It’s just life. And choices.

A couple of weeks ago, I noticed this inspirational post about extraordinary success.  I’ll be honest that I really love most of the wisdom in it, and I’m likely to work through various pieces of it over the next month or two, simply because much of the wisdom resonates with things I write about frequently in this blog.

May has been wild and crazy in terms of deadlines and commitments.  A couple of weeks of clinical service.  AHRQ grant proposal due.  Trying to get out of ATLS Instructor jail (I forgot to teach in 2014 and my instructor status was due to expire this month).  Ogden Half-Marathon. Manuscripts to finish before mentees leave town.  In other words, lots of the usual stuff shoved into the same 31-day time frame (though, remarkably, no airplane time).

As I was reading through Jeff Haden’s post, #3 hit me like a ton of bricks.  “You don’t think work/life balance.  You just think life.”

I’ve previously bemoaned the concept of work-life balance (I still can’t stand that idea), and have also emphasized the importance of “no” as a central part of the professional vocabulary (when you say yes, it’s honestly forcing you to say no to something else anyway).  While Haden writes about your work being who you are, for most of us in medicine that’s even more true- our career, our calling is a central part of our identity.  I’ll admit that while the first thing in social conversations is definitely not, “I’m a surgeon,” it definitely sets parameters for my life and how I life it.  Those parameters aren’t good, aren’t bad…they just are part of the whole picture.

Can my cats write my research strategy for a grant proposal?  Well, no.  But does taking time out for a run or dinner with a friend make me a better surgeon?  No question that it does.  I’m also learning that the to-do list will ALWAYS be here.  It’s not going away, and the project post-its on my Personal Kanban white board in my office seem to multiply faster than bunnies.  Watching the sunset while I go for a walk with my dog?  Yep, that can’t be replaced and won’t always be there.  And my mind might be just a bit clearer for editing that manuscript when I come back.

I’m not saying we don’t ever deserve time off from work; I’ve made a deliberate move to take a day a week off from the projects and my email, and it’s honestly been helpful for me.  What I am saying is that if you’re obsessively focused on work-life balance, it’s quite likely you’re looking for something that doesn’t truly exist.  It’s all just life.


Digital ones, that is.

Last month I was the co-moderator for a postgraduate course on technology during the annual American Burn Association conference; I previously shared my presentation on blogs and personal learning networks (and this week failed my own advice to post regularly).  We had some great presentations on a variety of aspects of using technology for professional networking and for patient care; questions on Day 1 were almost uniformly about social media and navigating the challenges of having a significant social media presence and maintaining a professional persona.

I know that many people, physicians in particular, shy away from having a significant digital presence because of concerns about interactions with patients and families.  There is also the issue of how professionalism is defined in the social media world- does “I know it when I see it” still hold?  And who gets to decide if something is “professional” or not?  I have been told by colleagues that their institutions essentially forbid them from having any online presence that can be connected to them.  And of course, people often hold on to what is a delusional hope of having separate personal and professional presence (hint:  in this day and age, good luck with that).

As far as patients and families go, everyone has to figure out what works for them.  I have some colleagues who have a “no, never” policy about being Facebook friends with patients and families.  My choice on that has been (1) I won’t send them a friend request, and (2) I will only accept friend requests once they are no longer in the acute phase of their care.  So far, this seems to have worked well, and I’m hopeful that since I am both clear and consistent that the effectiveness of this plan will continue.

In terms of professionalism, I suppose I’m honestly grateful for two things.  First, Facebook, Twitter, and Instagram weren’t a “thing” when I was in college- and that’s probably good.  Those Party Pics from mixers and date parties are quite enough in retrospect.  I’m not saying I was wild (I wasn’t), but our judgment at 20 and judgment at 40-something are quite different.  Second, I lead what amounts to a boring life, at least if you’re in search of something incriminating.  My current Facebook profile photo is me with Santa and Mrs. Claus at Mile 8 of a half-marathon last December.

Santa & Mrs. Claus, Mile 8.
Santa & Mrs. Claus, Mile 8.

If you dig, you can find this:

Michigan 3-day with our flamingo walker-stalker
Michigan 3-day with our flamingo walker-stalker

Scandalous, right?  And while I’m certain there are people out there who would argue these aren’t professional, I would argue that there is nothing questionable about either- and that if anything, they deliver the message that I don’t take my life or myself too seriously.

Quite honestly for me, there is the added angle of being an educator who is expected to be a role model for my students and residents…something I admit that I get right most of the time, and something that I can get wrong too (because I am human, after all).  However, I like to think that I am showing them in the public domain how to life an authentic and joy-filled life that’s not all about surgery all the time.

Because, you know, it’s not.

Happy weekend friends!  Think of me running 13.1 miles in the morning and send thoughts for no rain until after 930 am Mountain time and strong feet and legs.

Saying no, without excuses

One of the most important lessons we (hopefully) learn as we go through life is that our time and our energy are not infinite.  I admit I’m one of the guiltiest of behaving as if they are; cognitively, however,  I really do know better.  An important lesson that I learned in a very bumpy fashion a couple of years ago is that saying yes does mean saying no to something else.  I was asked by our Dean (you know, the BIG Dean) to take on a liaison role with an external organization.  I did think a little bit before I said yes, mostly because the role would provide a direct schedule conflict with another commitment that I enjoy.  Ultimately, I was blinded by being flattered to have been asked, said yes to the Dean’s request…and regretted every moment of that yes.  The regret wasn’t about the Dean at all.  The regret was instead about taking on a role that was ill-suited to my personal priorities and my career interests, and having sacrificed something I valued deeply to do so.  I resigned the liaison position within the year, which was received graciously, and recognize the whole chain of events as a lesson learned the hard way.  I won’t discuss how many days I labored over that resignation email…I think I’ve had some publications that have required less time.

While my trade-off was almost purely at the professional level in this particular instance, so many of our yes and no choices have a broader ripple effect, requiring us to sacrifice the personal for the professional or the self for the collective.  Culturally, we’re taught not to say no.  It’s a form of rejection, it makes us feel like we’re disappointing people, we have the dreaded fear of missing out if we say no.  And while saying no is against most of our nature, it’s particularly challenging for women, minorities, and those in more junior roles.

By not saying no (also known as “saying yes”), we’re giving up something- as in my story, or perhaps something more valuable at a core personal level.  If not-no doesn’t force us into a trade-off with our activities, we are pushing ourselves a bit closer to the brink of exhaustion because we are trading off sleep or yoga or a run.  Yes has costs.

I’m not advocating that we all run around saying, “No!” like a bunch of two-year-olds for the next week.  But your time and my time are valuable, and the choices we make should reflect our priorities, our values…what matters most to us.  If we say yes to everything, we’re not showing others that we believe our time is valuable and we’re not showing them who we really are.  The reality is that to function at the high level that we all tend to favor, we need to say no.  And when we say no, it should be said bravely, without any expectation.  The way I have heard it described is, “No is a complete sentence.”  If you don’t want to use it as a complete sentence, what about making a list of the ways to say no that work best for you?  Some starters:

  • “I can’t do that right now.  You might talk to (fill in the blank with someone’s name here who would be interested in the request and possibly able to fulfill it).”
  • “I really couldn’t give that the attention it deserves, and I don’t want to disappoint everyone involved.”
  • “I am having to narrow my responsibilities right now, and this won’t fit in.”
  • Or, alternatively, “No, and thank you for thinking of me.”

No.  It’s a brave word.  It’s also an important one.  Channel your inner two-year-old (who may have been more prescient than any of us realized) by saying no- and meaning it.