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Let us take as an example the profession of surgery. Few jobs involve so much responsibility, or bestow so much status on its practitioners. Certainly if challenges and skills are significant factors, then surgeons must find their job exhilarating. And in fact many surgeons say that they are addicted to their work, that nothing else in their lives compares with it in terms of enjoyment, that anything that takes them away from the hospital—a Caribbean vacation, a night at the opera—feels like a waste of time.

But not every surgeon is as enthusiastic about his job. Some grow so bored by it that they take up drinking, gambling, or a fast life-style to forget its drudgery. How can such widely diverging views of the same profession be possible? One reason is that surgeons who settle down for well-paid but repetitive routines soon begin to feel their tedium. There are surgeons who only cut out appendices, or tonsils; a few even specialize in piercing earlobes. Such specialization can be lucrative, but it makes enjoying the job more difficult. At the other extreme, there are competitive supersurgeons who go off the deep end in the other direction, constantly needing new challenges, wanting to perform spectacular new surgical procedures until they finally can’t meet the expectations they have set for themselves. Surgical pioneers burn out for the opposite reason of the routine specialist: they have accomplished the impossible once, but they haven’t found a way to do it again.

Those surgeons who enjoy their work usually practice in hospitals that allow variety and a certain amount of experimentation with the latest techniques, and that make research and teaching part of the job. The surgeons who like what they do mention money, prestige, and saving lives as being important to them, but they state that their greatest enthusiasm is for the intrinsic aspects of the job. What makes surgery so special for them is the feeling one gets from the activity itself. And the way they describe that feeling is in almost every detail similar to the flow experiences reported by athletes, artists, or the cook who butchered the meat for the Lord of Wei.

The explanation for this is that surgical operations have all the characteristics that a flow activity should have. Surgeons mention, for instance, how well defined their goals are. An internist deals with problems that are less specific and localized, and a psychiatrist with even more vague and ephemeral symptoms and solutions. By contrast the surgeon’s task is crystalclear: to cut out the tumor, or set the bone, or get some organ pumping away again. Once that task is accomplished he can sew up the incision, and turn to the next patient with the sense of a job well done.

Similarly surgery provides immediate and continuous feedback. If there is no blood in the cavity, the operation is going well; then the diseased tissue comes out, or the bone is set; the stitches take (or not, if that is the case), but throughout the process one knows exactly how successful one is, and if not, why not. For this reason alone, most surgeons believe that what they are doing is so much more enjoyable than any other branch of medicine, or any other job on earth.

Excerpted from pages 155-156 of Flow by Mihaly Csikszentmihalyi