Staying Present in Chaos

Sarina Schrager, MD, MS

Sarina Schrager, MD, MS

My house is full of 7th graders; it’s a big party to say goodbye to my son’s friend who is moving away. As I begin to fall asleep over my computer in the home office, I think about the chaotic nature of my job.

Earlier that day I was awoken at 1 am with the news that an obstetrics patient was ruptured, and the resident was going to start Pitocin. Great, I thought, now I won’t have to worry about her anymore and stress out about the planned induction for next week that I probably was not going to be able to go to because of clinic and after-school activities.

I couldn’t sleep after that call, so I went to the hospital at 5 am and worked in the call room until I had to come home to prepare for the 19 children coming to my house after school—all before my patient delivered.

My head was spinning from all I was thinking of: managing a dysfunctional labor, worrying about the well-being of the baby, and buying 24 pumpkin cookies at Costco. I felt like I was on a roller coaster. It’s chaos.

Some days I wonder how I can be an effective physician with all of these thoughts and to-dos. My patients’ well-being is reliant on my ability to be present and pay attention to detail. No wonder so many of us are up at night panicked that we have forgotten something.

The most peaceful times in my life are when I can only do one thing at a time. Seeing patients is fabulous and is all that I am thinking about. Writing a paper is a wonderful, all-absorbing feeling of accomplishment and intellectual stimulation. Being home after school with my kids is always an adventure and controlled chaos.

The goal every day is to be present and focused on one thing at a time. This is how I can be an effective physician and parent. I stay present and focused by changing my hats. It’s just as we learn to compartmentalize during training—putting work in one box, life in the other.

I remember when my children were young and I would visualize changing hats during the drive home from work. I mentally put away the doctor hat, saved for a time later in the evening when I would finish my charting, and put on my mom hat. This visualization helped me transition between being a doctor and being a mom.

However, the smooth transition between roles can be interrupted by many external factors—lack of sleep, an illness in the family, or a crisis at work. Today, I am tired and will try to get through the night and go to bed early. My aim is to be easy on myself and set reachable goals on these recovery days. Simply making it through the day or night is often an accomplishment in itself.

How do you handle the chaos of work-life balance? Do you compartmentalize or change hats? Share your story in the comments below.

5 responses to “Staying Present in Chaos

  1. When my son was younger, I really did not know how to compartmentalize. Thankfully I had help. My office staff, husband and my son helped me make the transition between the two demanding roles. I turned to planning outings with my son. A movie and lunch with other Moms and his friends. It did help that they were also colleagues and could step in if the beeper went off even if I was not on call. That was over 20 years ago.

  2. Madeleine Shernock

    Self care has been a huge part of my midwifery education, and providers learning how to care for themselves and prevent burnout is even integrated into the clinical curriculum. Setting aside time for myself, learning to say “no,” and focusing on processing the more traumatic aspects of my job (which are bound to happen in any medical profession if you work with enough people) have been lifesaving. Being a care provider for others (usually strangers) is a lifestyle, not just a job, and having a supportive family and network of colleagues is a must!

  3. Kathryn Fraser

    Thank you Dr. Shrager for sharing this very personal struggle and how you deal with it. Having worked as a Behavioral Scientist in Family Medicine for many years, i have spent a significant amount of time trying to teach this kind of thing our residents. i agree wholeheartedly with your advice on being present-focused. I advise the residents, as well as my patients, that if they are being active outdoors, immerse themselves in the sights and sounds of what is around them and leave work behind. Being conscious of the transitions, especially leaving work and coming home, and taking a few minutes to switch your mindset over can also help you be the best for your family and yourself. These tactics have helped me personally, along with giving myself permission to not do everything perfectly and feel good about living a balanced life.

  4. As a new mom, reading this is very helpful. From the thoughts and feelings you have to how you juggle it all. I am compartmentalizing better but I still have a long way to go. Looking back, when my baby was young, I wasn’t able to be present. I remember rocking him and thinking about everything I had to do for work feeling overwhelmed. Very little of my time was spent on how to care for myself. Something happened when my son turned 9 months and I started to compartmentalize better, similar to what you describe, I would come home, be with family and then when baby goes to bed, do work. My husband and I try to do work the same nights of the week and have other nights together. Friday nights are always for family unless one of us is on call. I am impressed that you do OB along with FM. You are amazing. Thank you for sharing your story

  5. I appreciate this post. I am writing this comment as I missed yet another continuity delivery because I did not have childcare last night. I am on call 50% of the nights this week but my patient chose to have her baby on one of the nights I didn’t have childcare. I am a single mom who has stubbornly refused to give up obstetrics care for the past 11 years. Are there any other single parents out there who have this same struggle?

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