Why surgeons need the Sabbath from The American Journal of Surgery April 2026
Surgeons 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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