Every Moment Counts

It is a fair assumption that the vast majority of our readers are (or have been) restless, type-A, list-making, data-collecting machines dedicated to crushing diabetic macular edema and neovascular membranes while making an “impact” in whatever way possible. Our can’t-stop-won’t-stop attitudes have fueled us throughout our training and, frequently, our interpersonal relationships, physical health, and psychological well-being have taken a back seat to our career goals. For many of us, fellowship may seem like the busiest time in our lives, but the collective experiences of Wills Eye Hospital retina surgeons suggest that life only gets busier. It might seem like common sense to others, but we high-yield medical types need permission to relax and be “normal” sometimes. Here, we share words of advice gathered from our esteemed faculty, both junior and senior, on achieving a sense of mental and physical balance during rigorous fellowship training and beyond.

— Bryan Kun Hong, MD; M. Ali Khan, MD; and Jayanth Sridhar, MD

RELATIONSHIPS

Carl D. Regillo, MD: Have a mix of both medical and nonmedical friends to interact with socially and to socialize with from time to time. As with any job, work well with your colleagues. Be fair about any issues that come up, such as covering for each other or helping each other in times of need.

Omesh P. Gupta, MD, MBA: Because many of us have young families, it is difficult to make time to do everything we want to do. Like many fellows, work consumed most of my weekdays and some of my weekends. The rest of my time I spent with my wife and kids. Other priorities, such as regular exercise, were not really an option during fellowship. Sometimes we have to make choices, and I do not regret my decision to focus on my fellowship and family over other priorities.

Allen Chiang, MD: Commit to excellence during fellowship training and as you start out in practice. Likewise, commit to being excellent in your life outside of work by not taking your family and friends for granted. Remember: Both wheels on a bicycle must be in balance in order to avoid a bad crash.

EXERCISE AND RECREATION

Dr. Gupta: Aside from maintaining good posture, you also have to make sure that you are physically fit. Regardless of your workout routine, we all must focus on strengthening our core to ensure a long, pain-free career.

James F. Vander, MD: Just do it. Find something you like to help maintain physical fitness, find somewhere to do it—at odd hours if necessary—and then do it. It does not have to be a huge workout, but sitting on an OR stool all day does not generally burn many calories nor maintain strength, despite leaving you tired.

Dr. Regillo: Make time for enjoyable hobbies and activities outside of medicine (eg, sports, music, travel, cooking, dining, reading). Whether during fellowship or afterward, also consider pursuing new activities if you find yourself getting bored with existing activities.

Allen C. Ho, MD: Rebalance during a time of relative imbalance in your life. A lot of work and long hours are required of a retina fellow, so be sure to carve out some time to do whatever it takes to hit your reset button, be it spending time with family, running, having coffee with friends, exploring your new geography, reading a book, or doing yoga. Being able to rebalance will not only make you more efficient at work, but it will also help you to be a better listener—and therefore a better doctor for your patients.

NUTRITION

Dr. Chiang: Pay attention to your own body and well-being in order to better care for your patients. A few minutes spent eating, staying hydrated, and using the restroom can be easy to neglect during a hectic day in the clinic or OR, but if you forget to do those things you will only hurt yourself and diminish your work performance.

Dr. Vander: A fellow has to actively plan a strategy to maintain a healthy diet. Hunger turns into “I am starving” and several cheesesteaks, which later leads to weight gain. Figuring out how to bring a healthy lunch with stuff to graze on between cases makes all the difference. That means finding a way to get to a market to buy items that are easy to store in the refrigerator or freezer and then taking 2 minutes each night to pack something for the next day. Healthy liquid options exist, as well. These can be simple to prepare and provide a quick source of good calories.

REST AND TIME MANAGEMENT

Joseph I. Maguire, MD: Getting enough rest is probably the hardest thing for retina fellows to manage, but it is achievable. Clinical decision-making and surgery are high-level tasks that require constant executive function day in and day out, so you have to make sure you have adequate sleep the night before clinic and before a long day in the OR. Understandably, this is not always possible, but I think I can speak on behalf of all attending physicians supervising fellows that we want you to be sharp when operating.

Dr. Regillo: Budget your time and do not overextend yourself with commitments, whether medical or nonmedical. In other words, do not take on more than you can manage and spread yourself too thin. It only adds stress and reduces the overall quality or performance of any given task or activity.

Sonia Mehta, MD: I recommend staying organized. Fellows do not have much control over their clinical responsibilities and required activities, so make sure you build in time during the week to work out, and set aside some protected time for your family and personal relationships when you are not on call.

VISION

Dr. Maguire: To survive, you need food, sleep, and water. To live, you need relationships, experiences, and vision. Vision requires introspection, planning, and goals. Highly motivated individuals are goal-oriented, but goals are not a vision. If you accomplish a goal but then ask, “What now?” you lack vision. Vision is about who you want to be as a person, spouse, parent, partner, colleague, and friend. It demonstrates what you truly value. One of my mentors told me that the degree of your preoccupation and time spent is a measure of what you value and what you are prepared to do. This requires introspection. The mindset that gets you here—to a retina fellowship—can create issues if you do not exhibit discipline.

The admirable work ethic and focus that got you through college and medical school can become hubris, but we do not control the physics of the earth’s rotation, and we cannot make a day any longer. Thus, planning is key. It may seem odd to add another task to a busy day, but setting a time agenda by the week, month, or year preserves time, creates focus, and carves out space for those people and interests most important to our being. The few moments it takes to create a schedule saves many wasted hours and removes indecision and bad decisions from your schedule. Flexibility is a must, but a basic plan protects that which is central to your vision and creates balance in your life.

Dr. Regillo: As with any job, take the good with the bad. There will always be unavoidable, undesirable aspects to every job that must be accepted and tolerated. Furthermore, there will always be ups and downs, often on a daily basis. Learn from any and all mistakes you make, move on, and resolve to do a better job next time. You will find that, over time, the ups will start exceeding the downs both in magnitude and frequency.

THE GIST OF THINGS

The general consensus is that we must be as deliberate as possible in planning our nutrition, rest, exercise, and time spent with family and friends, while allowing for variables that require flexibility. Obviously, it is not possible to plan for every contingency, but life becomes more complex as growing families, added practice responsibilities, and debt management consume more of our time. Thus, we must learn how to make time for things that are important to us before these complexities multiply.

As our senior fellow Ehsan Rahimy, MD, once lectured his junior fellows, “Let’s work out. If you do not make it a priority now, your body will continue to get weak with each kid you have and then you will not even be able to play with them when you are in your 50s.” n

The section editors would like to give special thanks to the attending surgeons who shared their insights.

Bryan Kun Hong, MD; M. Ali Khan, MD; and Jayanth Sridhar, MD, are second-year retina fellows at Wills Eye Hospital in Philadelphia, Pa. They are members of the Retina Today editorial board. Dr. Hong may be reached at bhong@midatlanticretina.com. Dr. Khan may be reached at akhan@midatlanticretina.com. Dr. Sridhar may be reached at jsridhar@midatlanticretina.com.