The rest of the story

Posted on August 28, 2017 by Amalia Cochran MD

Some of y’all have been helping me to celebrate a not-so-little piece of work that was published last week, and I truly appreciate the enthusiasm for the manuscript and what it means for our understanding of mentoring in academic surgery. When I posted that this work was a labor of love for me I meant it; I started looking into questions around mentoring in surgery when I was a resident through my ASE SERF project. At that time, what I really wanted to do was a qualitative project that would help us better understand what mentoring should look like. Alas, 16 year ago I had neither the resources, the time, the know-how, or the patience to do this. I’m still proud of the work we generated that year but it wasn’t what I really wanted as my major contribution in this area.

So, fast forward to 2014 (yeah, I know, that’s a long fast forward). I started on one of my curiosity/ passion projects, intending to expand upon work we’ve done describing barriers to careers in academic surgery. Again, the first pass was survey based and more quantitative, and just like the original mentors work I worried that something was getting lost in translation. I believe in the power of story, I had learned quite a bit about grounded theory method through our professionalism work, and I had a couple of VERY willing accomplices who are also patient when projects take a while. In this case, “a while” means 3 1/2 years from Interview #1 to online publication of the first manuscript from the project.

The interviews that I started in January, 2014, and that extended over the course of the next 16 months were intended to illuminate the barriers to careers in academic surgery. I believe they’ve done that, and the barriers manuscript associated with it is in the works. However, I realized about 6 interviews in that I was going to have the stories to write the mentoring paper that I wanted to write in 2001-2002; mentoring was raised as a critical factor in every single interview about career barriers, and this happened without any nudge from the interviewer. Of course, once the interviews were done my collaborators and I spent a few months working out our conceptual model, and once that was done there was manuscript submission, revisions, more revisions followed by rejection, selection of a new journal, resubmission, revisions, then acceptance.

Submitting this manuscript was arguably one of the hardest things I have done; in truth it was harder emotionally than submitting my professional paper in graduate school was, primarily because of the level of personal investment I have in this topic. Mentorship is something I am passionate about, it’s something I think is incredibly important (thanks to the interviewees who confirmed my bias!), and I love the work that Leigh and Will and I generated about it. When you send a manuscript like this one out you want everyone to love it as much as you do, even though you know that’s probably not what will actually happen. That rejection HURT, particularly because of how long it took to get there after trying really hard. Perhaps it reminded me a bit too much of my last bad boyfriend.

Anyway, back to the relevant story. As part of the mentoring process I wanted to share with people (particularly junior faculty!) the time line behind all of this. I know that the tenure clock doesn’t encourage projects of this nature, and I recognize that’s one of the shortcomings of our academic system as it currently exists. My take home message would be if there is something that you MUST figure out, if there are questions that you MUST ask, don’t let go of them. It might take you 15-ish years, a fair amount of heartburn, incredibly patient friends/ collaborators, and some late nights puzzling over getting something that seems really minor “just right.”

It will be worth it.

Taking care of you, because no one else will

Posted on July 21, 2017 by Amalia Cochran MD

The concept of “self-care” is definitely a cornerstone of wellness discussions. It also appears to have become something of a generational battleground. Staying at work for a week and eating poorly and not seeing the light of day is no longer considered the badge of honor it might have been. Nevertheless, we all have these pesky adult and professional commitments that preclude us from focusing on ourselves all day, every day. Surely there’s a happy medium in there somewhere?

A lesson I learned about 10 years ago is that I need to have a list of the things away from work that bring me joy, and that it also helps me to recognize how often I need for them to be part of my life. Examples?

Walks with Olivia– daily, at a minimum. This is important head clearing time for me.
Running– the benefits for me are myriad. It keeps my head on straight, it gives me time to think, and I just feel better for completing a good run.
Yoga– I know that going to a weekly group practice is best, and it makes a difference when I keep this in my schedule
Live music– A couple of times a month. The rules match my OR music rules: No rap, no metal, no Britney Spears. I love Americana and “alt-country” (again, as many of you know) and also have a great fondness for outings to the symphony and the opera.
Reading, particularly literary fiction- I still remember getting halfway through my intern year and realizing that I hadn’t read a novel all year (and that I really missed it). The moment our in-training exam was done in January, I dug back into good novels and haven’t stopped since.

I put my own list out there not with the goal of making it your list, although I’m always happy to share ideas in any of these areas. I put it out there so that you can see that none of these are majorly time-consuming unless I choose to make them a Big Deal in my schedule. In fact, it’s pretty easy with some practice to prioritize all of them in a way that I get to push the reset button for an hour or two AND still manage my grown-up responsibilities. And even though I fight it sometimes, I know that these things really do contribute to helping me be my most effective self.

So, what about making sure we’re our most effective on a day-to-day basis, even in the midst of a chaotic day? I loved this piece in last month’s HBR, probably because all of the ideas they raise are things that I’ve espoused or embraced in one place or another.

Cut yourself a break: I’ve previously summarized this blog post from Karen Walrond as “Try your best, cut yourself some slack at the end of the day, rinse, repeat.” Why is it so much easier to be kind to those around us than we are to ourselves?
Value time, money, and resources: No is a complete sentence if something doesn’t align with what you want or need to get done. Truly. Practice it often.
Take a victory lap: How often do we celebrate our “wins”, either individually or collectively? This week I started something new to me on Twitter with #Wednesdaywins. If you’re on Twitter, I hope you’ll join in there. If you’re not, I hope you’ll develop your own practice.
Surround yourself with good people: Maybe it’s a product of being in my 40s, but I simply no longer choose to have time for people who drain my energy (see “value time, money, resources” above). I definitely view friendships as a mutually supportive enterprise, and have chosen to surround myself with spectacular people whom I LOVE having as part of my life. Some of you have heard me say, “Find your tribe. Love them hard.” It’s key when things get challenging.
Update your workspace: Okay, I really don’t have much to add here. I am better than I used to be controlling my desk piles. Mostly.
Recharge and reboot: Those walks with Olivia? That’s part of it when I get out of the hospital. At work, sometimes I’ll just go for a walk between the Burn Unit and my “real” office. I’ll pause and fix myself a cup of tea. I’ll walk through our therapy gym so I have an excuse to stop and visit with one of our rehabbing patients. Or I’ll sit down and simply chat with someone I find interesting; this person can be a co-worker, a patient, or a family member. Sometimes just getting your head out of what it’s stuck in can make a HUGE difference. If you want to be Zen about it, it helps you detach from whatever is troubling you.

So, what can you do this weekend to be more effective for next week? It doesn’t have to be onerous, and ideally it will be fun. Most importantly, I hope it brings you some joy.

You can have it all, just not at the same time

Posted on July 16, 2017 by Amalia Cochran MD

“The price of anything is the amount of life you exchange for it.” -Thoreau

Common refrain from faculty (that may be a symptom of Impostor Syndrome): “I just can’t do everything.”

My response: “Yes, you’re correct. You can’t. None of us can.”

We have essentially two key limitations in the battle to do everything, as I see it. First, our day has 24 hours in it. We can fight that one all we want and pretend it’s not true, but that’s the day we’ve got. Then there’s the second limitation of energy. We’re not set up like the Energizer Bunny to simply go…go…go…quick battery change…go…go…go. I’m sure almost all of us can think of the last time we tried that (all nighters in college, anyone?) and the net effect is never what we hope it will be.

As mentioned in the July Reading Round-Up, I’m working my way through Eric Barker’s Barking up the wrong tree right now. Chapter 3 has a great section talking about someone brilliant who has a chronic illness that can be incapacitating. This individual adopted a strategy for many years of accomplishing one thing a day, even on the bad days. Sometimes that meant that he was only able to cook dinner if that was the day’s goal; the key was to choose that one thing and do it.

Here’s what he had to learn that we all try to superhero our way out of at some point in our career: every single choice that we make to do something means we are choosing to not do something else. When we spend hours on Facebook, we’re choosing (perhaps only subconsciously) to not work on that research project that needs our attention. When we spend time working on that research project, it comes at the time expense of watching Game of Thrones. When we spend time with our family, it comes at the expense of finishing the day’s charts. If you have a background in economics, you’ll recognize this immediately as every choice we make in life having an opportunity cost.

If you have a young family or an aging parent, focusing on them may be your first choice for a few years and it may require you to choose to let something slide from a scholarly or administrative perspective. If you’re building a career as a researcher, you already know that forces choices about what you can and should do from a clinical perspective. If you’re trying to stay mentally and physically healthy, you might choose to save that manuscript where it is right now and leave for yoga or go out for a run (note: I often find that by doing this I end up being more productive, perhaps because it gets my brain into a different space).

Again, every time we choose to do something, we are choosing to not do something else. That alone means that we can’t do everything.

Here’s a thought experiment for you, cribbed directly from Chapter 3. What would you do if you were ill and could complete only one task per day?

There’s your answer to what matters most to you, and what should be done first.

And when you thought, “It would NOT be clean my house!”, that’s probably a hint to you too.

Here’s to a week of making wise choices, one at a time, that allow us to do those things that matter most. What is your big goal this week?

(Title credit to Leigh Neumayer, content idea credit to Jamie Lewis)

Keep it simple

Posted on October 14, 2016 by Amalia Cochran MD

Opening confession: I’m writing this as much for me as I am for you, readers. I had intentions of writing about resilience today because it’s been a recurring theme for a bit. Instead, you’ll have to read about it next week.

This morning as I was listening to the weekly dharma message from Susan Piver, her focus was on simplicity in our meditation. As I listened to her incredibly simple (and brief) message, I realized that as I go into a week that is always characterized by absolute pandemonium, simplicity is exactly what I need to focus on right now. If I’m 100% honest, simplicity has probably been a sub-theme for the last couple of weeks for me. I’ve noticed that I have unintentionally been laser-focused on getting some tasks (which may or may not have been procrastinated upon!) finished; many of them are tasks that involved things cluttering my house and my creative space. It felt really good to get those things done and get the associated “stuff” out of my way.

So, simplicity. It seems like an oxymoron if you look at my schedule this week, particularly for the next 2-3 days. I’ve got multiple times that I’m supposed to be multiple places. Yes, I know that I haven’t been cloned (yet), which means I’m going to have to make thoughtful choices and then embrace them. Those choices will absolutely be based upon what is most meaningful to me, and if you’re with me this week you may see me making some tardy entries and early exits. I emphasize the issue about things being meaningful “to me” because that also means that I have time blocked into my schedule to run and for some yoga…because those things are meaningful to me (and, quite candidly, no one wants to be around me if they don’t happen).

I can’t fix the fact that I have chosen these things that will make me intensely busy the next few days, but I can choose how to best manage that busyness. I can be present in the moment (another choice), I can turn off for a few minutes every day (even 5 minutes helps, right?), and I can be grateful (this morning while walking Olivia I reminded myself, “You CHOSE this. And how fortunate you are to have been able to do so.”).

Who’s with me? Let’s be simple together.

“The key to finding a happy balance in modern life is simplicity.”- Tibetan Book of Living and Dying

Mind the (author credit) gap?

Posted on May 10, 2016 by Amalia Cochran MD

HT to my Dad, who is a more reliable NPR listener than I am (it’s an advantage of retirement, I’m told). Yesterday he shared a short segment from All Things Considered that discusses the gap in women as first and senior authors in medical publishing.

I have two key concerns looking at the article they discuss and after digging a bit more deeply into the literature in this area. One is the evidence of a plateau in women as first or senior authors in the last 7 years. Is this because we’ve hit a glass ceiling in science? Is it because we’re not trying? Is it because of implicit bias? Or is it some combination of the three? Those concept are all subtle enough that it’s almost impossible to determine the role that each plays without employing qualitative methods. Of course, the beauty of qualitative methods is that more reasons we aren’t even thinking of might be playing a role and this would help to identify them.

My second concern is the one alluded to in the conversation with the female cardiologist in the NPR piece. We know from many areas of the business and academic literature that as women we tend to advocate poorly for ourselves; most of us culturally can’t get comfortable with the probability of being viewed as pushy, which is a documented consequence of aggressive negotiation tactics. Is our absence as first or senior authors a result of us failing to negotiate and advocate effectively for ourselves in yet another realm? Is this another manifestation of “Women don’t ask” in a way that is perhaps even more insidious than failing to negotiate salary?

And, of course, I can’t help but wonder if this isn’t generally representative of our global shortcomings in attracting and retaining women into careers in academic medicine. Until we have a system that provides the professional development opportunities, the hard resources, and the work-life integration capabilities that are expected in the modern world, there may be little additional room for change.

The aftermath

Posted on April 20, 2016 by Amalia Cochran MD

This week has been dedicated to recovery/ clean up after being out of the office for a week, as well as “catching up” on my call load. I can’t say that any of those things are enviable but they’re part of the package if I’m going to stay engaged with the broader surgical world.

When I have these long trips (this one included three separate meetings), I’m reminded of the great parts of what I get to do. I mean, I get to spend time with amazing colleagues like these:

ACS Leadership and Advocacy Opening Reception

ACS Advocacy Reception at the Top of the Hay

Association for Surgical Education Twitterati on the loose!

Celebrating the always-fabulous Celeste's birthday in Boston — Celebrating the always-fabulous Celeste’s birthday in Boston

Did someone say chocolate fountain at the Presidential reception? I'm there! — Did someone say chocolate fountain at the Presidential reception? I’m there!

Shhh...don't tell anyone I was playing hooky and clearing my head... — Shhh…don’t tell anyone I was playing hooky and clearing my head…

I realized coming home that I would have to do a lot of “next manageable bites” because of three different deadlines I’m juggling these next two weeks, and that’s been largely successful. One of the deadlines is making me nutty, mostly because I don’t think I have all of the information I need to make it happen, but that’s something I’ll brainstorm the next few days.

And, of course, coming home is always great. I’m back in my “native” eating environment, I get pet therapy every time I walk into the house, and I’m able to process lots of things that happened during some spectacular meetings last week. Oh, and I got to go for a little run on Sunday and spend time with my running tribe.

We run because we get to- and it's a wonderful thing on a beautiful April day like this one! — We run because we get to- and it’s a wonderful thing on a beautiful April day like this one!

It’s a privilege to get to travel and be part of amazing things. It’s a joy to come home, even with a wackadoodle (and busy!) call schedule this week.

Zzzz….

Posted on March 14, 2016 by Amalia Cochran MD

I would start with a few comments about the Daylight Savings Time change that occurred yesterday, though I try to be civil here. Let it suffice to say that I don’t enjoy my dark early mornings that are the “new normal” for a few more weeks again. I always whine a bit about this Spring change, particularly because the bases for it are weak at best. And while I seldom rail about sleep disruption from my travels, the energy drain I tend to experience from the time change is huge. And, of course, that has the potential to really impact my work.

Last month the Harvard Business Review published a terrific summary reviewing the link between effective leadership and getting adequate sleep. I do think that sleep piece is without a question a big piece of it, though I also believe that fatigue in general affects our ability to engage in the four types of leadership behavior that the authors describe. There becomes a domino effect where fatigue directly results in disengagement, and disengagement is intimately related to burnout. While a great deal of the discussion about residents and duty hours has been focused on the impact of adequate rest and safety, the truth is that the impact of sleep deprivation throughout medicine is far more insidious than we’ve previously estimated.

When I was in my 30s I honestly wasn’t as protective of my sleep- perhaps because I spent the first half of the decade finishing my residency before workhour restrictions went into place. As I’ve become a bit wiser (and, in association with that, a bit older), I have learned to better prioritize my rest, though I’m still not as skilled as I would like to be. No matter how much I look at all of the professional advice- get off of your screens, turn the lights down, don’t eat late, don’t exercise late- some of those things simply can’t happen for me all of the time. When I’m not faced with clinical demands I certainly do my best, but it’s a very imperfect best. And while I have been largely successful in creating a 10 + 10 (meditation + free writing, 10 minutes each) morning ritual for myself prior to my morning walks with Olivia , I really wrestle with what my evening ritual could and should look like. I’ve generally stopped sending emails after 830 pm. I’m generally off-line an hour or more before I plan to go to bed. I generally read for 10-30 minutes before bed, depending upon what time it is when I sit down with my book and when the alarm will go off the next morning. Nothing in the evening has stuck for me as well as 10+ 10 + dog walk, however. I’m still working on this concept to figure out what works for me.

I’ll close by saying that I’m a realist. I take call 1 in 3 averaged over the year, and when I need to take care of patients sleep becomes secondary. It doesn’t mean I don’t take a power nap when I get the chance (I love power naps!) or make a conscious decision about managing my energy in other parts of my life (yes, I do skip runs if I haven’t slept well). I’ve made a conscious decision that it’s okay to stop working at some point in the evening, especially because I’ve embraced that my do-to list won’t go away completely anytime soon.

And with that, I should close. It’s after 830 MDT, after all.

Happy resting!

I really mean it this time

Posted on February 24, 2016 by Amalia Cochran MD

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It appears that almost three weeks ago I committed to getting back to posting on the blog.

I also appears that I have not been successful in posting for the last three weeks. I’ve come close many times and just haven’t successfully overcome the “backside in chair” phenomenon that is required to generate blog posts or manuscripts or anything along those lines.

I could make up some excuses, but they would be just that. And they would likely be silly. I’ve had a fair amount of the ever-important time to think, I haven’t been that overwhelmed with work, and I haven’t been thrown any curveballs that messed up my game.

Instead, I’ll simply come back to writing, sharing the two foci of that recent time to think.

#1 On the concept of “preventing too many activities” (Item #3 of the 7 Characteristics of the Dharmic Person): Maybe this is my “excuse” for the blogging break. I’ve been really conscious lately of saying no to things that really don’t align with my goals and priorities. I’ve also been spending time thinking about those things that don’t light me up like they used to and finding ways to effect change there. And, perhaps most importantly, I’ve been focused on not having too many things going on at a given time (and yes, that includes my tendency to multitask). This idea of being really intentional and staying out of overwhelm is one that just makes sense to me where I am right now. I do still care about the blog…I’ve just put other things higher on the list the last few weeks.

#2 On being grateful: I’ve spent the largest portion of my time lately considering how incredibly grateful I am. Part of this has been driven by travels in which I have consistently been surrounded by friends; from Baton Rouge to Austin to Bozeman in the last 5 weeks I have eaten very few meals alone, and I have been able to treasure time with amazing people who have become part of my life in a rich variety of ways. I’m fortunate to have the opportunities that I do to travel to beautiful places. I’m fortunate to be able to run and do yoga and play outdoors. I’m fortunate to have clinical and administrative jobs that excite me and constantly challenge me, and to work with people in those roles who “get it.” I have managed to revel in the little joys of friendship and adventure, and I’m grateful that I’m able to recognize how fortunate I am.

So, with that, I’m back. And I mean it this time.

Pushing the reset button

Posted on December 4, 2015 by Amalia Cochran MD

Today’s post is driven by a conversation with a respected colleague whom I spent time with this morning, when we became immersed in a conversation about how surgeons fail ourselves in terms of wellness. Although I pride myself on my ability to set limits, this week has been a whirlwind.

Let’s recap:

Sunday night- burn call, 1 pre-bedtime admission

Monday- orientation of a new group of medical students, meetings, annual trip to the veterinarian for my cats, during which I get the opportunity to observe my usually Zen boy cat have a complete and total meltdown (also an annual event)

Tuesday night- helped host the first-ever Association of Women Surgeons tweet chat, a new way for us to network that I hope will grow. Committee conference call just after.

Wednesday-resident interviews, quick clinic visit with a lovely patient, then off to the airport for an evening flight to Edmonton, AB

Thursday/ Friday-Visiting professor at U of Alberta

I’m writing this post somewhere in the skies of Canada or the northernmost parts of the US as I head home from that visit. Now, to give myself credit for things I did “right” from a wellness standpoint in the midst of this wild week, there were quite a few. I went a got a pedicure on Sunday since it wasn’t too close to next weekend’s half-marathon. I did core and weight work on Monday and Wednesday and ran on Tuesday and Thursday. And this weekend…tomorrow morning run with my fabulous running group, afternoon haircut (sorely needed!), evening at the Symphony. And Sunday…a facial in the morning and Restore yoga workshop in the afternoon. Did I mention restorative yoga? Because it’s really amazing and restorative.

Why am I rambling to you about the minutiae of my week and weekend (hey, I didn’t catalog my meals for you!)? Mostly to make a point that even in the midst of tremendous busy-ness I managed to hit the “reset” button a few times, and I plan to hit it repeatedly this weekend. I do these mini-resets regularly because I learned my lesson about not doing them, resulting in those times when you need to do a hard reboot. While hard reboots are still beneficial, the reality is that it’s better for us at an individual basis and for those who love us the most that we not achieve a need for one.

It’s Friday evening and there’s a weekend in front of all of us. While I recognize the demands of our profession mean that more than a few of us are working (I am on call Sunday night), I hope that I can encourage you to stop for just a moment…and push the reset button. Do something, even for 15 or 20 minutes, that is just for you and recharges you. Don’t do it because you “should.” Do it because you can.

Thanksgiving, 2015 edition

Posted on November 25, 2015 by Amalia Cochran MD

(Slightly edited and cross-posted from the November 2015 AWS Connections)

I started an active gratitude “practice” a few years ago in which every week I sit down and document at least one thing for which I am grateful. Granted, there are some weeks that gratitude is easier and more obvious than others, but that practice really does help keep me focused on the good things that are present in my life. I also find that it helps me turn challenges and frustrations on their head.

So, what am I grateful for in November 2015? Plenty of things.

I have a home that I love in a city that I love that I share with amazing rescue animals who I love.

Good coffee.
My Mom lives 1½ miles away from me and is always here when I need a hand or an ear…or a hot meal that I didn’t have to cook.
Yoga.

I have this tribe of people in my life who have huge hearts and huge vision and huge hopes for the future. Those kindred spirits are who pull us through the tough days, aren’t they?

Dark chocolate.
My professional life has reached this beautiful point where I am able to spend a great deal of time focusing on mentoring and giving people a hand up.

One of my mentors, and two of my mentees

Running (especially running with friends).

My personal life has reached this beautiful point where I am able to spend a great deal of time focusing on giving back, both financially and personally.

Winter retreat plans in Montana.

Because of my academic activities and my role as the AWS President and within the ACS this year, I have incredible opportunities to reach out regarding the continued relevance of diversity in surgery and healthcare.

Summer vacation plans in the wilderness in Alaska.

ANWR, 10 years ago. It's time to go back! — ANWR, 10 years ago. It’s time to go back!

Have I mentioned my Burn Unit Family/ team/ tribe? Because I can’t step back without mentioning these amazing people. We love BIG. We do hard things. We take care of the people. (And I don’t have a recent photo of us…so the one below is the best exhibit I can give. We apparently need to get a new family photo.)

Even if times are hard for you right now, it’s my deepest wish for you that you will be able to find something, no matter how small, as a source of gratitude today. And tomorrow. And each day following.

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