The other day our department chair gave us a lecture about time management. The first thing he said was “it’s only going to get busier.” Then he spent the rest of the hour giving us his tips for success, one of which was to get up at 5 or 5:30 am daily. (He is one of those fortunate people who can function quite well on 5 or 6 hours of sleep).
There is an often heard theme throughout the medical education process: I will have time for this when…. I have heard it hundreds of times in the past 9 years. I’ll clean my apartment after the test on Friday. I’ll start eating healthier after this anatomy block. I’ll start exercising after this rotation is over. I’ll spend more time with my spouse/family/loved one the next time I have a day off. I’ll start going to bed earlier after I study some more this week. I’ll start reading that novel I’ve wanted to read after I finish this research project.
All this putting off until tomorrow reminds me of the dean’s lecture on the first day of medical school. I can still see Dr Keenan up at the black board. He drew a picture of a large mountain range with a line of peaks from left to right that kept increasing in height. He pointed to a spot near the bottom and told us this was where we were starting. (Actually now that I recall, the starting point was already partly up the first slope, as we had all gotten through college/pre-med to get to this point). He told us were were going to have to make sacrifices, to put off short term gratification for the long term goal. He used the mountains as a metaphor for the long climb that was coming. The arduous years of medical school, followed by the even more tiring years of residency.
I recall there was a definite peak in this mountain range, and I now wonder if the peak was supposed to represent our graduation from residency, when we would enter the working world as a real physician, all on our own. And I have realized that the peak does not stop there. It continues to climb, as echoed by our department chair when he told us what it would be like to start building a practice as an attending, to keep up on continuing education, and for some of the younger residents in the room, to balance all that with having a family.
Now this realization can either fill a resident with dread, or it can, as it did for me, be a tremendous realization that becoming and being a doctor does not have a end point. There will be no time that I finally say “I have arrived. I am here.” It is a process. It is a way of life. My to do list may get things crossed off, but they are quickly replaced with new topics to study, new research to publish, new quality improvement projects to lead, and more patients to take care of.
I will never forget what a rural doctor told me once. It was during the hardest rotation I had in medical school, way out in rural Eastern Oregon. He told me that he worked more hours as a primary care doctor in a small town then he did during residency. He loved his job. He didn’t mind being approached in the grocery store by his patients. He was one of only three doctors in the entire town. He did primary care, emergency room care, minor surgeries, and he delivered babies. He was on call all the time. Not to mention the fact that he was married and had 4 children. He told me how disappointed he was when he heard students or residents complain about the number of hours they worked. Or when he heard them talk about their quality of life. He said something along the lines of “being a doctor is about service. Your time is not your own. It belongs to the people you are in service to. The ones you are privileged to take care of.”
At the time I thought he was being unreasonable. That he was an old school doc who didn’t understand the new wave of physicians who also need a life outside of medicine. Who need, and deserve, balance. I think I understand him better now. I understand the sacrifice students and residents must make in order to learn medicine. And I understand why my primary care doctor looked at me like I was crazy when I told her so many years ago that I was applying to medical school.
Now what I am attempting to do is embrace is my busyness. I am learning to love my to do list, as each item is an opportunity to learn something new, to grow as a physician and as a human being. And I have learned how to have small moments of balance in my life. Times when I am a friend having dinner (and not talking about medicine), a spouse having a laugh with my husband as we watch some TV, an ex-English lit major when I listen to a classic novel on my MP3 player, a plain old nerd when I do a cross-word puzzle, and a mother when I call my daughter to catch up and find out how she’s navigating the busyness of business college.
Yes it’s true. I will always be busy. I will always have a never ending to do list. It will never end. The next peak is just up ahead. And yet, for the most part, I still feel truly blessed to be able to put one step in front of the other, and to be able to touch other people’s lives in the process.