Un petit cimetière

René Leriche wrote this in 1951, at the peak of his career. He was a French vascular surgeon, a man who'd spent decades opening bodies and trying to fix what was broken inside them. And I’m thinking that on the day he wrote that, he had probably borrowed a few cigarettes from his fellow countrymen Camus and Sartre. But it was a pain he had lived. By the time he wrote those words, he'd accumulated enough losses to know that surgery doesn't just leave scars on patients—it leaves them on the surgeon too.

I heard his quote last week at an orthopedic oncology conference in Mexico City. Someone referenced it during a presentation of a case with poor outcomes, and it landed in the room like a stone in still water. Around me sat dozens of surgeons who treat bone cancer—a field where even the successes are most often measured in borrowed time, where you're often just trying to give someone a few more years of walking before the disease takes them anyway. Leriche's cemetery isn't theoretical for people who do this work. It's real estate they visit regularly.

The image stuck with me on the flight home. This internal graveyard where surgeons go to kneel among their failures, searching for explanations, tallying their mistakes. It's an honest accounting of what it costs to hold other people's lives in your hands, at least in a small way. Leriche wasn't being melodramatic—he was just saying the quiet part out loud.

But I would argue that it doesn’t have to be only that, a place of bitterness and regret. The imagery of his refuge is rather beautiful, if pained, but can we build refuges that do something more than preserve our failures in perpetuity?

My dad is a primary care doctor. And he’s not just good; he’s quite possibly the very best on planet Earth at what he does. He is excellent, and moreover, adored. He's been practicing for over thirty years, which means he's truly come to know more patients than I've treated in my entire residency. When someone dies—particularly someone he's cared for over years, someone whose kids he knows, whose story he's been part of—he has a ritual.

He goes into a room in his house, closes the door, and listens to Adagio for Strings by Samuel Barber. He thinks about the person. He reflects on their relationship, on what they meant to him, on the shape of their life. It usually lasts one playing of the piece, to its climactic end, about eight minutes. Then he's done.

It's different from Leriche's cemetery in a crucial way: my dad isn't excavating his failures. Rarely, if ever, is the death his fault—people get old, diseases progress, hearts give out. It is the way of the world. He's not going there to search for explanations or catalog his mistakes. He's going there to honor someone, to let himself feel the weight of losing them, and then—and this is the part that matters—to release it enough to keep practicing medicine the next day.

The refuge isn't about preservation. It's about processing.

I have my own version, though mine handles a wider range of hardships. There are a few paths I walk in nature—actual physical trails I've worn down over the years—where I go to metabolize the hard things.

Sometimes it's mistakes I've made: a personal letdown I second-guess, a conversation that that went sideways, the everyday anxieties that come with learning to be an adult in a messy, often disorienting world. But sometimes it's just the accumulated weight of things that happened to me, things I had no control over. The patient who died despite everything being done right. The bad news about someone I used to know. The randomness of suffering I witness every day.

I walk those paths and let it all unspool. And wouldn’t you know it, the tree line stays the same, the creek runs where it always runs, and somehow the constancy of the landscape absorbs what I'm carrying. It will be there for me again tomorrow. And I don't come back unchanged—I am still shaped by the memory of hardships—but I come back lighter. Ready to go back in.

These refuges work differently than Leriche's cemetery. His is a place you visit to excavate and examine, to give penance. To dig up what went wrong and turn it over in your hands. There's value in that—God knows surgeons need to learn from their failures, need to sit with the weight of what happens when judgment fails or hands slip or luck runs out. Because  of course, when the situation returns to us again, we choose differently. It is a brutal but necessary form of learning.

But we also need places that let us process and release. Places where we can acknowledge the hard thing without being crushed by it. Where we can honor what was lost without building a monument to our regret.

The difference matters because it determines whether we can keep doing the work. Leriche's cemetery, as he describes it, sounds like a place that accumulates weight. Every failure gets a headstone. Every mistake gets memorialized. You visit to pray, to seek understanding, but there's no mechanism for letting go. Just bitterness and regret, compounding over a career until the graveyard gets so crowded you can barely move through it.

That's not sustainable. Not for surgeons, nor therapists, nor for anyone who does work that involves immediate stakes and consequences for other people.

My dad's ritual with Adagio for Strings isn't about avoiding the pain of loss—that music is devastating, it doesn't let you off easy. But it has boundaries. Eight minutes. One patient at a time. The grief is honored, fully felt, and then gently released. He's not trying to forget the person. He's trying to metabolize the loss so it doesn't calcify into something that makes him afraid to care about the next patient.

My paths in nature work the same way. I'm not running from what happened. I'm walking through it, literally and figuratively, until it becomes something I can carry without being bent by it.

This isn’t just for doctors. And it’s not always so drastic, so life-or-death, but we all need a place like this. We’re all carrying something. Mistakes we've made at work, in relationships. Losses we've suffered. Hardships that found us through no fault of our own. The question isn't whether we need refuges—the question is what kind we build.

Leriche's cemetery is real and necessary. We need to face our failures, to understand what went wrong, to learn from the bodies buried there. But we can't stop there. We need refuges that do more than catalog our regrets. We need places that allow for release—not forgetting, not denial, but actual metabolization of the hard things so we can keep living forward.

Maybe it's a room with music that breaks your heart but only lasts eight minutes. Maybe it's a path in the woods you've walked so many times your feet know every root and stone. Maybe it's something else entirely—a morning ritual, a conversation with someone who understands, a practice that creates space for grief without letting it metastasize.

The specifics don't matter as much as the principle: we need places where we can lay down what we're carrying, even if only temporarily. Where we can honor the weight without being crushed by it. Where the scars remain but don't dictate everything that comes after.

The small, inner cemetery is real. I carry mine, my dad carries his, Leriche carried his. And you carry yours. We all do. But I've learned this: you get to choose what kind of refuge you build. You can make it a place where failures compound and calcify, where every mistake gets its own headstone and the ground gets harder to walk on every year. Or you can make it a place you visit to grieve and honor and then—gently, deliberately—let go. The losses still happened. The scars still mark you. But you walk out ready to keep going.

John

Thanks for reading The Mayfly Letter.

Your support allows me to continue doing something I truly love.

John Conrad