In search of balance

Now that I’ve made the push through my first several months as an attending, two sets of board exams with a vacation squeezed in, and a dozen or so swing shifts to keep my income stable during my studying, I have finally settled in as a full-time academic hospitalist.

I am working with a colleague on a research paper, attended quality improvement and patient satisfaction meetings, and squeezed in some writing for this news organization to chronicle my journey and its many moving pieces. Amid the surreal and mundane encounters, I continue to look for balance in my life and career.

For several weeks, I’ve volunteered to spend afternoons teaching second-year medical students how to present complex medical patients. I spend my morning, from 6 to 9 a.m., reading about my patients’ conditions, planning what and how to teach my senior medical students and residents. Since I am finally in charge of rounds now, they tend to be heavy on pathophysiology and mechanism pimping, which I craved for all of my own residency. The rounds are performed at bedside – even sitting – to try to improve patient satisfaction, and we include the nursing staff to improve communication. I make sure everyone on the team sanitizes their hands going in and out of the rooms. I try to bill appropriately and to addend my notes so that the billing matches the documentation while also reflecting the daily plan.

At home, my wife and I have bought our first house and I spent a recent weekend, between two 7-day stints on service, moving everything we own and cleaning the old apartment. We are hoping to soon have a family. I am trying to be a good husband, and when my mom was in town on my supposedly off week, a good son. The latter ended up being somewhat challenging, as not a day went by without a meeting or an extra shift.

I’m not complaining. To be honest, this is how I had always imagined being an academic physician would be.

One of my mentors, Dr. William Aird, a true renaissance man who is not only a hematologist but a basic scientist, often talks about the "academic physician" when he gives lectures on Aelius Galen, one of the most influential and accomplished researchers and physicians of antiquity. When discussing the mass of writing that Galen accumulated during his career and how he could "write circles" around his contemporaries, Dr. Aird states that Galen continued to attend to his many other responsibilities including teaching, performing experiments and research, and his clinical practice. He also contributed to philosophy, was Marcus Aurelius’ personal physician, and practiced epidemiology as he faced plagues that wiped out thousands of people a day.

I don’t pretend to compare myself to someone like Galen or Aird, but I do feel honored to join a profession where it has been almost a tradition, or perhaps a by-product of a certain personality, to be so engaged and so curious about so many different things. However, with this, I have found, it is necessary to find balance.

I am writing this blog on what should be my lunch hour, a break after rounding, teaching, and seeing and talking to patients. There was also a brief conversation with my wife about the cable guy not arriving on time. In 1 hour, my next second-year medical student arrives to practice presentations. Last Friday, I spent 5:30 p.m. to 7:30 p.m. with a family who was torn by the decision about whether to put their dying father and brother on comfort care or to move him to MICU, as he was in respiratory failure and had MRSA abscesses along his spine and chest; 12 hours later I was vacuuming my old apartment and moving cardboard boxes.

I suppose I will find this balance easier to obtain as I continue to mature into my career, keeping Galen, Bill Aird, and of course my wife, close to my heart and mind.

Dr. Horton completed his residency in internal medicine and pediatrics at the University of Utah and Primary Children’s Medical Center in Salt Lake City in July and joined the faculty there. He is sharing his new-career experiences with Hospitalist News.