The other day, I came upon this quote by University of Houston professor Brené Brown, Ph.D., L.M.S.W.: "It takes courage to say yes to rest and play in a culture where exhaustion is seen as a status symbol."
It gave me pause because of its relevance to me on a personal level, as well as to the conversations I've been having with my patients. "Downtime," or unscheduled time, is undervalued in our culture, especially where my partner and I live in Silicon Valley.
Since becoming a parent, I have actively tried to protect the idea of downtime for my child. With the constant pressures that come with being on a schedule (get up, get ready, go to work and school, come home, have dinner, go to bed, repeat), compounded by the options to register for activities and a variety of events, I have sometimes felt like we are the lone voices advocating for time at home with nothing scheduled. Kids used to have extended periods of time to run around and play without direct adult supervision or enforcement. "The Overprotected Kid," a 2014 article in The Atlantic, eloquently illustrates this change in parenting over the decades. To me, ensuring adequate time is available to allow for long stretches of creativity and playing is crucial to my child's development and well-being. I find that it also helps my well-being.
Many years ago, my partner made a remarkably wise comment to me: "Just because you have the time in the day to schedule or do something doesn't mean you should."
It seems simple enough. But, for the first time, I started to see openings in my days as opportunities to not schedule something.
For a while now, though, I have struggled to accept the inevitable fallout of these decisions: the feeling that I have not accomplished as much as many of my colleagues who are in similar stages of their careers and lives. It's hard not to compare myself to them and not to feel as though I have less to show. And while I know on an intellectual level that I shouldn't be making comparisons because I do not know what struggles they are working through or what challenges they are facing, there is a little voice inside me that argues I'm not doing enough.
As physicians, our career paths have been marked by tangible accomplishments: complete undergrad (check), complete medical school (check), complete residency (check), pass the board certification and licensing exams (check, check). For me, I also threw in graduate school (check). Finally, get a job (check). And even though I didn't take the straightest path to get here (I applied twice to medical school, worked and volunteered for two years), it was always clear what goals I had in front of me.
Now that I have checked off the big items on my list, what is next? There are still smaller goals, but they are less well defined: Be a physician leader within my community; advocate for patients on local, state and national levels; present at conferences; mentor other health professionals and students. It isn't about needing a checkbox, but my career goals now do not necessarily come with an end outcome that finalizes and documents successful completion. Furthermore, what do I have to show when I say "no" to taking on additional tasks because I have chosen to prioritize playtime with my daughter instead of submitting a presentation for the next conference?
In a recent discussion with a colleague who is Swiss but living and working in the United States, she commented that one of her biggest struggles has been adjusting to less time off. She said most physicians in Europe take off the month of July or August, and there is often a requirement to take off a minimum of three weeks for vacation. This made me think about my own friends, family and patients, and how rare it is for anyone to take three or more weeks of vacation.
My parents were recently affected by the PG&E blackouts here in California. I was struck by the fact that they simply went to bed one night. Without TV, Wi-Fi, social media, etc., they did what most humans used to do before electricity transformed our lives: They went to sleep because it was dark. What a simple yet revolutionary idea.
My patients are stressed out, and as I try to counsel them about lifestyle modifications (which our own blogger, Alex Mroszczyk-McDonald, M.D., so appropriately wrote about recently), I realized that what they really need is a prescription to do less. Because, as the old adage states, sometimes "less is more."
And so, despite my inner struggles around what I am truly accomplishing these days, exhaustion is definitely not a goal of mine. What I have come to realize is that I need to move away from the reassuring process of marking off achievements and find peace enjoying my journey wherever it takes me. Ultimately, I want my legacy to be that I advocated for the healthy choice of saying "yes" to rest and play, and I want to be a role model for finding ways to return to simpler times when we weren't pulled in thousands of different directions at once.
Margaux Lazarin, D.O., M.P.H., provides comprehensive family health services at community health centers in the San Francisco Bay Area, with a focus on providing evidenced-based care for underserved communities.