Why surgeons need the Sabbath from The American Journal of Surgery April 2026Surgeons are familiar with a menu of wellness offerings aimed at
combating burnout: mindfulness apps, therapy dogs, and resilience
seminars. While these efforts are well-meaning, they tend to focus on
restoring efficiency rather than renewing humanity. Resilience training
implies that after moral injury, we can return to our original form.
Burnout mitigation imagines us as depleted machines that can be refueled
and redeployed.1 Yet prolonged exposure to our patients’ suffering—and to our own limitations—is not so easily mitigated. It leaves us
changed. Perhaps we need something older and deeper: the Sabbath.
By the Sabbath, we mean a regular, protected rhythm of ceasing from
work —our clinical, academic, and administrative tasks — to be present
to others and the world outside ourselves. The Sabbath was not created
as rest for the sake of more work, but as a reminder that we are more
than what we produce.
1. The Sabbath
In the Jewish tradition, every seventh day work ceased—not only for
landowners but also for servants, foreigners, livestock, and even the
land. In a world of slavery and ceaseless toil, the Sabbath was a powerful
equalizer.
Over the centuries, the Sabbath has been reframed across various
traditions, but its central insight endures: rest is not merely the absence
of labor but instead requires the discipline of attention and intention.
The concept of Sabbath reminds us all that our identity is not only to be
found in our work. In society at large, and in surgery in particular, this
sort of rest seems extraneous. We are vulnerable to what Howard
Friedman calls “hurry sickness”
2 — the guilt of idleness, the panic of
stillness, the frustration of waiting. The Sabbath offers another rhythm:
attention to what restores, intention to resist what depletes.
2. What the Sabbath can be
1 The Sabbath as gift.
The Sabbath is not only about ceasing activity but also about
inhabiting time differently. Rabbi Abraham Joshua Heschel called the
Sabbath a “sanctuary in time.“3 The Sabbath invites us into a world
suspended from ordinary struggles of time management and efficiency.
The Sabbath invites us to experience the world without feeling the need
to manipulate or control everything. Walking through an arboretum,
sitting with a painting at your art museum, or spending time with a
friend with no agenda. In surgery, where every encounter asks “What
must be done?,” the Sabbath reframes the question as “What may be
received?”
2 The Sabbath as protest.
At its core, the Sabbath is a form of resistance. To rest is not simply a
temporary pause but a declaration that productivity is not all that
matters. In modern surgery, where productivity and efficiency have
become the virtues of the medical marketplace—and wellness programs
function to refuel us for more labor—the Sabbath reminds us that our
value goes far beyond our RVUs and that our own healing requires a
willingness to cease. The Sabbath teaches all of us, religious or not, that
our value is not bound to our output.
3 The Sabbath as community.
The Sabbath has always been communal. Whole households rested
together and communities slowed together. Surgery is interdependent;
we need our colleagues. A trauma activation or a decompensating ICU
patient may warrant our attention and delegation, but even at that
moment, our first obligation is to the patient on the operating room table
in front of us. The phenomenon of a busy surgical service teaches us the
importance of interdependence: we cannot be two places at once. The
world continues to spin outside of the operating room, with or without
us.
Practicing the Sabbath in surgery also requires small, deliberate
practices that honor this interdependence. This can look like protecting
a colleague's day off with the same vigilance we protect an OR start time,
creating cross-coverage structures that make true rest possible, or
establishing shared rituals—such as a weekly communal meal or
walk—that remind us we belong to one another outside of clinical
productivity. Sabbath-keeping in surgery is rarely an individual
endeavor; it becomes sustainable only when colleagues participate in a
culture where rest is expected, protected, and practiced together.
4 The Sabbath as limit.
Surgery daily reminds us that we have limits and that we are all
finite. Heschel writes, “[we] must say farewell to manual work and learn
to understand that the world has already been created and will survive
without the help of man.“
2 Our work is valuable, but we are not indispensable. Age, illness, or disability will eventually necessitate our
retirement. The Sabbath teaches us to ultimately hold our work loosely,
to resist the illusion that everything depends on us, and to remember
that our worth is not erased when one day we are forced to lay down our
scalpel.
3. What the Sabbath is not
1 The Sabbath is not catch-up.
Not every pause is a Sabbath. Time “off” often gets filled with work:
catching up on emails, preparing for upcoming cases, finishing presentations, or running errands. These activities, however necessary, miss
what Sabbath rest can offer.
On the other hand, social media and streaming can be equally
tempting when away from our places of work, pulling us away from the
good life. The Sabbath is not a day to get ahead or a day lost to
distraction, but a day where rest is protected.
2 The Sabbath is not competition.
Even hobbies can become disguised labor when they are scrutinized
through a marketplace lens. The word “amateur" comes from the Latin
root, amator, which means "lover." We must resist shifting our focus from
our loves—our intrinsic joys—to goal-oriented, quantifiable processes.
The Sabbath creates a space free from monetization, where creative
expression and relaxation can thrive without the pressures of productivity or the Peloton leaderboard.
3 The Sabbath is not inactivity, but the right activity.
Just as a case will not move forward without attention to the proper
steps, our time away from work can be squandered if filled with the
wrong kind of activity. True leisure is not achieved by sleeping the day
away, numbing ourselves with substances, or binging on television. The
concept of Sabbath challenges us to focus on what restores rather than
what depletes. Philosopher Matthew Crawford reminds us that,
“Attention is a resource — a person has only so much of it.“4 If we settle
for distractions, we will have no attention left for truth, goodness, or
beauty.
4. Margins
In surgery, we emphasize margins— the boundary between pathology and health, what must be removed, and what must be preserved. Yet
we rarely acknowledge our own margins. When do we cross from
empathy to detachment, from care to numbness, from service to selferasure? We are well-trained to obtain oncologic margins with precision, knowing the difference between cure and compromise. But it is
easy to fail to examine the emotional margins that separate resilience
from moral injury.
The Sabbath asks us to honor the margins of our own lives. Boundaries are not failures but safeguards—the difference between healing
and harm, between being fully human and being consumed by the work.
For surgeons, the lesson is both enduring and urgent. The Sabbath
teaches us all to reclaim our boundaries, to remember that we are more
than what we accomplish, and to discover that the work of healing requires that we, too, be made whole. The Sabbath is not rest for the sake
of more work; it keeps us human.
Funding/Support
None reported.
CRediT authorship contribution statement
Hima Bindu Thota: Writing – review & editing, Writing – original
draft, Conceptualization. T. Clark Howell: Writing – review & editing,
Conceptualization. Kevin I. Ig-Izevbekhai: Writing – review & editing.
Ryan M. Antiel: Writing – review & editing.
Declaration of competing interest
The authors declare that they have no known competing financial
interests or personal relationships that could have appeared to influence
the work reported in this paper.
Acknowledgments
We thank Dr. Michael Shapiro, MD, from the Department of Surgery
at Rutgers New Jersey Medical School, and Shay Strelzik, from the Hebrew Union College, for their contributions to the Jewish perspective on
the Sabbath.
References
1. Kinghorn W. Wayfaring: A Christian Approach to Mental Health Care. Grand Rapids, MI:
William B. Eerdmans Publishing Company; 2024.
2. Friedman M, Rosenman RH. Type A Behavior and your Heart. first ed. New York, NY:
Knopf; 1974.
3. Heschel AJ. The Sabbath: Its Meaning for Modern Man. New York, NY: Farrar, Straus
and Giroux; 1951.
4. Crawford MB. The World Beyond your Head: On Becoming an Individual in an Age of
Distraction. New York, NY: Farrar, Straus and Giroux; 2015.
Hima Bindu Thota, MD, MTSa,*
, T. Clark Howell, MD, MSHSb
,
Kevin I. Ig-Izevbekhai, MDb
, Ryan M. Antiel, MD, MSME, FACSb
aDepartment of Surgery, Rutgers New Jersey Medical School, Newark, NJ,
USA bDepartment of Surgery, Duke University Medical Center, Durham, NC,
USA
*
Corresponding author. Department of Surgery Rutgers New Jersey
Medical School 185 South Orange Avenue, Newark, NJ, 07103, USA. E-mail address: hbinduthota@gmail.com (H.B. Thota).
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