For those in a moment (Season? Era?) of “head down, do work, grit teeth, repeat” and unable to mark the passage of time, I have a gentle notification coming from a place of absolute love: the month of January is over.

I have been at DEFCON 2 for the past three days…

Thinking about artificial intelligence makes me feel old.

I have a toddler that lives in my brain.

I’m one of those people who picks a new word to guide their year.

Oh, the breathless possibilities of a new, blank planner.

Physicians are deeply accomplished people. If you’re already spiraling into thoughts of, “Yes, in principle, but I have a manuscript I need to submit, and notes I need to complete, and everybody I work with is way more accomplished than I am…” just put a pin in those thoughts for a second and stay with me. Compared to all humans alive on the planet right now, physicians, even those still in training, are deeply accomplished. We’ve accomplished as much as we have because of thought patterns that have moved us from step to step: from quiz to test, from semester to graduation, from gross anatomy lab to board exams, from the completion of training to our first faculty positions.

A few years into my first faculty position, I recognized taking a week off for vacation wasn’t enough time.  I’d spend the first couple of days getting used to being on vacation, two days enjoying myself, and then 2 or 3 days getting anxious about returning to work.  This spring, I looked at what all of my colleagues’ July schedules were doing and realized that I could take the entire month off without any of them having a horrible schedule to accommodate my absence.  The break came at a serendipitous time: I was ending the academic year with a lot of overtime shifts, so I had a long stretch of clinical time without a break.  I was tired and verging on burnout.  I was also admittedly using work as a distraction from grieving a death in my family.  A month-long blank calendar looked like a vast, open space of possibilities. 

My best friend from medical school is currently practicing on the West Coast. When I visited her for the first time, we started comparing notes about the (admittedly stereotypical) personalities of different parts of the country. I relayed that my time in Seattle had worked my Midwest “Smile at strangers when you lock eyes” out of my system because I’d found people in Seattle to be more reserved than those in the Midwest. Moving from Seattle to Nashville brought that tendency back to me, though, because folks in the South are so effusive that they ask strangers how their days are going and actually want to know. My friend said, “The people here are just nice,” but she said it with a tone that conveyed a bit of, I don’t know, distaste, maybe?

Quitting has a lousy reputation for physicians.  It makes sense; we became physicians by just not quitting.  We didn’t quit our educations after high school; we went on to college.  And then from college to medical school, residency, and sometimes to fellowship.  Sometimes we “not quit” our way into advanced degrees.  When my training got difficult, I learned to give myself the “I can do anything for (insert hours to weeks to months)” pep talk.  Practicing medicine requires a commitment to lifelong learning, so “not quitting” is woven into our profession.  Maybe it’s not so much that we don’t quit; it’s just that we never finish.     

“You need to set boundaries” is a common refrain to burned-out physicians. I heard it so much that it became a thought running through my mind whenever I opened my email inbox. Whenever I got a request to give a lecture, join a workgroup at my hospital, or put my name in for a professional organization’s subcommittee, “I need to set boundaries.” It even started to run through my mind whenever my text messages would ping (or, Heaven forbid, my cell phone rang when I was at home for the evening). Common parlance is that we have around 60,000 thoughts a day, most unconscious (otherwise, we would not be able to function). So if “I need to set boundaries” was a conscious thought that often, I have to wonder how often it was an unconscious thought, rolling around in the recesses of my brain, taking up energy and leading to feelings of helplessness that were boiling just below the surface.

“Altruism” is the “practice of…selfless concern for the well-being of others,” according to the New Oxford American Dictionary (via Google, of course). The site also notes that in zoology, altruism is a “behavior of an animal that benefits another at its own expense.” I don’t remember the day in medical school when I learned that my patient’s needs came before mine. But I remember gradually learning to moderate my liquid intake lest I need to use the restroom during rounds or in the OR. Ignoring my aching bladder merged into ignoring my grumbling stomach, and eventually, those two sensations just stopped happening. When I’d overeaten to a BMI of 35 because I couldn’t tell when I was hungry? Maybe that’s when I started to exemplify the zoologist’s more-aggressive idea of altruism.

Service weeks can feel difficult. We know patient care is the priority, but the in-hospital and out-of-hospital world doesn’t stop. This guide assumes your service week starts on Monday, but you can modify it however you need to for your service schedule. With that, here’s how to have your best service week yet!

July 1st can feel like New Year’s Day in academic medicine. As new learners take the place of the seasoned ones, it’s a natural time for us to take stock of what we’ve accomplished over the past year and think about what we’d like to do differently in the upcoming year. Yearly evaluations with division directors can serve as a jumping-off point toward achieving those goals.

Stay with me. I’m writing this as a human who witnesses suffering first, then a pediatric intensivist, and then a clinical ethicist. So, like this:

Human > Pediatric Intensivist > Clinical Ethicist

I’m writing this with the utmost respect for all the physicians, nurses, and ethicists who have researched this topic and are trying so hard to help us out of this burnout hole we find ourselves in.

My husband and I are re-binging the first two seasons in preparation for the new season of Ted Lasso being released. For the uninitiated, Roy Kent (played by Brett Goldstein) is an angry, foul-mouthed curmudgeon of a soccer player (ah, apologies, footballer) who (spoiler alert) turns out to have a massively huge heart.

How many times has this thought crossed your mind? I can start the day with the best of intentions and then get to the end of the day feeling that I haven’t accomplished a single thing (even when “the end of the day” comes an hour and a half after I’d intended the day to end).