shout-out to my guides to Everest Base Camp, Vern and Terrell Tejas. And to my guide at Kilimanjaro, Eric Murphy. Peaceful warriors, thank you so much for being here. And until next time, be at peace. Peace.
