13,000 Days on the Hamster Wheel: Finding Meaning on the Way to Retirement

Adapted from a version in the 8/21/2020 issue of the Transformational Times

 

 

13,000 Days on the Hamster Wheel: Finding Meaning Before and After Retirement

 

 

Bruce H Campbell, MD, FACS 

 

In this essay first published in the Transformational Times in 2020, Dr. Campbell reflects on how the self-care trajectory on which we place our students and residents will carry them beyond their careers …

 

Medicine differs from many other professions. Once a physician joins a practice, it is possible to become a perpetual-motion machine, working day-after-day, seeing patients and generating revenue. As long as the physician directly or indirectly generates enough cash flow to pay salaries, keep the lights on, and move the enterprise forward, the process can continue unabated. Theoretically, this hamster-on-a-wheel activity can continue for around 13,000 days. That’s thirty-five years. Then the hamster retires, and another is recruited to keep the wheel turning. 

Of course, I don’t usually view myself, our students, or our residents as hamsters, but there have been days when the thought crossed my mind. Still, what can medical educators do to prepare the next generation of physicians in ways that will enrich – rather than deaden – their lives and careers? And how do we help our trainees step back and begin to grasp the arc of their journeys from graduation to retirement?

 

Talking with trainees about their careers

A couple of years ago, I held a session on retirement with our otolaryngology residents. We read an article where the authors asked brand-new Johns Hopkins internal medicine interns to write down and then share what they thought a colleague would say about them at their retirement celebration many years down the road. I asked our residents to do the same. We also discussed which of their character strengths would be most noticeable in their careers (from the list at www.viacharacter.org/), what they think they will miss about their careers after they retire, and what aspects of retirement they are thinking about now. 

Not surprisingly, the Hopkins medical interns in the article and our MCW otolaryngology residents all see the distance from where they are now to retirement as being an incredibly long time. The brand-new interns hoped that their colleagues would see that they had lived out their core values, been accomplished in their careers, and been good teammates. Among possible character traits, our residents hope that they would have been most admired for their dedication to teamwork and their humility. They anticipate that they will find their greatest personal satisfaction–and what they think they will miss the most–from being part of a team focused on helping others in times of great need. Like the interns in the study, our residents worried about retirement but, being so far off in the future, they could not imagine what it will feel like to get there.

 Our otolaryngology residents did differ from the internal medicine interns. Although they know they will miss many things, they believed they will be able to replace professional relationships, the joy of helping others, and stimulating conversations with other post-retirement activities. As surgeons, though, they worried that they will have difficulty replacing the unique privilege of performing surgery. As one resident said, “I can’t imagine not operating again. That’s why we went into this.” Many agreed. 

 Our otolaryngology residents, who had been in training much longer than the brand-new interns in the Hopkins study, focused on how quickly time passes, even in training. “I am already realizing how much I will miss my fellow residents,” one of senior resident noted. “I’m sure my career will seem to pass by just as quickly.”

 

The challenges of helping students, residents, and faculty gain insight into themselves and others

There are data that strong relationships and lifelong self-care habits can yield benefits much later in life. MCW faculty members and the Kern Institute are building a portfolio of curricular and extracurricular opportunities that encourage resilience and insight.  The challenge is to make these types of offerings available, appealing, and effective. Baking caring and self-care into the institutional culture and the curriculum creates opportunities for both transformation and scholarship. 

But, let’s get real 

Finding time for reflection, creativity, and long-range personal planning is difficult and, frankly, of low priority for busy students, residents, and faculty. Institutions can readily measure clinic slots, RVUs, grant funding, and fiscal margins, but we don’t (yet) have metrics that measure sustained empathy, strengthened character, prevented suicides, and successful prevention of burnout. If we cannot demonstrate that these habits can be nurtured, or if they aren’t seen as valuable, our interventions will have little impact and won’t be sustained. 

Yet, raise your hand if you think that a graduate who is unprepared to thrive in practice will suffer needlessly over the coming decades. 

  

Retirement isn’t for sissies

Over the years I have been at MCW, dozens of colleagues have retired. The end of a career rarely goes exactly as planned. Some have retired amid accolades for lives and careers well-spent while others have left baffled and reluctant, having no idea what they would be doing a week later. Some, after long and productive careers, were forced out after bitter disputes. Some packed up and left in disgrace. Some became ill or died before they had the opportunity to retire. Some, unfortunately, held on too long. Some left huge holes in the institution when they retired. Others barely caused a ripple. 

 Guiding our students and trainees toward rewarding careers and eventual retirements carries responsibility. We must do more than suggest they be financially responsible and keep track of their retirement account outlook. We have equally important responsibilities to help them develop well-rounded professional identities, “seize the day” mentalities, and careers as reflective, empathic, and mindful physicians. If they enter practice self-aware and focusing on character, caring, and practical wisdom, they should have a better chance of emerging into retirement possessing the same values. 

 

Living each day

The act of living intentionally came to mind when I read a story in an interview with Duke University’s director of medical humanities, theologian, and pediatric oncologist, Raymond Barfield, MD: 

 “Think of each day as a gold coin that you are required to trade for something. You’ll never get that coin back, so whatever you trade it for had better be worth it. You also don’t know how many coins you have left to trade, and you don’t know what will happen when your bag is empty.”

My career shot past me like a rocket since I completed my fellowship and joined the MCW faculty 12,945 days ago. I now wish I had learned early on to treat each day like a gold coin. 

As I look back on my clinical practice, there were too many “hamster on a wheel” days. Still, I am grateful for the moments when a colleague or mentor, some of whom have died, encouraged me to take advantage of the self-care and reflective skills I acquired along the way. It helped. A lot.

Here is hoping we all learn to pay it forward. Your retirement will be here before you know.

 

Bruce H Campbell, MD, FACS, is a Professor in the Department of Otolaryngology and Communication Sciences and in the Institute for Health and Equity (Bioethics and Medical Humanities) at MCW. He is on the Faculty Pillar of The Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education. He serves on the editorial board of the Transformational Times. 

 

Pulse Announces a Writing Contest - "On Being Different" - Deadline 3/31/2023

Pulse Announces a Writing Contest

The online medical writing journal, Pulse, is looking for your essays. Through the generosity of a grant from the Josiah Macy Jr. Foundation, Pulse is sponsoring a writing contest. To further our mutual goal of fostering diversity and inclusion in healthcare delivery, education and work environments, the theme of this contest is: On Being Different. The contest is open to everyone--to health and mental health professionals, to patients and caregivers and to students and trainees. The contest will be judged by Pulse's editors, with a first prize of $1,000 and awards totaling $2,000 to runner-up entries. Top entries will be offered the opportunity to be published in Pulse. The submission deadline is March 31. What does "being different" mean? It could mean: being a member of an underrepresented group; or having an illness that sets one apart; or working on a team where one's credentials or role sets one apart. Your story should reflect your experience of feeling different--and how that has impacted your physical or mental health, your medical care, your education or training, or your work as a health professional alone or as part of a team. Submissions must be true stories--your own experience or that of someone close to you--with a word limit of 1200 words. No fiction, please, and no poetry. Please see the Call for Entries for more details and to learn how to make a submission. Feel free to share this announcement with friends, family, colleagues and students. Please contact Pulse if you have questions. We look forward to reading your submissions!

A Story About Maryam

 From the January 27, 2023 issue of the Transformational Times

Associate Director's Column

A Story About Maryam 

By Cassie C. Ferguson, MD 

 Dr. Ferguson, who is a reknowned mentor and educator at MCW, tells the story of one student who came to her when on the edge of academic despair ...

The most rewarding mentoring relationship I’ve had with a medical student began the day she came to see me in my office to tell me about her experiences on academic leave. Maryam* had heard that I started a task force to learn about our school’s remediation process and wanted to share her story with me. I now know her to be a fierce, determined daughter of immigrants, but that day in my office she sat hesitantly on the very edge of her chair, backpack on, and glanced frequently at the door, as if she hadn’t yet decided to stay. Her voice was flat, and she rarely made eye contact when she spoke. She told me that after failing a course by less than a percentage point, she was asked to take an academic leave of absence before her first year ended. She might be able to come back, she was told, in the fall and repeat her entire first year. What she was not told was that when she drove to school the day after her leave began, her student ID would not work, and she would not be let into the school’s parking lot.  

“They just threw me away,” she said.   

Maryam’s story—her whole story—would take me years to learn. How she was diagnosed with multiple sclerosis during her first year of medical school after months of attributing her symptoms to stress. How she learned that she was dyslexic in her second year of medical school. How intense test-taking anxiety finally drove her to seek help from a psychologist. That information would be given to me in pieces as she grew to trust me, and I have slowly and carefully put those pieces together. Even now, four years after we met for the first time and three years of meeting with her every other week, I know that Maryam has not revealed all the pain she felt during that time, or during the struggles she has had since. I believe that this is in part because of her reluctance to seem as if she is making excuses, in part because of the intense shame that accompanies failing in medical school, and in part out of deference for the archaic medical hierarchy that still hangs over our profession, and the accompanying perception that my time is somehow more valuable than hers.  

That hurt we embrace becomes joy. / Call it to your arms where it can change.

-Rumi 

Medical school is not for the faint of heart. As a result, supporting medical students—particularly those who are struggling—requires love, grit, and fierce compassion. I have learned both through my own experience with failure and from working with students like Maryam that if we are to live up to the titles of teacher, mentor, and advisor we must walk with our students; we must show up even when showing up is uncomfortable. It is precisely when things get hard that we need to lean in and wade through the uncertainty and pain with our students. This requires that we recognize that we have something to offer because of our own life experiences, but I believe the bigger imperative is that we acknowledge that the boundaries of our experiences limit our ability to know what our students are going through. The only way to begin to truly understand is to get very quiet and listen to their stories.  

When we listen to a story, research using fMRI demonstrates that our brain activity begins to synchronize with that of the storyteller; the greater our comprehension, the more closely our brain wave patterns mirror theirs. The areas of our brain involved in the processing of emotions arising from sounds are activated, particularly during the more emotional parts of the story. Even more amazingly, when we read a story, the networks of our brain involved in deciphering another person’s motives—in imagining what drives them—prompts us to take on another person’s perspective and even shift our core beliefs about the world. 

It is impossible to engage properly with a place or a person without engaging with all of the stories of that place or person.

-Chimamanda Ngozi Adichie 

These findings should not come as a surprise to those of us whose work includes caring for patients. As an emergency medicine physician, I have heard thousands of stories. Whether they are snapshots relayed through EMS of how a 14-year-old child was shot in the head at two in the morning on Milwaukee’s north side, an exquisitely detailed account of a 3-year-old’s fever and runny nose from her mother, or a reluctantly provided history of pain and despair that led a 12-year-old to try and kill himself, each of these stories should transform us. They should move us to want and do better for our patients, for our communities, and for our world.  

At the same time, it is essential that as physicians and educators we also recognize what Nigerian author Chimamanda Ngozi Adichie describes as the “danger of the single story.” As an emergency medicine physician, I only hear stories of peoples’ suffering; I am listening to them when they at their most vulnerable, on what may be the worst day of their life. I only hear of the tragedies that have befallen a neighborhood we serve. As an educator who mentors students who are struggling, I often miss out on their stories that are not about failure or crisis. Adichie warns that when we only listen for the single story, there is “no possibility of feelings more complex than pity, no possibility of a connection as human equals.”  

So then our charge as physicians, as educators, and as human beings is to make room for more than just a single story—to remember that all of us are much more than our worst moments, and that compassion and connection arise authentically when we recognize the full spectrum of humanity in one another.  

*Names have been changed.  

Cassie Ferguson, MD, is an Associate Professor in the Department of Pediatrics, Section of Emergency Medicine at MCW. She is the Associate Director of the Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education. 

Reflecting the Change You Want to See – The Importance of Involvement in Equity and Inclusion Initiatives

From the January 27, 2023 issue of the Transformational Times

Perspective/Opinion

Reflecting the Change You Want to See – The Importance of Involvement in Equity and Inclusion Initiatives

By Michael Stout, Ed.D. – Master of Science in Anesthesia Program Director

The importance of diversity and equity in our organization is demonstrated by our values. But how we invest our time is where real change is cultivated… 

Diversity, Equity, and Inclusion goals are often easier to design than they are to achieve. We value their importance, yet gaps persist. These issues were seldom mentioned when I first entered graduate school. More recently, I would be hard-pressed to find a college leader who does not support DEI initiatives. It appears we renewed interest and enthusiasm for addressing gaps and inequality wherever they exist, including our college campuses. Creating a thriving community built on principles of respect and inclusion remains an institutional priority, but how can we make it imperative? The benefits of participation in DEI initiatives can extend beyond individual growth and development and promote positive change beyond our role. 

Admittedly, I have struggled to find time to participate in development programs. There are countless instances when I have received an email and thought, “That sounds interesting. I would really like to attend that event” only to be pulled immediately back into the consuming list of my daily tasks. Inevitably, the date passes without consequence. While missing an opportunity is usually disappointing, the explanation that other activities were more pressing suffices to allay my concern. However, the impact my non-participation has on my team, and the larger organization, is often missed. A person’s priorities can be discerned by where they spend their most precious resource, their time. How could my faculty, staff, and students understand my support of DEI initiatives, if they do not see me participate? 

These programs are designed to help move our organization

The resources dedicated to them aim to transform our campus community and achieve outcomes that align with our values. As an academic leader, I wish for everyone in my unit to attend these events. I welcome the transformational ideas they bring back to our team. But if I choose not to participate, why would I expect that anyone else will? Therefore, my decisions have expanding ripple effects. These decisions not only impact my own development, but can also impact my team, and the larger organizational culture. 

There is growing evidence that improving diversity yields benefits in both private and public institutions. To this end, I pledge to attend an IWILL event to broaden my views on gender. These programs present opportunities to demonstrate our commitment to improving organizational culture. I am grateful for all the hard work, generously provided, by those who organize and attend them. 

While the demands upon our time are likely to remain unchanged, investing in these initiatives can help close the gap between the aspiration for change and its achievement. 

Michael Stout, EdD, is an Assistant Professor in the Department of Anesthesiology at MCW, a Certified Anesthesiologist Assistant, and Program Director for the Master of Science in Anesthesia Program at MCW.