Beep. The microwave door opens. We get an annoyed glance. Again.
So there we were, crammed into the ICU kitchen — me and 15 surgery residents and consultants — trying to have a “crucial conversation” about the state of the union and training fairness. The kind of meeting that in any functional institution would happen in a conference room with a whiteboard and decent lighting.
Instead: fluorescent overhead buzzing, the smell of reheated hospital food, a microwave beeping every 90 seconds.
Dr. S started it: “Why does Dr. X get three flap cases this month when I only got one?”
Then Dr. M: “The schedule isn’t balanced. You promised equal rotation.”
Then Dr. K: “This whole system is unfair.”
I tried to explain. That the goal was to provide equal distribution. But that the schedule depends on a million little things — which patients come through the door, who calls in sick, which skill levels are available. In a system under strain, distribution becomes a secondary matter to ensuring patient safety and keeping the boat afloat.
Not merit. Not fairness. Not divine justice.
And then I said it: “Life isn’t fair.”
The room went cold.
A nurse walked in to warm up a patient’s dinner. Microwave beep. She squeezed past us, clearly annoyed we were taking up her workspace.
I kept talking: “The sooner you accept that life isn’t fair, the sooner you can focus on—”
The head nurse — the one who’d been tolerating our presence — finally had enough:
“Gentlemen, we need the kitchen. Patients need dinner. You’ll have to continue this elsewhere.”
Three residents stood up, walked out mid-sentence, mumbling: “Yeah, yeah. Life is not fair.”
We filed out. Everyone angry. Me questioning whether I’d just made everything worse. Nobody got what they came for.
The Suffering of Non-Acceptance
Looking back, I realized that I had that same sense of entitlement when I was younger. It was actually one of the reasons why I opted against an academic surgical career right after med school — because I was sure the system was flawed and unfair.
I also overestimated my skills and ignored the fact that surgery — by definition a craft — requires a step-by-step apprenticeship that compounds over time and experience, and can only partially be sped up.
The underlying problem though was something else.
It was the fight against reality itself.
Expecting the world to operate according to a principle — fairness — that simply doesn’t govern how things run. And fairness by itself is highly subjective — fair is where I feel treated fairly.
So when reality refuses to comply with expectations, we have three options:
Option A: Keep fighting. Keep scorekeeping. Stay angry that the universe isn’t delivering what you’re “owed.” Option B: Accept reality as it actually is, then figure out how to act on it. Option C: Quit.
Most of us are stuck in Option A without realizing it’s a choice.
And boy, is Option A exhausting.
The Buddha’s equation for suffering:
Obviously, we’re not the first to figure out that there’s a problem. The Buddha already described this brilliantly in this little formula:
Reality - Expectation = Suffering
The bigger the gap between how you think things should be and how they actually are, the more you suffer.
You end up expending enormous energy trying to change something that isn’t changeable — how things already are at any given moment. And things like the fundamental randomness of how life distributes opportunities.
Often we focus on how things were and are — tracking who got which cases, calculating “fairness” metrics, building resentment toward colleagues who “got lucky,” or waiting for someone to fix the system.
None of this made us better surgeons. All of it made us miserable.
So while we’re litigating fairness, we’re missing the things — or cases for that matter — we actually did and do get.
When we’re so focused on what we weren’t getting, we can’t extract maximum value from what we have.
That’s what fighting reality actually does:
It doesn’t change reality — it just blinds you to the opportunities within it.
What I Was Trying (Badly) to Say
I wasn’t trying to tell my residents to give up and resign.
I wasn’t telling them to accept exploitation or stop advocating for better training.
I was trying to free them from an unwinnable mental battle that was paralyzing their growth.
What I should have said: “Accept reality as it is, not as you want it to be. THEN you can change your position within it.”
But I didn’t use those words then.
I was standing there as senior consultant, no longer subjected to the randomness they were experiencing, telling them to accept being subjected to randomness.
Of course they walked out.
They thought I was saying: “Life is unfair, so stop complaining.” What I meant was: “Life is unfair, AND you can still win — but only after you stop fighting the unfairness itself.”
That distinction matters.
My buddhistic meditation retreats helped me a lot with that. And life wasn’t stingy with opportunities to put my learnings into practice. I learned that lesson a lot through constraint.
I learned it, for example, from being parked — twice. And when I learned it, I was the one being parked, not the one doing the parking.
Right before certification, staff shortages meant I spent six months in outpatient clinic instead of the OR.
Wound checks. Suture removals. Minor procedures. Post-ops. Pre-ops.
Not exactly the complex reconstructions I’d trained for, not the microsurgery I wanted.
I could have spent those months resentful — counting the cases I was “owed,” calculating how far behind this set me.
Instead, I decided to act as if I were already independent.
Not a frustrated resident serving time, but a consultant running that part of the department. That single mental shift changed everything. I began managing patients like I was the attending — documenting, communicating, and triaging with full ownership.
Additionally, I used every gap to write or analyze data for my research papers and academic career. I found myself sitting at the top of the staircase for lack of rooms before my clinic started, generating boxplots.
Those minutes added up. On the longer timeline, all of this gave me leverage. I wasn’t behind — I was ahead. My gift was hidden inside the constraint.
But I only found it after I stopped waiting for someone to rescue me from it.
Different year, similar frustration: I found myself parked in burn surgery.
Burn debridement after burn debridement. Skin graft after skin graft. Repetitive. Monotonous. Not exactly intellectually thrilling.
I found myself complaining to one of my mentor attendings. What he said stuck with me ever since:
“Look for opportunity in every little case. There’s gold to find everywhere for your surgical skill. Any necrosectomy can be turned into an exercise to identify and preserve perforators.”
He was essentially teaching me to accept the case I had, not to mourn the case I craved.
So I began treating every (burn) case with strategy: primary plan, backup plan, danger zones, anatomical structures to preserve.
I even built custom “surgicards” — case-prep index cards assessing these items — that served me and others I shared them with very well.
This pushed me extremely forward, not because the cases changed, but because I did. Those burn months taught me more about tissue handling and three-dimensional thinking — and system thinking in surgery — than any “exciting” microsurgery rotation.
These parkings were valuable not because they were secretly great opportunities disguised as setbacks, but because accepting them as reality forced me to create my own opportunities within the constraints.
That’s what I was trying to tell my residents in the kitchen.
Not to “accept unfairness and give up,” but to “accept unfairness and find the gold inside the constraint.”
It’s something like an acceptance paradox: accepting unfairness gives you more power, not less. It feels like resignation — but it’s actually the starting point for change to come.
But there’s actually more going on. If you thought ‘life isn’t fair’ was hard to hear, this one cuts even deeper:
Nobody Owes You Anything
Nobody is obligated to make life fair FOR you.
Not your partner. Not your mentor. Not your department. Not the universe.
For unknown reasons, we think we’re entitled to things. Just because we are. Or we did certain things.
“I did my time, I deserve the good cases.” “I sacrificed my life, the system owes me.”
That thinking destroys you. It will make you resentful.
And you can wait forever for fairness.
Once you start accepting that nobody owes you anything, you become appreciative of the things you do get.
Now, I’m not saying that you should accept systemic injustice.
Fight for better work-hour regulations, demand safer conditions, advocate for structural reforms.
But do it from a place of accepting the current reality, not denying it.
Acceptance isn’t resignation. It’s the prerequisite for effective action.
Landing
I still don’t know if my residents took with them what I had intended. When I left, they gifted me a book with the title Life isn’t fair — so I guess something stuck.
But I can’t teach acceptance anyway.
Only life can. And boy, isn’t it a great teacher. You get lesson after lesson delivered straight to your door.
And a hospital is essentially a high-speed pressure chamber that beats that lesson into your bones until fairness stops making sense as a framework.
There is often not much to do about the circumstances at any given moment. But there is often much to do about how you decide to deal with them.
I can stop reinforcing the illusion that fighting reality is productive.
Accept reality as it is. Not as you wish it were. Not as it “should” be. Not as it would be if things were fair.
As it is.
Only then do you stop suffering and can start moving.
My kitchen meeting was a disaster — but maybe that was the point.
Maybe you can’t teach acceptance in comfort.
Maybe it only lands when the nurses kick you out, the microwave keeps beeping, and reality refuses to cooperate.
Maybe that’s when you finally stop arguing — and start living.
To more from life,
Nicco
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