Work-Life Balance

Why do some people always seem to have time for vacation, camping trips, and concerts while others always seem to be working? How do some people function on what seems to be no sleep? What exactly is work-life balance? Is being a workaholic a problem or just one way of giving life meaning?

Some Case Studies

Hospitals

Health care is full of people who work almost around the clock—nights, weekends, and holidays are fair game. But, for example, the shift work of nursing can allow for many days off every 2 weeks. Plenty of nurses I know take advantage of 36-hour, full-time work weeks (broken into 3, 12-hour shifts). A sample biweekly work week is 3 days working, 1 day sleeping, 3 days working and 7 days off. Despite the exhaustingly long shifts, these nurses enjoy 4 more days off every 2 weeks than a person who works a job Monday through Friday.

My American Family

In my immediate family, there are many models of work. Several of my family members are self-employed. They may work every day but they might also take long stretches off. Some days are long; some days are short. My sister is a trainer and fitness queen. While she often works fewer than 40 hours per week, her hours are spread out across every day of the week and at different times of day such that taking even one day off requires scheduling magic. There’s my step-mom who has the stereotypical workaholic, business schedule which is based on an 8-hour slot Monday through Friday. Of course, a few hours are tacked onto each day and she works additional hours over the weekend. In the end, she works something like 80 hours a week even though she’s on paper for 40—and, stepping away for any stretch of time seems impossible.

Paraguay

In Paraguay, holidays are sacred, summers are lazy, and commutes are so long they seem unreal. Except for the man I knew in the Navy and some small business owners, no Paraguayan I met while living there worked during a national holiday. Perhaps that’s different in Asunción (the capital) and in major hospitals (of which there are few) but generally Paraguayans don’t work holidays. Additionally, few people work on Sundays. Almost nobody works past midnight. While many Paraguayans have long commutes to work and work long hours, the number of days off they have in a year dwarfs the number of days off many Americans choose to take.

Paraguay vs US

In Paraguay, family comes first for most people. Most people work to support their family and buy nice things. Most Paraguayans prioritize time off visiting, eating, celebrating, and watching soccer over working endless hours. Most Americans prioritize working. Many Americans bank hundreds of vacation hours that they cash out or lose entirely. Of course, these are stereotypes…but, during my experience living in both countries, the stereotypes of family-first for Paraguay and work-first for the US seemed justified. I’ve often asked myself, “Who has it right?”

The Perfect Balance

The balance between work and other activities isn’t static. The perfect balance, the one that yields the greatest happiness, is unique for each human. Neither the Paraguayan approach nor the American life approach is better, they are just different. Paraguay taught me the importance of downtime while the US emphasizes overtime and constant production. Regardless of who you are, there are times when work should come first and times when family, vacation, rest, or anything else must come first.

Winning the balance comes down to being willing to reflect on your life and to make changes. For example, when one of my friends frequently complains about working too much or is always exhausted, I often ask if it’s time to scale-back or change their work schedule, job, or approach to working. When another friend often talks about being bored at work or not making enough money, my thought is that it’s time for them to invest more effort in professional growth. Is it easy to change things up and move toward something different? No.

It’s hard to reflect on your life and make meaningful changes. What I do to face the challenge is break my life into chapters and then identify what made me happiest and saddest during each chapter. I use what I identified to inform my guesses about what I need to do today to tip the scale more towards happy going forward. I tend to be work-centered (mostly because I love learning and feeling productive). As a result, the life side of my balance always requires more attention and energy than the work side. Knowing this, I put extra effort into “life” to keep my scale level. My scale often dips one way or the other, but I try not to let the off-kilter stretches jar me. Rather, I make small adjustments until I waver around a mix of experience that feels right for the time.

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Sirens

Life boils down to tidbits like sounds. These days as I walk the sidewalk—scuttling, rambling, or strutting from one place to another—I listen to the sirens. Since running (EMT talk for “working”) on an ambulance, I accidentally developed the ability to distinguish fire truck, police car, and ambulance sirens. Since studying the Doppler effect, I can tell if the sirens are approaching or withdrawing. And since learning to drive an ambulance, I know that a change in siren tune or the blast of an air-horn indicate that the vehicle is at an intersection.

I never cared much for automobiles. I still don’t. I’m not particularly proud or impressed by my siren radar. Nor am I gleeful about that fact that I always notice ambulances, no matter where I am. Before joining a rescue squad, I hardly ever processed sirens or saw ambulances because I lived in a city where there are so many of both they become part of the background. But, since moving to the countryside again and joining the world of emergency medicine, my consciousness has changed. I find myself almost subconsciously tracking the progression of sirens around my large Vermont town. A cop car went first—drugs or a car accident maybe? Just an ambulance—maybe the firetruck is out already and it’s just a medical call? Firetruck and ambulance—maybe cardiac arrest?

I started noticing that I listen to sirens because I was thrown into a different world of sounds: the soundtrack of the emergency department. The emergency department is noisy. There are the heart monitors that beep along with patients’ heart rates and alarm whenever the heart rate or oxygen levels deviate from a norm. There’s the clicking of blood pressure cuffs inflating. There’s the sound of wheels scraping as wheelchairs and beds and carts with supplies skid across the linoleum floor. There’s the clacking of those typing about what medications they gave and assessments they did. There is the thud of quick footsteps and the shuffle of walkers. Patients groan and puke and roll in their beds. And that is only the beginning.

I think all the noise is why, after a long week of work, I seek a few hours where people are scarce. It’s hard to think when there is so much to grab your attention. In the bustle of life, we can forget what the wind and the waves and the trees and the birds sound like. But more than anything else, we forget the sound of silence. I’m not talking about the strained, artificial silence of a library during finals week. When I say “silence,” I mean those moments when no one else is there to drop a pin. I’m talking about the silence that can’t be found in a city and is endangered by our social lives. If nothing else, I think true silence helps us ground ourselves and gauge when life’s racket is distracting us.

When I stroll about my town, I always hear the sirens. When I visit the woods where I grew up, I erase the ringing of so many sounds and soak in the quiet of the trees. I’m grateful that I can experience both.

Mansplaining Women’s Empowerment

I went to a training on managing aggressive patient behavior, mostly via verbal de-escalation. The class included a section on basic physical defense—such as getting out of a chokehold and escaping when someone grabs your arm. The skills were useful, but I found myself more frustrated than fulfilled by the class. What ruined the class was that one of the instructors preached for 20 minutes about how the young women in the class should feel empowered by the self-defense skills he just taught us. He told us some stories about women who were raped and killed because “they didn’t put up a fight.” He explained how we should be careful, avoid bad situations, and if attacked fight back.

Mansplaining: definition from the wiki article, “(of a man) to comment on or explain something to a woman in a condescending, overconfident, and often inaccurate or oversimplified manner.”

I was insulted by the lecture because as a woman I’ve been told countless times to be careful. When I told my family I was joining a night crew on an ambulance squad, almost before I was congratulated on finally starting as an EMT, I was asked if it would be safe for me to sleep at the station with my male crew members. Throughout my Peace Corps training, we had sessions on gender relations and how to avoid getting raped in our host country. In college, our advisers used to give us party-going strategies to avoid getting drugged. The list goes on.

It is NOT empowering to be told that you’re a victim and will always be a target. It is NOT empowering when people create boundaries (perceived or real) for you. It is empowering when others complement you on your success, offer intelligent advice as you work through challenges, and lend their support as you strive to reach lofty goals. Let me offer an example of what disempowering and empowering look like:

Disempowering: In a recent conversation with a male nurse, both the fact that I’m applying to medical school and my age (I’m almost 30) came up. The nurse didn’t comment on my age until I mentioned I’d applied to medical school. Upon hearing about my professional ambition, he “jokingly” asked why I wasn’t married and pregnant at my age. That is such a classic example of sexism it could be in a textbook. He never would have asked any man that question, even in jest, about applying to medical school.

Empowering: Upon telling one of my mentors about a test score I wished was higher, he said that he was sure I’d be just fine and turned to the other person with us to explain that “good” by my standards was quite different than “good” by most standards because I have high expectations.

Being an adventurous, single woman does clash with society’s view of women. How can I travel to foreign countries alone? It’s so dangerous. How can I go hiking or camping alone? It’s so dangerous. I’m not going to argue that those activities are safe. What I wish to suggest is that I have the intelligence to decide for myself what is safe and not safe, worth the risk and not worth it, and how to avoid unnecessary danger. I don’t need people to remind me how awful the world is. I need people to help me figure out how to overcome the challenges between me and reaching my goals.

What I wish that the instructor of the class about managing aggressive behavior knew is how many creepy men I’ve avoided in my life already, long before his class. I wish he understood that I don’t need him to tell me I should be careful and fight back. It is not empowering to be viewed as a potential victim of aggression, especially sexual aggression, even if you know how to fight back. It is empowering to be seen as a peer and fellow human with dreams, strengths, and weaknesses that transcend sex and gender. That is what women’s empowerment is all about; being viewed as an intelligent being and not an object or target or static lump.

On Not Becoming Jaded

One night a coworker in the emergency department, who also aspires to be a doctor, asked me if I was worried about becoming jaded as I worked in health care. I answered confidently that I wasn’t worried about becoming jaded, my hope for humanity waning, or burning out like so many medical professionals do. He was skeptical, but I am certain of only that one aspect of my future.

Defining Jaded

Especially late at night when most patients are tired and grumpy, the drunks roll in after exhausting the bars, and the patients held for mental health evaluations decide to spend the early morning hours holding yelling matches that involve nonsensical accusations against staff, it’s easy to see how one can grow tired of working in a hospital (and specifically the emergency department). In medicine, we take care of everyone, even if they’re jerks to us, because the fundamental principle of health care is that we serve all people.

Not so long ago I was greeting patients in the waiting room at the emergency department. We had around 20 folks waiting for rooms, the rooms weren’t changing over, and the wait times for many were over 2 hours. That’s a recipe for an unpleasant experience as a greeter, and the recipe was rich that night. I had a parent repeatedly insult the staff, including me, and ask why we hadn’t brought her child to a room yet. That was annoying, but manageable. What got to me was when she stormed up and demanded to know why we brought back “a drug addict” (her words, not mine) before her child. Her argument was that her child had a bright future while that person was a lost cause. Of course, I couldn’t tell the hysterical mother just how awful it is to watch a person go through withdrawal shakes and then seizure. That’s something you can only understand once you see it. I couldn’t tell her about the alcoholic who came to us one night shaking so badly he couldn’t drink water from a cup. I couldn’t tell her how he had looked me in the eye and told me he wasn’t human anymore. That mother was choosing to believe him, but I knew that that patient was human even if he didn’t feel like he was. That angry mother in the waiting room clearly had never seen a person beat an addiction—winning the daily fight to not give in to a drug or alcohol for years. I have.

It’s not the job of medical professionals to pass moral judgment. Sometimes we are weak and tired, and we do judge our patients’ life choices. But if we were to slip into a world where we used our personal morals to decide who should receive care, we would betray the heart of medicine. Medicine was never meant for only a select few.

In my view jaded is another way to describe losing empathy. There are many presentations—impatience, anger, and hating work to name a few. These feelings come when we are too tired and too worn out to see patients as humans. They come when we no longer find joy in the small things about the job that are awesome. And jaded becomes the norm when we give too much. It’s easy to work hours no one else would dream of working when you’re in health care. Each hour is rewarding because we help someone feel better, but the hours take a toll on the giver.

Considering all the above, how am I so certain I won’t become jaded?

  1. My empathy comes from selfish sources, so I don’t expect that it will fizzle. The first source is curiosity and the second is a love for stories and puzzles. Each human has a story. Each sick person is a puzzle. The curious mind can’t help but wonder about the story plot and the answer to the puzzle. These two factors are some of the main reasons I veered down the medical path in the first place.
  2. I know that I’m brave enough to step away and recharge as well as to shake things up when caring for patients under specific conditions becomes wearisome.

How do I know I am brave enough? Paraguay. While living in the land of Guarani, I cultivated an ability for self-reflection and the bravery to face fears because they were required to survive the Peace Corps. Paraguayans also showed me the value of letting yourself be still. In America, we are so determined to be productive we schedule every moment. I think running around all the times makes everyone miserable no matter what their profession. I also think those who become jaded forget to reflect and change. They fail to see that their job is draining them until it’s too late and, then, they lack the courage to change their work so it’s fresh again. It comes down to the best professional advice I was ever given. When I asked a presenter in one of my undergraduate classes how she knew when it was time to leave a job (she had an awe-inspiring, lengthy job history) she said, “You’ll know. You know when it’s time to leave.”

She was right. We do know when it’s time to mix things up. The hard part is taking the steps to act upon what we know. But, if we do take those steps, then jadedness can never catch us. The moment she gave me that advice, years ago now, I promised myself I’d be strong enough to change my course whenever I “knew” it was time. That strength sent me to Paraguay and brought me back to Vermont. So, no, I’m not worried about becoming jaded. I’m just excited to see where my adventures in medicine bring me.

Human Side of Medicine

Not so long ago I worked a code (cardiac arrest = patient’s heart stops and they neither have a pulse nor are breathing) in the field. The patient was middle-aged and had a complex medical history. The patient’s father, visiting from out-of-town, found him unresponsive, started compressions, and called 911. We did all we could—did compressions, ventilated, pushed epinephrine and other medications, and analyzed for a shockable rhythm. As we worked the father knelt at his son’s head. The patient’s fiancée sat outside the house. As it became clear that we were not getting our patient back, my crew chief reviewed, outload, all we had done. She asked us if we could think of any other interventions we hadn’t yet done and then she engaged the father, explaining why we were going to stop resuscitation. Once we had stopped she went outside to talk to the fiancée.

As heartbroken as the patient’s family was, they were calm when we stopped CPR. They had seen us sweat over their loved one, try everything we could, and ask for suggestions. We included them in our decision to stop our efforts. We lingered after our care was done to answer questions and offer condolences. This call showed me how it is within the pauses between action that we connect with our patients.

The human side of medicine comes through when we take time to ensure our patients understand what is happening and our plan for treatment. It comes when we include our patients and, when appropriate, their family in decisions about their care. And it’s completed by taking a moment to share their feelings, whether of relief after a successful procedure or sorrow after the loss of a loved one, before we scurry on to our next case.

Amid medical histories and assessments of signs and symptoms that lead to differential diagnoses it can be easy to let the presence of a disease or condition consume our attention. We can focus so intently on the disease that we forget humans bear the illness. But, below the clammy skin and wheezing is a person with a family and life experience just like you and me. And, what the patient will remember from their time during the flurry of a medical crisis is how someone treated them. It’s the offering of a kind word or an act of kindness on the worst day of someone’s life, not just the hope and likelihood that we have a cure, that defines good medicine. I try to remember to take advantage of the pauses by offering a blanket or bit of conversation to my patients. There aren’t always many pauses in my day, but when there are I don’t like letting them go to waste. It’s in the shared moments between points A and B that we build our humanity, but we must be attentive or we’ll miss the opportunity.