Balance is in the Moment

Physician burnout is a real phenomenon that impacts us all, even from the early days of our training in medical school, residency, and fellowship (1). In a recent study by Goldhagen et al., the investigators reported an alarmingly high rate of burnout (approximately 80%) among resident physicians (2). As a mother of two young boys, a pediatric intensivist, and a physician scientist, I am acutely aware of the need for work-life balance. How do we strike this mythical balance, when each aspect of our lives, in their respective roles demands our fullest attention? When I am on service in the Pediatric Intensive Care Unit (PICU), my time and energy is entirely focused on my patients. When I am running a critical experiment in the laboratory, successful execution of the procedures is the priority, regardless of the time of day. When I am with the boys, I embrace my role as their mom, teacher, and friend, not as a physician scientist. Is it possible for us to have it all? Physicians, especially those who work in the front line of medicine are more likely to experience burnout and dissatisfactionwith their work-life balance compared to the general population (3). The implications are significant, as those in our field are at increased risk for having depression, suicidal ideation, failed relationships, substance abuse, and addiction (4–7). Just as important, these issues can extend to our professional life, with serious consequences on patient care and the health care system (8–10). For me, balance is found in the pause – at that moment when we stop to reflect and consider life. When I first became an attending, I took care of a child1 and family whomade a profound impact on me. He was 5 years old, and had a neuro-metabolic condition that affected his mobility and left him mostly blind. He presented to the PICU with an acute illness, and despite all our efforts, it became clear that his outcome was poor. It was early in the morning, and I was sitting with the mother near his bedside. There were a lot of hustle and bustle in his room, but for his mom and me, it was quiet. She was telling me about this little boy’s childhood, his love for life despite all his challenges and limitations. Just a few nights prior, he was caught on video, dancing to his favorite band. We laughed together as we watched it, and reflected on the life that he had. He passed away soon after, in the arms of his parents. As physicians, we are trained to fix the problem – if the blood pressure is too low, give more volume or tirate the inotropes. Respiratory failure? Intubate and secure the airway. Renal failure? Initiate dialysis. All necessary steps and procedures, but in our efforts to treat our patients, sometimes we forget about who the patient is, their life and person. The mother later told me that in reflecting on her son’s life, in having that moment during such an overwhelming time of crisis, it helped her in letting go, and in saying goodbye to her son. For me, it reaffirmed the importance of always treating the patient and not the disease – for us all; it is ultimately about life, even in moments of death. I went home the next morning, and spent the day in the park with the boys. Every now and then, especially during an immensely busy day, I pause to reflect on the life that is given to me, and in that moment, I find balance. Balance is also fluid and dynamic, not static. It is realizing that at any one moment in time, there is a task (or person) that is the most important, and needs to be on the top of our priority list. To maintain balance, it requires us to be flexible and to be able to shift with our priorities. It also means