The trouble with discourse that drives us apart in response to a death in the line of duty

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Cross-posting from the heenastat blog.


 

My heart sank when I heard the news that a local police officer had been killed in the line of duty. I was not on call that day but I knew exactly what the words “he was taken to a local hospital where he was later pronounced dead” meant. As trauma surgeons we provide care for those injured in senseless, often preventable ways daily. But when an officer is stricken it hurts in so deeply because we share a position with them at the forefront of the worst that happens in our society.

So when I heard the news I mourned for the officer, for his family, for his colleagues, for all of law enforcement, and for the people who tried so valiantly to save his life and would forever be asking themselves “was there something else we could have done?”

Let me assure you, there was not.

As with all trauma centers, we have a comprehensive morning report where we discuss all of our new patients: what was the mechanism, how did they present, what was done for the work-up and subsequent treatment? So it was clear that the trauma team did everything they scientifically or physiologically could in this case. In morbidity and mortality* terms, this would be a ‘non-preventable’ death.

Here’s the thing though, of course it was preventable. And we are all (as members of the community, as his brothers and sisters in law enforcement, as representatives of both sides of the criminal justice system, as providers in the healthcare system) asking this same question “why, why did a good man—a good cop, a good husband, a good father, a good son, a good citizen—die this way?”

In a statement to the press less soon after losing her son, the officer’s grief-stricken mother was quoted as saying there is “no respect for police anymore” suggesting perhaps that a pervasive devaluing of law enforcement by society might be at the root of her son’s preventable death. She was no doubt alluding to the national discourse evolving in recent years due to some high profile episodes where the actions of responding officers have been questioned. Some actions have been proven to be criminal by our justice system, as in the case of an Oklahoma City Police Officer who serially raped women he had pulled over, in other cases, however, the facts in support of criminal behavior beyond a reasonable doubt are less clear (e.g., Officer Parker of Madison, AL and Mr. Sureshbhai Patel; or Officer Wilson of Ferguson, MO and Mr. Michael Brown; or Officer Pantaleo of New York, NY and Mr. Eric Garner).

Clarity notwithstanding, there has seemingly been a shift in public rhetoric questioning of infallibility of those on the front lines of law enforcement. Sadly, in some cases the rhetoric has escalated to vitriol, rioting, and even directed acts of violence against law enforcement.  It truly is maddening that a man, fueled by the overarching discourse questioning police intentions and behavior, would then seek an opportunity to kill the police as in the case of Mr. Ismaaiyl Brinsley who gunned down Officers Wenjian Liu and Rafael Ramos of the NYPD, not during the act of apprehension or while committing another crime, but just because.

However, no matter what the headlines are, the overwhelming majority of our men and women in blue are good men and women who take on their duties with the best of intentions and model professional behavior. And so, when this good man’s mother cites this volatile discourse as a possible cause of his death—as much as my heart breaks for her—it hurts our community by suggesting a local conflict where there was none.

By all accounts, the cop killer in this case was a sociopath lacking any respect for human life or the laws of our society in general as evident by a lengthy record replete with charges ranging from cocaine trafficking, to assault & battery, to weapons possession. Those of us who are not career criminals might get tachycardic or diaphoretic during traffic stops but our natural instinct is to reach for our license & registration, not for our gun. A man with no moral compass felt cornered and so he fired; but, this was no more because he was cornered by an officer than if I had made some gesture to this armed and dangerous criminal during my nightly dog walk.

So, while a family, a profession, and a community mourn, I urge each of us to contemplate how the criminal justice system might have functioned differently to prevent this senseless tragedy but to avoid stoking fired up rhetoric that pits people against the police and police against the people. Discourse that drives us apart stands in the way of viable solutions to combat the socioeconomic and psychological factors that may drive one to a lifetime of crime in the first place and to take those who cannot be rehabilitated off the streets before another preventable death, be it of an ordinary citizen or a man/woman in blue.

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*Morbidity & Mortality, or M&M as it is called is a weekly conference held by surgical teams to review all deaths and complications in an effort to learn more about the systems-based and disease-based processes that led to the adverse outcome.

 

 

An Open Letter to Young Women Considering a Career in Surgery

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Dear Young Woman Considering a Career in Surgery,

It was lovely to meet you the other day. Many times a month, a young woman just like you comes to me with similar interests and concerns. “I really love surgery,” she says, ” But I am afraid of the lifestyle and I really want to have a family.”

Oh, and thank you for also inviting me to speak at your seminar the other day on Women in Traditionally Male Dominated Fields. I have been speaking at similar panel sessions since 2005 when I was a bit of a novelty at my training program as a clinical PGY-4 with an infant daughter. Your collective curiosity on what my life must be like is of great interest to me because to me it’s just my life. It’s the only reality that I know because, like you, I was young (just a few days into my 25th year, just 5 days into my first ever surgical rotation) when it occurred to me that I really loved surgery. It was unexpected; but every day since then (from the remainder of that MS3 rotation, to my sub-internships, to my years in residency, to research and clinical fellowships, and to these past 6 years on staff) I have crafted a reality, as tenuous as it is, that works for me and my family in any given moment in time.

And I am here to tell you that you can do the same too if you, in your heart of hearts, can think of nothing more exciting than surgery as your professional passion.

People outside of surgery will tell you that it’s a career that is too hard to integrate with family life. They are correct that it is generally harder than other fields in medicine; but, ask yourself if you truly want a career in general pediatrics, or dermatology, or invasive cardiology or anything in between. If the answer for whatever alternate field(s) you are considering is no, then no matter how many fewer hours your profession requires, no matter how much more flexible those hours may be, your family will be left with a present, well-rested, yet bitter wife and mother.

[NB: I use the word integrate very purposefully here. Anyone from a demanding profession, surgery or otherwise, who tells you that work-life balance is possible is conning you. Your life will never be in balance. Something will always have to give: your work, your family, or yourself. It’s in how you integrate these things in a shifting, fluid professional and personal lifetime that you will craft your own reality.]

 

The same can be said of those who encourage you to enter surgery training but then offer that you may consider a career in breast surgery or start an exclusive vein clinic or choose some other presumably less time sensitive and/or less time consuming surgical practice to balance your professional work with your desire to have a family. Again, ask yourself  if you can truly be happy in such a practice. (I personally would be bored with only a few kinds of procedures in my armamentarium and the absence of physiologic chaos; but everyone is different.) You may not know the answer until you are well into your training; but, choosing a medical specialty in the first place, or a surgical subspecialty in the second, simply because you presume it will be easier for family life is fraught with potential for professional dissatisfaction. I promise you that professional dissatisfaction will always stand in the way of overall family life satisfaction. Always. Forever.

Finally, as hard as it might be to envision yourself as a surgeon who wants hobbies, and a spouse, and a smoking hot body, and children of your own someday,  remind yourself that divorced parents, widowed parents, disabled parents, parents with deployed military spouses, and parents with far fewer socio-economic resources than practicing surgeons, and trainees for that matter, somehow get it done. Every life has it’s particular challenges when it comes to parenting but surely being a surgeon is not the most insurmountable of them all.

So think long and hard about alternatives to surgery; but choose one only if it speaks to your professional soul. No matter what career you choose, you will likely spend more time at work than on any other aspect of your life be it parenting, self-care, love-making, you name it. Therefore, it is critically important that your choice of career light the fire in your belly to show up every day leaving behind, at least temporarily, everything else including your children. Because one thing is for sure: when you are practicing surgery, your head needs to be in the game. You cannot be distracted by guilt about not being with  your family or about delegating some of the more mundane aspects of childrearing or homemaking to others. You must love the work enough to drop the guilt and create practical solutions to raise your children and provide them with a safe and loving space in which to grow while reimagining whatever stereotypes you hold about being the perfect parent.

Because you know what: There is no such thing as a perfect parent, surgeon or otherwise. So there will never be any point in beating yourself up about it. Know that you will love your children more than you could have ever imagined loving anything, including surgery, but that you will still be a great surgeon. The two are not incompatible, but it takes some effort and creativity.

So, now that I have convinced you to choose the career of your dreams here are some thoughts on the effort and creativity it will require.

Do not underestimate the importance of choosing a life partner who gets the soul inspiring nature of your career choice. He/She may be another surgeon, or physician in another specialty, or a non-medical professional, or a skilled laborer; it doesn’t matter as long as your life partner understands that, when you are tired from the long days and nights, or sorrowful for the lost lives, or otherwise distracted, it is not because you love work more than you love them. Bottom line: as awesome as any career may be there is something messed up about your priorities if you really would choose work over loved ones. So your life partner needs to get that you aren’t messed up; you just have a demanding career.

With the demands of that career comes the need for a real partnership in planning life. That doesn’t mean a 50:50 split or a 80:20 split or anything conscribed; it means a constant openness to splitting however it needs to be split or not splitting at all to ensure that life outside of work happens. It means making the most of precious few waking moments together through physical contact and communication. It means having a very user friendly calendar/shared to-do system. It means providing feedback without judgment for the practical things in life and making space for shared emotional and spiritual needs. If you find yourself paired up with someone who can’t work with you on life this way, then consider dumping him/her. Seriously, it’s not worth trying to make them happy if they just don’t get this hugely important part of what makes you whole.

[NB: If a life partner is not your thing or things just don’t work out, that’s okay. The same principles of reimagining, outsourcing, and dropping the guilt apply. It’s just that your village, or metropolis as may be the case for some surgeons, has a different population structure.]

 

Choose your job based on both professional and personal needs. Training is finite and there is always an end from which to take on a new direction. However, even though many surgeons change jobs, think of your job as your forever job so you don’t accept a situation which will turn out to be toxic for you. Choose partners who will have your back, and you, in turn need to be willing to have theirs. Choose geography that at least satisfies some of your desires for commute time, distance from extended family, lifestyle, weather, etc. and makes life easier. You can’t blame surgery if your long commute destroys your soul, or if having your parents thousands of miles away makes you sad, or if humidity, piles of snow, or whatever your most dreaded weather phenomenon is drives you crazy, or if it takes a flight to get to your favorite past time of hiking, biking, skiing, etc. That’s on you and the choices you have made as a surgeon and not on the profession itself. Finally, choose a practice type and setting that will make you excited to show up every day (for me it was research, teaching, and a level 1 trauma center in a university based system).

If you do have a life partner and working is important to him/her, don’t pick a location that will railroad his/her career. As much as being a surgeon defines you, your soul mate is similarly defined. Please don’t create a situation where he/she will be susceptible to resentment about having his/her professional goals squashed. (I’ve been there. It puts a real strain on a marriage. It sucks.) It’s already hard enough to be paired up with you, a surgeon. Both your jobs may be equally demanding, or one may be more demanding; it doesn’t matter as long as together you negotiate a mutually satisfying life-long give and take about who prioritizes what and when depending on the stages of your respective careers and the ever evolving needs of your family.

When is comes to family, do not waste too much mental effort over-thinking when you should start it. Fertility, along with finding the right person with whom to test your fertility, is a complex and unpredictable thing. No pregnancy is guaranteed to proceed smoothly. Given these inherent limitations and unknowns, along with the demands of a surgical career, there is no perfect time to start a family. This is about as certain as death and taxes. I will spare you the perceived pros and cons to having children during training compared to while in practice. Just know that every time period poses challenges and every passing year makes infertility more likely; so if you are ready in your personal life to try to get pregnant go for it; because, if you choose to wait for a perfect time, you will be waiting for a very, very long time.

And, if having children in a traditional sense is not possible for whatever reason, there is also no perfect time for assisted reproduction, adoption, or surrogacy either even though the salary increase a staff surgeon or faculty job may be necessary for these options. In the end, whatever approach to becoming a parent will be required,  you will figure out a way to get through the challenges because you will have mentally and emotionally committed yourself to the idea of being a mother who also happens to be a surgeon.

[NB: If you choose to not have children-by this I really mean choose as there are myriad other mishaps of life and physiology that prevent women who want to be mothers from becoming mothers-, please do not make that choice simply because you want to succeed as a surgeon. You will never forgive yourself. Not ever.]

 

When it comes to family there are various options to manage childrearing and homemaking. A nanny, two nannies, an au pair, daycare, a nearby grandparent, a neighbor who is a stay-at-home parent, or various combinations of these may be required to keep your children loved and safe. It’s different for every family and I promise you that you will find what works for  you. It will be a source of stress but it is doable. And, no matter how much time others spend rearing your children on your behalf, those kids somehow know that your are their mother, that you love them in a way beyond any other love, that you would give your own life if it would save them, and that you also happen to be a busy surgeon. Trust me. They will. And, they will be really proud of the uniqueness of their surgeon mom. They really will.

When it comes to your home, be it your 600 sqft rental in residency or your 2500 sqft grown up home in a cul de sac, outsource any jobs you and/or your partner simply do not enjoy. I cannot emphasize this enough. You will, in fact, have precious little time with your family. Ask yourself how you want to spend that time. Do you want to being cleaning and doing laundry? Or do you want to plan a family outing? If hopping on your John Deere and showing your lawn whose boss on your Saturday off is a fun activity for you, then by all means go for it, otherwise someone else will be happy to mow your lawn for a fee. If you love cooking, knock yourself out planning, shopping for, and preparing gourmet meals along with the associated clean up, but if you don’t then find a meal service. You get the point. If you don’t love it and it can be done by someone else outsource it. Even on a trainee’s budget you should strive to rid yourself of any household obligations you abhor. (For me the $55 spent every other week during residency for cleaning was well worth never having to spend a day off cleaning a toilet and now the extra hours we pay our nanny to do all of our laundry has spared me a monthly power weekend of washing and folding 10 loads of laundry because we just could not get to it all with the many kids’ activities, call nights, etc. that prevent daily washing.)

Remember: as little time as you will have at home to spend with family, you must also prioritize time for yourself. Don’t expect it to just happen. Just as you schedule elective OR cases, you must schedule elective you time. It may not happen very often but if you don’t take the time for self care in the midst of the stresses of the job and the stresses of parenting you will be cranky and miserable to be around. How you spend time away from family when you have so little time with them will change over time and you may even develop hobbies incorporating your family (we have taken to family bike rides and kayaking trips as the kids have gotten older to combine wellness with family time) but remember to schedule things that feel completely selfish to you. A girls’ night, date night, a pedicure, reading a trashy novel, going to a Zumba class during bath/bedtime, or whatever you enjoy is totally not selfish but you will feel that way; so a good barometer for whether or not you are making time for self care is how selfish it feels. My advice is feel selfish at least once a month.

[NB: If your selfish thing is not a fitness thing then you have to also figure out how to fit that in because your patients and your family need you to be healthy.]

 

Being a surgeon is not incompatible with being a good wife, mother, athlete, whatever else; it’s just trickier. But, if young women keep being scared away from surgical careers then these same fears will linger generation after generation; we will never achieve a critical mass of women surgeons in the profession who can set good examples for one another and for future surgeons. With the same focus we apply in the OR and the same organization we bring to rounds and the same compassion we bring to patient encounters, we can create a life strategy that overcomes these perceived barriers for both a happy family life and a successful surgical career. The barriers will change depending on the stage of the career you love so much and the needs, wants, and development of what and who you love outside of work; but, take it from this surgeon mom: they are barriers to be overcome, not shied away from.

I am pretty sure that’s why you showed up at my door and asked me to that seminar, to make what seems impossible to you at the moment seem possible. Let me tell you: if I can do it, you can too. Go forth, be a surgeon, be a wife, be a mom, be good to yourself and craft a reality that works for you. Then, pay it forward so that someday these meetings and seminars might be rendered obsolete.

Sincerely,

@surgeoninheels

Not just a token surgeon-mom-wife-runner

PS. Here is some inspiration. Your potential in surgery is limitless. https://www.womensurgeons.org/in-practice/leaders-in-surgery/

PPS. The Association of Women Surgeons is an invaluable professional organization whose goal is to: ENGAGE current and future women surgeons to realize their professional and personal goals. EMPOWER women to succeed. EXCEL in those aspirations through mentorship, education and a networking community that promotes their contributions and achievements as students, surgeons and leaders. https://www.womensurgeons.org/

PPPS. I have been fortunate for the last 10+ years to be a part of the American College of Surgeons Women in Surgery Committee working towards improved gender parity, opportunities for professional development, and better work life integration in our careers. https://www.facs.org/about-acs/governance/acs-committees/women-in-surgery-committee

The Office Cleanse

I wrote a post this past weekend on doing nothing.

I think it was a successful strategy, albeit unintentional. I arrived fresh on Monday morning intent upon a full detox of my current state of academic and clinical affairs.

It was to start with the inbox. Somehow (well, I know how–too much spam targeting my clinical work, too much spam targeting my research, too many mass emails from my medical center, too many mass emails from my medical school, too many predatory journals,  too many published before print journal alerts, and well too many bogus unsubscribe links in the past), it has burgeoned to >3500 emails. Most were read but just had not be disposed of or allocated. In the ensuing 4 days I meticulously cut through these emails. I made choices not to be tied to past opportunities for knowledge or connection and got down to <10 rather efficiently.

In between I had several important meetings which were a good break from the task of purging all of these electronic communications. I also found a few almost missed opportunities and was able to take a break from the inbox to write a grant application due Friday and an abstract due Friday. I finally got around to editing a manuscript sent to me a few weeks ago. I updated my CV as with events/accomplishments I was triggered to remember by some of these emails.

Yah me!

When the inbox was a tamed beast it was time to shed more excess weight from my work life.

Though not really behind, I did not look for an excuse to wait another day to get my billing and coding done (yes, I was trained and educated to be a surgeon and a researcher. no, I did not go to school to become a medical coder. yes, I code and generate a bill for my own notes only to then have a trained coder submit them without ever having to code them for a portion of the fee). The electronic record came after that. Every time a resident gives an order over the telephone it has to be signed later. If it does not get signed, when the chart gets sent to medical records it becomes my job to sign the order. So on top of the discharge summaries, operative notes, etc. that I got of my front burner (yes, undropped bills and unsigned charts don’t really care what else must be done and there’s a stiff penalty looming so yes never on the back burner like say 3500 emails or a manuscript without a hard real deadline) I signed several dozen orders for the likes of “may go to x-ray off telemetry” and “okay to resume diet.”

And finally, even though I decided a few months ago to forego paper subscriptions to journals in so far as possible (mostly for the environmental impact but also to remove the possibility of visual clutter in my office; sadly, with this came a burgeoning of full journal contents in my inbox!) I had a pile about 5 inches high that I tackled. I read a few articles and scanned a few more after looking at each TOC and determining which were worth my time. I then filed some for my endnote library to keep for my future perusal. I have this thing about losing knowledge even if it was not mine in the first place (I think I got it from my immigrant parents). So if it shows up in my mailbox, it will get read lest I miss a chance to learn something I didn’t even know I wanted to learn.

And now, a mere four days after I walked into morbidly obese office situation, I feel cleansed and ready to tackle my real jobs.

I hadn’t planned on hitting the week this way. I did shift around my to do list a bit. I can’t help but wonder if it was the awesomeness of just doing nothing that gave me the pep to get through some of the most onerous stuff I have to do for my work.

Allowing myself to just be deserves accolades, not guilt

I am always telling myself to not be one of those bloggers who gives a play by play of his or her day. I prefer to blog about fun things or things from which I derive meaning and I hardly think that anyone gives a rat’s ass about what I did and when so fair warning:

THIS IS A POST ABOUT WHAT I DID YESTERDAY.

I woke up even earlier that I do when I feigning to be morning exercise person to get my daughter to a 6:30am arrival for a field hockey tournament 70 miles away. 4am is brutal for mom, for the tween player who now routinely sleeps until 10 or 11am on weekends, and for the sad sap of an 8 year old brother who needs to tag along since dad is away on a much needed and well deserved guys’ weekend. Of course I am chronically fatigued and it’s nice now that the kids are older that I can use the weekends to catch up on sleep. So to have this privilege stolen from me for a sporting event deeply hurt me but parenting wins so there I was driving 1 hour and 20 minutes each way. The kids both slept in the car both ways. I jacked myself up with caffeine hoping not to become a statistic we trauma surgeons like to study on driving and fatigue.

When we got finally got home at midday I was exhausted. Despite the caffeine coursing through my veins I could not keep my eyes open so I stumbled into a sleep on our ever so cozy sectional. But it was a broken sleep. I refused to simply go up to the bedroom and just give in completely to the tiredness. Nope, I kept hoping that I would soon rise and have a productive day. You see, after several years of working on work-life integration, I am still having a hard time with simply relaxing. I am so trained to think of it as lazy and unproductive that when I do nothing in particular (or choose to sleep rather than doing) I feel an enormous sense of guilt and failure.

In between my fits and spurts of sleep I was thinking:

The house is a mess. (I should be tidying up!)

There are multiple loads of laundry to be done. (I should be washing and folding!)

The kids are somewhere in this house fighting boredom. (I should be playing with them!)

The work to-do list is out of control. (I should be tackling whatever I can remotely!)

There are thank you cards to write. (I should be putting pen to Crane’s paper!)

The Kindle is filled with newly downloaded e-books. (I should be reading!)

My ass is getting fatter as I lay here and the sun is shining. (I should go out for a run!)

I woke up at dusk. I felt like kicking myself for these myriad failed opportunities to get stuff done, to be a better wife (who helps around the house every so often), to be a more engaged mother, to utilize any one of the 7 habits of highly effective people, to take care of myself.

Argh! The self-loathing was quick and sharp.

Later on, once the kids had made sure I ate and stayed hydrated (their dad has trained them well) and had headed to bed (after showering and reading to themselves)* I took the dog for a nice long walk feeling the need to pad the mere 1k steps I had accumulated up to that point since my daily target is 10k. It was a serene and beautiful night. There were no cars zipping by. No sound of Lifeflight that is frequently overhead. No other dog walkers even. Most lights in the neighborhood were off on the eve of returning to school after winter break.

As I was retelling myself all the failures of my day and tryinng to forgive myself, the peace and calm of the night got to me. It occurred to me that I surely deserved some peace and calm with all that I do day in and day out, at home and at work (okay, fine mostly at work!). It turns out that a perfectly calm and peaceful night was a fitting ending to a day of rest that I unintentionally engineered for myself despite all of my intentions (including with this blog) to take better care of myself. I deserved accolades and not self-flagellation. And so I tacked on 4k steps dropping a little more guilt with each stride, congratulating myself on a job well done, not for being lazy but for successfully allowing myself to just be. 

Today, I can see that it helped recharge me for the household chores, unending work obligations, needy family, and self-care that are still there today waiting for type A, get-the-job-done, me.

[*NB: It gets better as they age, I promise. I miss the cooing and burps and smiles of my babies but I sure do appreciate their self-sufficiency on these lazy, ummmmm restful, days.]

 

Organized Surgery Begins to Battle Burnout

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General Surgeon Lifestyles -- Linking to Burnout: Medscape Survey by Carol Peckham March 28, 2013

General Surgeon Lifestyles — Linking to Burnout: Medscape Survey
by Carol Peckham
March 28, 2013

US surgeons are burned out and the numbers are staggering. Whether experiencing emotional exhaustion, depersonalization, or a low sense of personal achievement, 4 in 10 US surgeons exhibit signs and symptoms of burnout. Among neurosurgeons that number jumps to nearly 60%. Burned out surgeons are more likely to report substance abuse, clinical depression, and suicidal ideation. They are more prone to medical errors.

Interestingly, academic practice, trauma sub-specialty, increased nights of call, longer hours worked, younger age, female gender, and small children at home were all risk factors for burnout. For those of you who are new to this blog, I am a female academic trauma surgeon who routinely works long hours and takes in-house call while my small children are at home.

To be clear, these data prove associations and associations do not equal causation; but still, it is sobering to think that so many who entered a profession to fundamentally improve the lives of others are themselves leading such troubled lives due to their chosen occupation.

Embed from Getty ImagesThe occupational hazards of surgical careers are multiple. We suffer moral distress when our patients experience complications or die whether or not an error occurred. We develop compassion fatigue by bearing witness to our patients’ collective and continuous suffering no matter how successful any individual’s outcome may be. Due to our long and often erratic hours, we suffer from chronic fatigue and sleep deprivation. The physical plight caused by fatigue is complicated by many hours on our feet and maintaining awkward postures in the operating room. By routinely putting our patients before ourselves, we often exhibit illness presenteeism. Not infreqeuently, we face the double bind of choosing between being there for our patients or being there for our family. Meanwhile, whether it’s catching up with billing and coding one day, keeping up with meaningful use another day, or spending days studying subjects totally irrelevant to one’s daily practice for maintenance of certification, delivering care in the modern error mandates many a frustrating task that ultimately does nothing to benefit our patients. Furthermore, there is constant fear of litigation that might ruin us in financially or reputationally. And so, it is not surprising that so many of us are burned out.

Emotional awareness (how are you feeling, how does what you are feeling impact your behavior, and how does what you are feeling impact those around you)

All is not dark, however. There are ways for us to be well and resilient. They require both individual effort and culture change. Importantly, they demand emotional awareness. When we understand how we are feeling impacts both our perceptions and our actions, we can act in a way that props us up rather than gets us down.

I was heartened this past week that the American College of Surgeons chose to put surgeon wellness and resiliency on equal footing with the likes of “what’s new in hernia repair” or “ethical challenges in geriatric surgery.” There were a number of educational panel sessions tackling burnout head on. Whether is was about bouncing back in the face of personal loss, gender discrimination, pathways to help surgeons recovering from alcohol abuse back into clinical practice, or managing fatigue, the program was replete with informative sessions on burnout avoidance. Mindfulness, time management, kinship, and down time were emphasized as was physical fitness.

And for the first time ever, the College had a fitness program. As that youngish female academic trauma surgeon with two kids who has struggled with tending to herself after spending her youth, college, medical school, residency, fellowship training, and early years on faculty essentially ignoring personal wellness, I was delighted that this change was happening at my profession’s annual meeting. It was something of a pilot test offering only a very early morning Zumba and a Yoga class, but it was a start. Sure many surgeons at this meeting probably went to the hotel gym or hit the lakefront running path but these efforts happened without the largest surgical professional organization’s imprimatur (hey I even got an American College of Surgeons yoga mat!) or beckoning. These surgeons are likely the 6 in 10 of us who aren’t burned out. But that doesn’t mean we should ignore the self-neglect of our brothers and sisters in the occupation. So this simple step of organizing these fitness events indicated to all attendees that the College both encourages and supports surgeons taking care of themselves. Embed from Getty Images

Making time for fitness has been shown to reduce burnout so I hope the College expands their offerings this time next year. I invite the College to challenge us surgeons to find time for wellness within the already overwhelming conference that offers 5 days of educational sessions geared at making us better surgeons technically and intellectually. The annual Clinical Congress of the American College of Surgeons has essentially had this format the entire time that I have been attending (every year for the past 12 years). With the pilot fitness program the College chose hours and days specifically to not interfere with this typical format. However, given that all the data shows that prioritizing wellness is a key factor in combatting burnout and that wellness takes on many forms, the College should offer multiple offerings–whether it is meditation, or high intensity interval training, or barre, or a knitting circle, or Zumba, or TRX, kick boxing, or spinning, or running– at different times throughout the conference thereby forcing us to prioritize just as I was forced to prioritize between “surgical jeopardy” and “what’s new in body contouring.”

Slide1It will be hard for us to make these choices but we need the practice. I figure its easier to choose wellness when there are no cases to be done or patients waiting in the ER or clinics to be staffed, when there are no lives at risk other than our own.

Fantasies of a Busy Surgeon Mom

 

  1. Driving past runners donning their night gear just shy of 6am as I head into work, I think, “I would love to be hitting the pavement every morning before work. My days always go better if they begin with run.” Alas, I just can’t make myself do it and be ready for work on time. And, after 12-16 hour days (when I am not on call, 26-40 hours when I am) I am usually too tired and hungry to get it together after work.  Embed from Getty Images
  2. Looking at this month’s calendar and seeing the school curriculum night this Wednesday and dinner with visiting professor next Wednesday and kids’ activities past 7:30pm every Mon/Tue/Thu/Fri, I muse “Wouldn’t it be great to actually go do that couple’s rock climbing class or attend the cheese making workshop one of these nights?” Between work, kids, and work-related travel the idea of making it out, just the two of us, at least twice a month has completely fallen by the wayside. Embed from Getty Images
  3. Seeing all the pictures of fabulous girls’ nights marching along my Facebook feed I contemplate “I would love to go for mani/pedis or finally try paint night with the girls.” Unfortunately, ‘the girls’ don’t exist in my life. Alas, a group of women (heck, even just one woman) in my age range with similar interests, who get(s) me, would love to hang out with me, and have/has a schedule that allows for regular get togethers with me just don’t/doesn’t exist in my life. Embed from Getty Images
  4. Waking up, yet again, in a little pool of drool on the couch with the DVR at the end of the show, I think to myself “I wonder what it’s like to not fall asleep during a much anticipated episode of a binge-watchable series or the football game or the Emmys…” Unfortunately, with my chronic sleep deficit putting me in a semi-recumbant position for any period of time soon leads to a slumber, mind you not a restful slumber just one that will subsequently mess up any hope I have of regaining a reasonable sleep wake cycle. Embed from Getty Images
  5. Having another frustrating call with my father about a health issue I think to myself “I would really like to be one of those children who goes to appointments with their aging parents.” I do my best but often work gets in the way (as it also does for my own doctor and dentist visits). So much gets lost in the translation between me, my parents, and their healthcare providers that I suspect that it leads to more stress and anxiety among all of us and the benefit of me having purposely settled near my family is lost. Embed from Getty Images

To be sure there are ways to overcome to all of these issues. My adult life has essentially been a series of work arounds to fit it all in. Some days I succeed and other days I just fantasize about what it would be like to not have to put so much mental energy into these work arounds so I could just let life unfold with me being the socializing, fitness buff, present mother, attentive daughter, and effective TV watcher that I dream of being.

My Kids Have Hijacked My Weekends

There is a high level alert going on in our household these days. What’s terrorizing me, you ask?

My kids’ activities.

I recall the time BK (before kids) when my time off of work was my time. Time to plan and to do (or to not). Sometimes I just spent all day in my pjs if I was lucky enough to have a weekend off. No agenda. Just a day away from the frenetic pace that  was the hallmark of my day job (and my night job and my weekend job!).

IMG_4007Then came the kids. Okay, it was work when they were infants. They had to be fed and diapered and generally kept alive. But their needs were simple and if I didn’t need to be in to be at work on a Sunday, I could sip a cup of coffee and read the Times while the baby (and later the toddler and the baby) were in my proximity. I kept them from sticking a fork in an outlet but essentially got IMG_4006to do my own, grown-up thing that made me happy. And when everyone was old enough, I was even lucky enough to sleep past 8am–a true luxury for a surgeon.

No longer true. Every weekend is now consumed by my kids activities.

Whether it’s 8am baseball practice or a 9am Field Hockey tournament over an hour away, forget sleeping in even though no one is awaiting a soggy overnight diaper change. Then mid-day rolls around and there is likely a dance show, a classmate’s birthday party, and another practice that vie for my kids’ time. And they don’t drive yet.

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IMG_3656We are forced to divide and conquer (thus separating me from my awesome husband who I actually like to spend time with when I am off). We are forced to eat in the car on the run when there just isn’t enough time between activities to sit down to a meal. We guzzle gallons upon gallons of gas going to and fro from event to event, some of which are on opposite sides of the state.

I can’t remember the last time I had an unscheduled weekend for myself. I struggle trying find time to get together with friends who are experiencing the same level of terror in their homes. I literally have gone years without seeing friends who live in the same very small state because with our kids we just don’t have time to be with anyone else on the weekends. In fact, I was so pleased with myself heading into this weekend. I managed to arrange both a work outing on Friday and a Sunday BBQ with my Ragnar van mates. I planned this as soon as the call schedule came out. And wouldn’t you know, out comes the email that the make-up baseball game starts a half hour before the work event and the playoff coincides exactly with Ragnar reunion.

Aaaaaaaaaargh!

My kids have hijacked my weekends and it’s infuriating. I want to support their interests (trust me I’m no Tiger mom; other than encouraging physical activity and retaining some cultural interests these kids a choosing to over-extend themselves with extra-curriculars and parties and playdates) but I can’t say I would shed a tear if they up and quit dance or ball or hockey.

Well maybe I would. If my kids end up too unidimensional to get into college then they’ll have nowhere to go after high school and I really need to get my weekends back.

Reflections on ‘The Great Work Life Debates’

Last week I, along with nearly 10,000 other surgeons of various specialties, attended our profession’s premier annual meeting, the American College of Surgeons Clinical Congress. Of these, some 50 attended a panel session I chaired called the “Great Work Life Debates.” Embed from Getty Images

Quite honestly, I was so relieved by the turnout.

Every conference needs to have a last day and the desire of attendees to duck out before that day (especially given work life issues such as not spending another night away from your nursing infant or not missing another OR day) is totally understandable. Nevertheless, some sessions will be assigned the dreaded last session of the last day.

So yes, leading up it, I was filled with dread that the co-moderator, six speakers, and I would be the only people in attendance. I was delighted to be wrong.

Embed from Getty ImagesWhy did these hearty surgeons stick around for this session? Why were there so many men (also much to my delight) in the audience? Were they there searching for the right answers to the Great Work Life Debates? Did the panelists even have any answers to provide?

The committee sponsoring the session was the American College of Surgeons Women in Surgery Committee (WiSC). I would posit, however, that in the modern era issues of balancing the demands of work and the demands of life at home (or as I like to think of it, the joys of my profession with the joys of my personal life) are not limited to women surgeons. WiSC just happens to have taken the lead in bringing such issues to a format that I imagine years ago was limited to the best technique for such and such procedure or what’s new with such and such surgical disease.

Just because male surgeons of a particular generation may have propagated a particular stereotype about how they valued or prioritized their work relative to their life outside of work does not mean that the male surgeons of today fit into that stereotype. Just because women are increasingly represented in surgical careers does not mean that socio-cultural norms for women surgeons’ roles outside of work have dissipated. An so, I believe that both men and women sought out this session because more circumscribed professional meetings are less likely to address non-biomedical topics even though concerns for wellness both in and out of work—wholeness as a person inclusive of professional and personal needs—transcend surgical specialties, and yes even gender.

Surgeons, irrespective of specialty, gender, or sexual orientation, who haven’t found a life partner, may be prone to wonder whether they should marry another surgeon or seek a non-surgeon with whom to spend the rest of their days outside of the hospital. Those who do have partners, may wonder how to make it work for the long term irrespective of their lifemate’s profession. Surgeons of both genders who do not have children may be experiencing deep inner desire to start a family or may be frustrated by the perception that choosing not to have a family is somehow not acceptable. And, those with children surely have days when inevitable stress of modern day parenting leave them wondering why they did it just as they surely have days when every worry, whether it is about work or home or world peace, is dissipated by boundless giggles of a toddler or the unexpected talkativeness of an otherwise moody teen.  Surgeons whose careers or family situations throw childrearing into chaos must consider the pros and cons of care rendered by nannies in the home or childcare in the diverse, highly regulated environment provided by out-of-home daycare. And, no matter what option or combination of options they choose there will be less than perfect days when both work and child(ren) will be needing you at the exact same moment.

Surgeons—not male surgeons, not female surgeons—but just surgeons sharing similar work life concerns came together to listen to these Great Work Life Debates. These points (and barring time limitations we could have point/counterpointed countless other work life dilemmas) were argued by women with different life experiences, different perspectives, and different debate tactics but both the pros and the cons resonated with the women and the men in the audience who it seems, based of their feedback thus far, simply desired a venue that acknowledged that we surgeons are in fact humans—we have lives outside of work, lives that are made ever more complex by long hours, possible lives at risk while we are working, and myriad other professional demands (which include, by the way, attending such meetings for so many hours/year for continuing medical education credits).

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So what was the bottom line for the men and women who stayed for one of the last sessions on the last day of our conference? Not surprisingly there wasn’t one.

Thus, while marriage is challenging no matter what your day job is (if it wasn’t they would just call it dating forever!) you can’t always control who you fall in love with; a loving, supportive spouse will make your work more manageable whether he/she understands to a tee what you go through every day work or has a vague understanding of why you sometimes come home tired or distracted or not at all. But you too have to be loving and supportive in return and that rendering of love and support may take different shapes.

While children come with the stress and anxiety of raising them along with the costs (~250-500k per child up to 18 years before including the costs of college according to one debator) raising them also brings the joy of nurturing, chubby cheeks, Disney World vacations, etc. but choosing to be childfree also brings many joys (e.g. unfettered travel that need not involve animatronics, increased focus on nurturing your relationship with your partner, increased time to pursue personal wellness) that parents often forego or delay.

Finally, both a nanny and daycare can provide a loving, caring environment replete with both educational and emotional growth while you are working but relying on a single individual may limit diversity and back-up options while relying on daycare increases the day to day burden of prepping the child(ren).  Either way, your children will know you are their parent and they will love you back even on the days when things don’t go smoothly.

My hope is that listening to a spirited debate on these issues related to the dilemmas of partnering, parenting, and childcare will have enabled the audience thoughtfully consider what matters to them and various strategies to help alleviate the strain between the joys of work and the joys of personal life. While there are no perfect solutions (and to strive for a vision of perfection is to set yourself up for disillusionment in your choice of life partner, your decision to (or not to) have children, or your childcare preferences), it’s about crafting a reasonable approach to your own great work life debate based on self-reflection and practical needs.

A hobbyless life

Work-life balance is hard. If you are passionate about your work, and your work involves long hours, life and death situations, and tight deadlines, how do you fit life part of work-life balance in? And, as much as you love your family, if you have a working spouse and kids with schedules about as full as full time jobs (and that’s only after school), how do you have a life outside of work and family?

I will confess, I have no idea what the answer to those two questions is. I am trying, as many of the posts on this blog might suggest, but truthfully I feel pretty clueless. I am in awe of those friends and colleagues who spend quality time with their family, set age group records in triathlons, take a ton of in-house call, get a decent amount of federal funding, and then take on a hobby or two. They knit, they golf, they collect stamps. I have honed no such skills or interests (unless you can count shopping as skill but my husband calls it a bad habit for which I need an intervention).

A few years ago at a job interview I was asked what my hobbies were. I had prepared and prepared to be drilled on why I wanted an academic career as a trauma surgeon and how I was going to achieve my academic goals in a modern medical environment. I was ready to talk about my growing family. (Nothing like asking for extra time between back to back to back interviews with senior male surgeons so that you can, ummm, pump breast milk.) But I was literally catatonic when it came describing my hobbies. It didn’t help that the person interviewing me was a nanogenarian who avidly road his bike for miles daily and was an antiquities collector. “Ummmm, I guess my kids are my hobby,” I said without the least bit of conviction.

Don’t get me wrong, I love, love, love my kids. The decision to have them was not one we made lightly. I absolutely wanted to be a mother and luckily my husband wanted to be a father. Happily, we were able to discuss and modify our professional priorities to make the life part work for our family, especially when the kids were really young. While it has very hard over the years for me to find time to really *be* with my children (e.g. to not just be near them whilst half asleep, or worse yet fully dead to the world recovering from a brutal call, but to really engage with them), is “being” with them really a hobby?

A quick internet search reveals that:

A HOBBY is a pursuit outside one’s regular occupation engaged in especially for relaxation; an activity or interest pursued for pleasure and not as a main occupation.

But honestly, though being with my children is my number one priority when not occupied by my occupation, some days being with my children is the furthest thing from relaxing. Bedtime routines, presence of green vegetables, absence of digital screen-based stimuli, etc. can often be infuriating. As a family we have kayaked in the ocean, gone to Broadway musicals, and engaged in arts & crafts. But none of these activities would qualify me as a kayaking, show tunes, or crafting enthusiast. Would I do more of these if I could? Quite frankly I am not sure. These and other family activities have definitely been a lot of fun and provided great respite from the work part of work-life balance; however, none have really sparked a passion in me. For me the these activities are not for the pleasure of the activity itself but for the joy of being together. (Of note, I have tried being to together on shopping trips as a strategy but it brings no one but me joy and eventually the vociferous protests of the children sap that too.)

So, between the challenges of balancing a demanding work schedule with the unpleasurable tasks of parenting and squeezing in those moments of togetherness that do bring pleasure, I am at a loss for hobbies. (I wish I were at that point in my life with exercise and fitness were a hobby but quite frankly they remain a chore; I am working on that but that is a topic for another blog post.)

So for now, I suppose I will settle for a reasonably well-balanced hobbyless life. When I perfect that, I will move on to cultivating some hobbies.

A decade of mommy guilt

My first born turned a decade old the other day. Surely hitting double digits was a huge milestone for her. For me it was a time of reflection on how fast the time has gone by and how much of her childhood I missed in the last 10 years. I want to close my eyes and turn on the reel of memories I have stored away of the day she rolled over for the first time, her first steps, losing her first tooth….. The list goes on and on.

Truth is, I was gone for most of those other milestones in her young life. It wasn’t just the firsts either. There are countless pediatrician visits, parent teacher conferences, sporting/dance events, etc. that I just could not make. Though I know better than to feel guilty anymore about the extra stuff that I might have taken on as a mom like being a coach or a troop leader or a school volunteer, what I wouldn’t give to have been able to console her when she got her shots or to be the one she ran to when she had a nightmare (I am sure she figured “Why bother, Mommy’s side of the bed is empty most nights.”)

While for much of the time I was, as this now wise young lady believes, “taking care of people,” there were plenty of times when I was simply busy doing the other part of my work where people’s lives were not in my hands (e.g. research, education, volunteer efforts for professional societies). While the trickle down effect of each of these efforts will certainly someday improve the care people receive, the guilt of being away from my child–the most amazing thing I have ever accomplished (albeit with some help from my remarkable life partner)–has been heartbreaking at times. Healing the heartbreak has been daunting. I am talking about healing me let alone the lingering effects my absence may have on her. (Luckily she has a great dad and amazing grand parents to counteract my absences.)

TIps for Healing Mommy Guilt found at http://dailymom.com/nurture/beating-back-mommy-guilt/

Tips for Healing Mommy Guilt

I have done more and more, in particular after finally getting my first grown up job in her 7th year of life, to assuage that guilt–to be there as much as I can.  When she was in preschool, everyone assumed that my husband was a single parent. I was that out of the picture. Entering into the picture has meant asking my parents to sacrifice daily contact with their grandkids so that I can have a more favorable commute that theoretically frees up times for the kids (alas most activities, events, and meetings still tend to occur between 6am and 6pm and I remain the forever absent mom). It has meant asking my husband to do every more to sustain our household so that I can get in some mommy time (i.e. he will do the dishes, bang out a few loads of laundry so I can maybe, just maybe be awake enough to read a chapter or two to my child). It has meant allowing myself to fall behind on the things where a life is not on the line or where someone else is not holding me to an expectation (I can’t ignore my billing or my employer gets on me, I can’t not proofread a paper that I told someone I would review for them, I can’t put off a grant that has a prescribed federal deadline but I sure can put off my own internal deadlines). In the end, an extra night or weekend of work will sort everything out. I am hardwired to get the job done, so I will. But every long day, every night, and every weekend of getting it done will come at a cost, another empty reel in the memory bank of my daughter’s childhood and, unless I pay re-calibrate the push and pull between work and family, I will find myself at her 20th birthday still ridden with guilt.

I attended a faculty seminar on work-life balance a couple of years ago. Everyone entered that room with a ton of baggage related to their inability to balance work and life with work seemingly winning every time. The upshot of the seminar was essentially: lose the guilt (if you are at work don’t feel guilty about not being at home and if you are at home don’t feel guilty about not being at work). While I have tried especially hard since then (not that I needed to be told but it was a good reminder at a time when I was really, really buried in my work life) to sneak in quality time with my daughter (and her baby brother but I will get all sappy about him when his birthday rolls around) the problem is that it has felt just like that–sneaking around. When spending time with your child feels like sneaking around, the Mommy Guilt has gotten out of hand.

The decade of Mommy Guilt I have built up won’t dissipate easily and surely my profession can move the dial a bit (both surgery and academics) so both men and women don’t have to “sneak around” so much when they choose life over work. But in the end, rather than letting the Mommy Guilt mount in the years to come, I am resolving to feel Mommy Pride for each of the moments that do make it onto the memory reel in my daughter’s teens. Guilt won’t make the reel amazingly devoid of gaps so why bother. I am better off feeling pride in the moments of parenting I am super savvy enough fit in given the nearly (but not completely) all-consuming career I have chosen (and do deeply enjoy).

So yeah, I am pretty proud that I proactively requested a day off over a year in advance so that I could be at my daughter’s birthday party, and that I might have put off writing a manuscript late one night to brainstorm venues and a guest list with her.  I ended up delegating the evites, the cupcakes, booking the actual venue to my husband (I could blog pages and pages about how amazing this guy is about getting it done at home while I work and work some more) but I wasn’t entirely absent and that is an accomplishment worthy of pride rather than guilt.