Cobb: An idea is like a virus. Resilient. Highly contagious. And even the smallest seed of an idea can grow. It can grow to define or destroy you.

Yusuf: Brain function in the dream will be about twenty times to normal. When you enter a dream within that dream, the effect is compounded: it’s three dreams, that’s ten hours times twenty.

Eames: I’m sorry, uh, maths was never my strong subject. How much time is that? 

Cobb: It’s a week the first level down. Six months the second level down, and… the third level… 

Ariadne: …is ten years! Who would wanna be stuck in a dream for ten years? 

Yusuf: Depends on the dream.

Eames: Listen, if you are going to perform ……….., you need imagination. 

Did these dialogues make any sense? Any guesses? It’s from Christopher Nolans’ movie Inception! If you have guessed it right, hearty congratulations. How many understood the concept of that movie the first time around!? Honestly, I didn’t. I watched it four times to get a sense of it! The gist of the movie is, for successful inception, an architect who can visualize and build the artificial dream world is essential! What a novel concept! It’s like opium on the giant silver screen! Anyway, what’s vital for us here is the Power of visualization. Albert Einstein has famously said, “Imagination is everything. It is the preview of life’s coming attractions.”

Around Circa 2000, I produced a few Surgical Instructional Video on Micro-ear surgeries to raise money for our Rotary free ear surgery program. They sold like hotcakes and crossed many shores. When I met some of the people who watched those videos sometime later, they complimented me for them. They told me that they have learned to perform all ear surgeries just by watching those videos! I wondered how could that even be possible? 

Anyway, my story was not different, either. I joined a Hospital in Kerala in 1997 as a foreign returned surgeon! I had returned from the USA as I couldn’t get into the ENT residency program despite having good USMLE scores. I could have got into either internal medicine or pediatrics. I decided against it, as joining any other branch would have been a dishonor to my teachers at PGIMER, Chandigarh, where I did my residency. Initial expectations to perform were very high, internally as well as externally. Internal reasons, my USA misadventure, had left me with huge debts. The external reason, I was from a premier institute and foreign returned! But my initial Otology surgical results were miserable. I couldn’t afford to go and work with somebody or attend workshops, initially.  

“Create a vision of who you want to be, and then live into that picture as if it were already true,” thus spake Arnold Schwartzanager. Around that time, I met Dr. Mahadevaiah, and he told me he had produced some surgical videos. I wrote to him immediately. I promptly received a personal hand-written letter within a week with the list of videos, their prices, and how to procure them. I followed the instruction, and in another week, I had all the videos with me. I must have watched those videos repeatedly until the tapes were worn out! When I was not watching them on TV, I played those videos on my mind. My success rates with ear surgeries improved within a short time. That was the power of Visualization. That compelled me to buy tapes of many surgeons available at that time.  

I had read an interview with Dr. William Devries, somewhere. He performed the “world’s first artificial heart” surgery. He said that his belief concerning surgery had always been ‘rehearse, rehearse, and then rehearse some more! For if you ‘stick to this principle, when it comes time to perform the actual operation, the procedure will have become almost routine for you.” When our residents are struggling to learn surgeries, I ask them to watch our surgical videos repeatedly and visualize them before coming to the OR. 

Our first endoscopic skull base surgery was Pituitary macroadenoma, a huge one with supra-sellar extension. We did a reasonably good job as a team in that two nostrils and four-hand techniques. Our neuro-chief was supremely pleased and asked me, “Have you done many cases earlier? Where did you get an opportunity to practice in a small place like Chitradurga?” I just smiled. I only had done a cadaver dissection at Niece in France. However, I had rehearsed the surgery thousands of times in my mind. I had visualized and internalized each step, its nuances, pitfalls, and complications. I had also used a few other techniques called ‘deconstruction,’ ‘London cabby technique,’ and ‘Parallel/Perpendicular’, etc., and I will write about them sometime in the future.  

I teach this concept of operating on each patient at least ten times during my presentations for learning surgery. The ten steps are: 

  1. The moment you advise him of surgery, run the entire surgical process in your mind. 
  2. When the patient gets admitted – visualize it again. 
  3. The previous night, if required, read about that surgery and discuss with a friend or teacher or run that mental video again. 
  4. During my morning “Octavation” session, I have a step called “Most Important Task of the day,” during which I go through the complete process step by step. 
  5. Just before surgery, while scrubbing, I replay the mental video. 
  6. The actual surgery. 
  7.  When they come back for follow-up, I assess what I did and positive or negative results. 
  8. Show the work to others. 
  9. Present your work in courses and conferences, 
  10. Publish it. 

American Engineer, Philosopher Alfred A. Monepart, has stated, “To accomplish great things we must first dream, then visualize, then plan…believe….act!” I am always in awe of one person, and who is a kind of idol for me is Josh Waitzkin. The famous movie ‘Searching for Bobbie Fisher’ is Josh’s biography. Josh is an American child chess prodigy. He is one of the few people who have managed to draw with Gary Kasparov. He became an international chess grandmaster at the age of 16. Josh successfully used the visualization technique to beat his opponents in chess and play blind-folded chess or playing with multiple participants at the same time.  

Dr. Prem Jagyasi, the author of the beautiful book, ‘Carve your life: Live a great life with Carvism, has beautifully said, “In order to find your true potential, what you need to do is simply determine your core values, visualize the person you want to be, challenge common thought traps, and have a clear sense of your goals.” When Josh lost interest in chess, he used visualization techniques to change his career, based on mental faculty such as chess to physical faculty such as Aikido and Brazilian Jiu-Jitsu. He won the 2004 world championship title in Taiji Push-Hands. Josh is a black belt in Brazilian Jiu-Jitsu. He successfully guided many teammates in the visualization technique and helped them to win world titles. He has authored two excellent books, Attacking Chess: Aggressive Strategies, Inside Moves from the U.S. Junior Chess Champion, and The Art of Learning: An Inner Journey to Optimal Performance.  

 One remarkable story about Josh is winning his 2004 World Championship title in Taiji Push-Hands. Few months before the Championship draw, he gets severely injured during a practice session. However, the visualization technique helps him practice the game and develop the same physical and mental ability required to win the World Championship. History is full of such stories where several athletes have used a similar technique to win their titles. An American of Lebanese origin and the author of the book ‘The Second Harvest,’ Nabil N. Jamal has quoted, “You cannot advance if you cannot visualize the end from the start.” The colleagues who want to become a master of their crafts must-read Josh Waitzkin’s book, The Art of Learning: An Inner Journey to Optimal Performance.     

Visualization cannot only help in mastering surgeries, but it can also help in designing our lives. A famous Indan author of multiple books, Sanchita Pandey writes in her book “Lessons from my Garden,” “If you can visualize it, you can certainly manifest it in your life.” The visualization is something readily available to everyone. Genevieve Behrend, one of the earliest French-born Mental science teacher, observed, “We all possess more power and greater possibilities than we realize, and visualizing is one of the greatest of these powers.” Everyone visualizes whether he knows it or not. “Visualizing is a great secret of success.”  

Dr. Prahlada N.B
prahlad@kenthospitals.com