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GUEST COMMENTARY
Year : 2019  |  Volume : 67  |  Issue : 1  |  Page : 44-52

The pursuit of wellness in neurosurgery: Investing in residents' current and future health: Spouses' perspectives


Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA

Date of Web Publication7-Mar-2019

Correspondence Address:
Dr. Alejandro M Spiotta
Department of Neurosurgery, Medical University of South Carolina, 6 Jonathan Lucas Street, CSB 210, Charleston, SC 29425
USA
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.253612

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 » Abstract 


Neurosurgery residency is daunting and all-consuming to those who undergo it, and the spouses of those residents are not exempt from the challenges it presents. In light of our institution's implementation of a wellness initiative in neurosurgery residency education, the spouses of various participants offer their insights on the program, shedding light on the full extent of its benefits.


Keywords: Mental health, neurosurgery, residency training, resident education, sleep, wellness
Key Message: On implementation of a wellness initiative in neurosurgery residency education, the spouses of various participants offer their insights on the program.


How to cite this article:
Estrella M, Henderson BG, Porto SC, Vargas M, Buchholz EH, Ellens SM, Spiotta V, Spiotta AM. The pursuit of wellness in neurosurgery: Investing in residents' current and future health: Spouses' perspectives. Neurol India 2019;67:44-52

How to cite this URL:
Estrella M, Henderson BG, Porto SC, Vargas M, Buchholz EH, Ellens SM, Spiotta V, Spiotta AM. The pursuit of wellness in neurosurgery: Investing in residents' current and future health: Spouses' perspectives. Neurol India [serial online] 2019 [cited 2019 Aug 24];67:44-52. Available from: http://www.neurologyindia.com/text.asp?2019/67/1/44/253612




With its constant physical and emotional demands, neurosurgery is certainly one of the most sacrificing specialties in the medical field, and our lives as the significant-others of those in its training are not exempt from some of these inevitable daily sacrifices.

Its influence becomes gradually infused in our daily roles as professionals and wives, and exerts an even greater impact over our family dynamics when life promotes us with pets, kids, adult responsibilities, and unexpected life events. From clean-scrub heroes to hunger menders to personal therapists and advisers, we voluntarily commit to building the foundation for these brain surgeons' support systems.

In addition to our own pledge, an additional role in the well-being of our other-halves is played by the Neurosurgery Department at the Medical University of South Carolina with the integration of Operation: La Sierra to its residency program. This wellness initiative has been created to aim for the physical and mental health of its training physicians, and the improvement of their work performance and quality of life.

In this section, we have shown a glimpse of our own personal perspectives on the pursuit of wellness in neurosurgery. This medley of collaborations is intended to reach out and connect to spouses of professionals in the medical field (or any other field) who might share similar stories, and to serve as guidance for other academic programs that also feel committed to provide their resident physicians and their families with a healthier lifestyle. [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8], [Figure 9], [Figure 10], [Figure 11], [Figure 12], [Figure 13] give the responses of the spouses to the wellness initiative that has been created to improve the physical and mental health of the trainee neurosurgeons.
Figure 1: Response to concern about spouse's health related issues

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Figure 2: Frequency of participation in the first year since the fitness program started in the neurosurgical residency

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Figure 3: The frequency of participation of the spouse in the fitness program workout or activity in the past 6 months

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Figure 4: The percentage of time the couple attends the fitness program activities/workouts at the same time

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Figure 5: Attendance of the physical activity program activities and workouts even if the spouse cannot attend

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Figure 6: Time at which the health impact of spouse's participation in the fitness program activity was noticed

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Figure 7: Benefit of participating in the fitness program to spouse's personal and professional life

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Figure 8: Benefit of participating in the fitness program to spouse's physical health

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Figure 9: Benefit of participating in the fitness program to spouse's mental health

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Figure 10: Benefit of participating in the fitness program to spousefs ability to manage work-related stress

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Figure 11: Motivation of spouse to still exercise regularly if the fitness program did not exist

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Figure 12: The three most important aspects in the fitness program

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Figure 13: The three most important aspects in the fitness program for the spouse

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 » Medical Student Applicant's Spouse Top


During my growing up phase, my family loved being active, and exercise was viewed as an integral part of our day, rather than something that we occasionally fit into our schedules. We often had to get creative as my father was a busy surgeon with an unpredictable schedule. Our definition of exercise was a looser one, I'll admit – involving anything from family walks to downhill ski team practice to working outside at our hunting cabin. Additionally, we did not exclusively view exercise as a means-to-an-end to increase athletic fitness, but rather exercise was a part of our lifestyle in pursuing functional and personal wellness. This appreciation for wellness while growing up, strongly influenced my decision to pursue a career in health care as a Physician Assistant (PA).

Immediately after graduating from a PA school, I joined a private practice neurosurgical group consisting of 5 adult and 2 pediatric neurosurgeons. I worked exclusively with one of the adult cerebrovascular neurosurgeons. We operated out of, and took consults at, 3 separate hospitals in the area. As there were no local neurosurgery residency training programs, my duties included early morning rounding typically at 2 or more facilities before joining my attending to first assist in the operating room for the day's cases. I also saw and staffed consults, placed pre- and post-operative orders, and discharged all of our patients. As a result, I worked anywhere from 50-70 hours a week, and was on-call at all 3 hospitals typically every 4-5 days, with cerebrovascular call on top of that.

During my tenure at the PA school, I was extremely busy but was often able to fit activity into my day, by walking over lunch or working out with my course-pack on the treadmill. When I started working in neurosurgery, I was single and living on my own, and I was lucky to make it home most nights with only enough time to make myself a homemade meal, let alone fit a work-out in. Now granted, not every workday involved getting out at 7-8pm, but overall it was a struggle to work in that surgical subspecialty and try to maintain a balanced life outside the hospital. A distressing realization was understanding that any stressors and demands I faced were multiplied exponentially for the physician(s) I worked for.

Ironically, I met my husband at the end of my first year working in neurosurgery at a local fitness center. At the time, he was working as a fitness coach and personal trainer, while preparing to start medical school. We realized fairly early on in his medical school training that he was particularly drawn to the field of neurosurgery. Over the next couple of years, his interest in this field continued to grow and he made the decision to apply to neurosurgery residency programs. With my personal experience in the field of neurosurgery, I initially had apprehensions about his career choice. We both love being active and share an interest in many outdoor and gym-based activities. As we began discussing career and lifestyle goals, we both agreed that my husband needed to pursue a career he was passionate about. And although his career will take an extremely high priority – particularly during residency – we plan to find creative and innovative ways, despite busy schedules, to pursue personal wellness and a healthy lifestyle!

In July of this year, my husband started his 4th year in medical school and left for his first sub-internship in neurosurgery at the Medical University of South Carolina (MUSC). When he told me about the La Sierra initiative implemented in July of 2015 at MUSC, it would be an understatement to say that I was surprised and intrigued. It was exciting to learn about a residency program taking an active approach in addressing how difficult it can be to balance a demanding medical career (in particular 7 years of neurosurgical residency) with personal wellness.

I think the benefits of the La Sierra initiative are multifold. La Sierra provides a platform to discuss lifestyle goals and then actively engage participants in achieving them. I love that this initiative gives busy residents and attending physicians a consistent, scheduled excuse to spend dedicated time each week on their own wellness, whereas the vast remainder of their time is dedicated to the wellness of their patients. La Sierra also seems to foster an environment of comradery among co-residents and co-workers, giving them a chance to spend time together outside of the hospital, hold one another accountable and work cohesively as a team during the workout. Furthermore, exercise serves not only to improve physical and functional wellness but also emotional wellness as described in the La Sierra pilot program article. Exercise can be an excellent cathartic and stress relieving activity, particularly when it is an enjoyable and consistent group activity.

In our experience, La Sierra gave my husband a chance to work out weekly and to interact with residents and attending physicians outside the confines of the hospital. It also made working out a feasible and integral part of his weeks spent as a rotating medical student at the MUSCs program. We applaud MUSC for being a training program that provides residents with the professional and operative skills they need to excel, as well as a program that invests in the physical and emotional well-being of their residents. Operation La Sierra is absolutely something that my husband (and myself) can look forward to as a neurosurgical residency applicant. As a couple who is passionate about pursuing healthcare, while desiring to maintain an active and healthy lifestyle, the La Sierra initiative seems like a promising approach to blend the two.


 » Junior Resident's Spouse Top


Our home is full of the essential neurosurgery handbooks and  Atlas More Detailses. Sometimes, I'll make eye contact with the skull sitting on the bookshelf. Our living room end-table has drink coasters that stack up like horizontal brain specimens and the graphic brain surgery pictures are always within sight. To some, this may sound like the opening plot of a horror movie, but this is just a day in the life of a neurosurgery resident's significant-other.

One of the most difficult aspects of being in a relationship with a neurosurgery resident is simply the strict time schedule it demands. He regularly puts in 80 + hours during the workweek and even when he is home or not on call, he will be found on the phone or computer—preparing for tomorrow's rounds, Thursday's presentation, taking calls from co-residents and attendings, etc.

Another difficult aspect is the day in and day out care of neurosurgery patients. They are usually very sick and near death by the time they need neurological surgical intervention. After seeing brain bleeds, babies with hydrocephalus, spine tumors and fractures in a single day, no one could possibly see that without taking some of it home. It is my top priority to make our home life as calm and relaxing as possible so he can get up the next day and do it all over again. Despite the challenges, I am so in awe and so proud of his work and that of his team. The success stories are the ones that bring light to this stressful and arduous journey.

The importance of a healthy mental and physical wellness is well known but it requires constant attention and competes with the thousands of other tasks associated with residency. It is easy to let personal wellness fall to the wayside but ultimately the hard reality is that resident wellness governs whether one can keep up with the long neurosurgery workweeks, academics, calls, nights, and operating schedule. Residents must take care of themselves if they expect to sustainably take care of others and therefore lead by example.

For my neurosurgery resident's pursuit of wellness, it comes down to the following trifecta—an early-to-sleep time, a nutritional whole food diet including the preferred Brazilian staples of rice and beans, and regular heart healthy exercise. This is possible with constant encouragement and support; whether it be taking the lead on to-do items at home, having a full plate available to reheat, or pushing at least a daily 10 minutes of painful cardio. Every day it comes down to little acts and decisions but looking back, they are large pieces to the success puzzle.

His department recognizes the importance of resident health and therefore, has implemented the wellness initiative Operation: La Sierra. One aspect of the program is a weekly group fitness workout where significant-others are encouraged to join. As a fitness enthusiast, I happily attend to spend the active time with him and support the goals of this initiative. As a Doctorate of Philosophy who follows the peer reviewed science, I know there is strong evidence for positive cognition, behavior, and mental strength effects of habitual exercise. La Sierra is a guaranteed block in the schedule for full body circuit training. It is challenging, endorphin pumping, competitive, and fun. It makes fitness and the resulting mental and physical benefits a priority in the neurosurgery community.

The life of a neurosurgery resident is stressful. I can only imagine down the road when kids, pets, and more life gets added to the mix. This is the time to implement and support long-lasting positive health and wellness habits. I think this mindset will be crucial for him, for myself, and our future personal and family life. In addition, healthy mental and physical wellness is essential for neurosurgery and patient care. Patients need a physician who is a healthy role model. It speaks volumes to the success of patient care. Resident wellness seems like a no-brainer.


 » Junior Resident's Spouse Top


My husband is a very physically active person, someone that had always shown interest in outdoor activities and enjoyed many recreational hobbies, from outstanding judo practices and exhausting surfing sessions, to amazingly fun salsa dancing. Honestly, it takes quite a lot to drain the energy from this go-getter and slow down his pace to an “I might have left the milk out of the fridge, again” kind of level. And by a lot I mean endless hours of surgery in a static position, countless patients awaiting evaluation, consults, rounds, admissions, notes, consents, night floats, ER calls and much more. To finally wrap up his day, having to choose between dining and much-needed sleep, preparing a book chapter that was due 3 weeks ago, studying for either a board exam, journal club day, research day, or honestly just most regular days, simply because “there's a very challenging case tomorrow and I need to be ready.” Feeling choked yet? Now, imagine marrying into this daily dose of adrenaline rush and exhaustion. Personally, I have already made my peace with it by updating my current civil status to: Married to Neurosurgery.

For the past couple of years, I've been the front-row-spectator of my husband's weight fluctuations, mood swings and constantly increasing stress levels. I have also had the opportunity to watch from the benches how residency training has consistently given way to deleterious lifestyle habits in the rest of the team. How can they promote healthy guidelines and become true role models for their patients, when their own personal wellness remains on the line? As stated by the World Health Organisation, physical activity plays a major role in the prevention of many chronic diseases and is fundamental to energy balance and weight control.[1] But is this knowledge strong enough to drive us to implement healthier habits such as exercising, good dieting and meditation? Do my husband and the rest of the residents do as they preach? How is it that, with such a demanding schedule and fast-paced environment, they can find the will or even the time to exercise themselves? Fear no more, Operation: La Sierra to the rescue.

Operation La Sierra is a wellness initiative created by the faculty leaders of the Department of Neurosurgery to create a safe and easily accessible environment that improves its residents' physical and mental health. Different studies have suggested the importance of implementing an incentivized exercise program in the medical training curriculums to assure physicians' health and proper patient care.[2] It seems that participants to these programs have higher exercise compliance than nonparticipants who have equal access to a training facility.[3] At La Sierra, residents are trained to develop the strength, self-control, and resilience demanded inside the operating room to perform fine calculated microsurgery movements for long periods of time, and to endure the back-and-forth power-runs between the hospital buildings to see their patients who are in a critical state and cannot afford to have their physicians being burned-out. Also, it is in the department's interest to help their residents build healthy lifestyles, and through their team workouts, they are given a chance to release all of their accumulated stress.

What makes all of this even cooler is that it is open for the rest of the department staff and their significant others to join. We are not only welcome, but constantly encouraged and reminded to step in for a nice workout session every week. I find it very helpful for spouses to be able to count on an inclusive team-based workout program like La Sierra. Research has shown how spousal support can promote, increase, and maintain the physical activity in couples,[4],[5] which gives scientific back up to the popular saying “couples who train together, stay together” - even if at first they start out being completely out-of-shape together.

My 2-months-in PGY-3 resident husband is dealing with much more responsibility in his current training than he ever did in the years before. He has gained new sets of skills and confidence that makes us feel as if things are finally “getting better,” although, not necessarily easier. Nevertheless, I acknowledge and have faith that his levels of self-preservation and self-love are higher. He now makes the extra effort to wake up earlier for a quick session of morning cardio, has religiously invested in the 1st Phorm protein stack, no longer tries to squeeze a Nutella jar in our shopping cart whenever I'm not looking, and often times he simply feels “great!” As for myself, after a year of zero exercising due to an exhausting studying schedule to pursue a career in medicine, I was encouraged to resume exercising and meal prepping for both of us.

I am confident that this initiative is already playing a central role in tailoring the foundation for healthy lifestyle changes in many of his co-residents and their families. Particularly for us, it has already done so by shaping our habits to work towards a long and productive life, the kind of habits that we will proudly pass on to our children in the future. As for now, we challenge each other to be better; and even at the end of the most chaotic day, we lift dumbbells, drink 1st Phorm shakes, and enjoy muscle gains while his brain is drained.


 » Senior Resident's Spouse Top


When you begin the seven-year journey of residency as a neurosurgeon's spouse, people tell you to expect long days, endless rotations of nightshift, and that you will walk alongside your loved one during one of the toughest seasons of his life. What you don't always hear about, however, is the toll that residency will take on your spouse – mentally, emotionally, and physically – over the years. Nor does anyone tell you how tough it will be to watch the person you love sacrifice his own health to care for others.

When my husband started neurosurgery residency at the Medical University of South Carolina (MUSC) in 2014, we were newly married and in our late twenties. We immediately dove into residency and the schedule that it entails: very early mornings, late nights, 14+ hour workdays, few weekends off, and lots of stress. There are many ways to describe residency, but I think Dr. Harvey Cushing, the father of Neurosurgery, put it best: “The capacity of man himself is only revealed when, under stress and responsibility, he breaks through his educational shell, and he may then be a splendid surprise to himself no less than to his teachers.”

While I don't know if Dr. Cushing had neurosurgery residency in mind when he wrote these lines, I believe the description still rings true. Residency is not meant to be an easy experience – it is a time of professional growth and transformation, of “breaking through”, and beginning as new doctors with academic knowledge and ending as capable surgeons. Everything that happens in those seven years is supposed to prepare and equip residents with a strong medical foundation they can use to save lives, innovate in the field, and build upon their careers.

The challenge of residency, however, is that it often focuses on solely medical training and not the life-balance training that residents need to survive the long-term demands of a surgery career. Burnout among doctors has always existed, but this “state of mental and physical exhaustion related to work or care-giving activities” has increased exponentially over the past decade, and continues to gain attention due to its effect on job performance and patient care.[6] Residents across medical disciplines generally experience high degrees of burnout (as measured by the Maslach Burnout Inventory test, or MBI), although surgery specialties – including neurosurgery – consistently have some of the highest reported burnout rates in the United States.[7]

Burnout also does not stop with residency; a study conducted by the American Association of Neurological Surgeons (AANS) indicated the burnout rate for neurosurgeons ranged from 47.7% among academic neurosurgeons, to 62.9% among non-academic neurosurgeons.[8] Furthermore, this study identified 'difficulty achieving work-life balance' as one of the three top causes of burnout among neurosurgeons nationwide.[9],[10]

With all of this in mind, I began to feel concerned when my husband started showing signs of increasing work-related stress and did not have the time he needed to rest, exercise, and cope with these newfound intensive responsibilities. Exercise has always been an important part of my husband's life; from being a part of the rowing crew in high school, to running throughout college and medical school, he has always prioritized fitness.

My husband is an active, compassionate, and hard-working man, and often says he feels like his “best self” when he gets to exercise. Even before we were engaged, we agreed to not go out on dates until he had worked out – even if that meant arriving separately for an event, or moving our dinner reservations to later in the evening. For us both, exercise is a non-negotiable and important part of life.

I was incredibly relieved when my husband came home one day towards the end of his first year of residency (also known as intern year) and told me the Neurosurgery Department would be launching a new initiative to help residents stay healthy and incorporate routine exercise into their residency training. This immediately got my attention!

At first, the program he described sounded too good to be true – the residents gathered together with attending doctors for a weekly team workout with a fitness instructor at the Medical University gym. They were given team workout gear, shirts with their names on them, and even fit bits so that they could count (and compete!) with each other on steps at the hospital each day. Most importantly, this initiative gave them dedicated time to work out as a team and recognized that physical and mental health were important parts of residency training. My husband told me it was called “Operation La Sierra” – a wellness initiative focused on improving residents' short and long-term health.

As the days and weeks progressed, La Sierra became a part of everyday residency life and the highlight of each week. The benefits of the program extended far beyond just time in the gym; my husband and I did some of the recommended workouts together at home, gathered baseline scores for push-ups, burpees, and crunches, and challenged each other in our workouts. I began to see the man I had married before residency, slowly return.

As a resident spouse, I think La Sierra's greatest impact is the mentality shift it has brought to the residents' medical training program at MUSC. Through La Sierra, my husband and the resident team were given permission to exercise, and in so doing, to add physical health to their long list of daily priorities. In an everyday content, this meant if residents finished their work and somehow had a free 20 minutes, they could use it to exercise. No questions asked.

It also meant my husband and his co-residents did not have to feel guilty about hitting the gym or having a few minutes to take care of themselves in a long day, because the department's leadership had recognized the importance of exercise in their overall work performance. Forming La Sierra and encouraging team-wide participation also signaled the department's investment in the team, and indicated that personal health was as critical to the residents' training as the coffee they drank and the intensive procedures they performed. It was incredible to see this shift take place at both an individual and collective level. The guys flourished!

It has now been over two years since MUSC's neurosurgery department implemented “Operation La Sierra,” and the benefits of the program speak for itself. Residency remains intense, but I feel my husband and his co-residents now have much healthier ways to manage work-related stress and provide better patient care. Coming together for weekly workouts seems to also help them work more cohesively as a medical team. Most of all, I am glad to see my husband pursuing the career of his dreams and getting the exercise he needs along the way. Already this program has made a difference in his personal and professional residency experience.

As Operation La Sierra continues to grow and involve more members of the Neurosurgery Department and their families, I think there are three key ways in which it can continue to implement its mission. One is to make weekly team workouts as accessible as possible, both through scheduling times when residents can attend and share the workout routines (such as over email or through social media) with members who may not be able to make it due to work responsibilities. Another is to tie in nutritional education aspects of resident health to build on the improvements made through the exercise portion of La Sierra. Lastly, I think there are more ways that family members and spouses can participate in La Sierra throughout the year, such as quarterly team-wide events that allow for friendly competition and community building.

Most of all, I am grateful to the Department of Neurosurgery for launching this initiative and investing in the health of my husband and his co-residents. By starting La Sierra, the Department has given the resident team a better chance of work-life balance, avoiding burnout, and being able to serve successfully in their careers - both today and in the future.


 » Chief Resident's Spouse Top


La Sierra is great part of the residency program at MUSC. It made taking time out to exercise not only acceptable, but it made it the expectation. Our guys work so hard and are stretched so thin that they are barely able to make time for anything else. It is wonderful that they are involved in residency program that places a priority on exercise and sees the long- term benefits of fitness. La Sierra has positively impacted our life by giving me an opportunity to work out with my husband and his co-residents. It is really fun to be able to work out with these guys and see them in an environment where they are a little less stressed. I think it is great for building a strong team and allowing them to connect with each other outside of the stress of the regular work day.


 » Junior Attending's Spouse Top


“…Out of the night that covers me, black as the pit from pole to pole, I thank whatever Gods may be for my unconquerable soul.” To me this excerpt of William Ernest Henley's Invictus beautifully summarizes the responsibilities that come along with being a neurosurgeon. Although it is emotionally and physically challenging, there is a sense of pride of being amongst the few entrusted with the honor of carrying out that assignment, but it comes with a cost.

I began my courtship with the world of neurosurgery 7 years ago when I met the man who I now call 'husband'. And in marrying him I took on the title of wife, and more specifically, wife of a neurosurgeon. I say that because he and his field of choice are intimately tied, the demands of the job over the years have been encoded in his DNA and without recognizing that, I would not fully be accepting of him. As spouses of those who have dedicated their lives to the world of neurosurgery, we grow an appreciation for the demands that this mistress called 'medicine' mandates… and the consequences are far-reaching. There are missed birthdays, anniversaries, holiday parties and delays in attaining personal life goals. These are just some of the costs of having the privilege of being tasked to quite literally save someone's life… I mean, it is brain surgery. And we, as spouses, grow to respect them for that level of dedication and simultaneously long for a sparing of time just for them to breathe; for the weight of the world to be lifted if only for a moment.

For us at MUSC, this moment of Zen presented in a way that I did not anticipate or quite honestly initially appreciate. My husband, as a PGY-5, came home announcing that the department would begin participating in a workout program called “La Sierra”- that these sessions were to include both residents, attendings and their spouses. In knowing this group, I immediately pictured a scene from the 'Hunger Games' and wondered: 1) how was this supposed to boost morale; 2) when would there be time for this workout; and, 3) was our disability insurance up to date. The answer to Question three was quickly confirmed with a simple search but as the answers to Questions one and two slowly began to reveal themselves, I began to wish that the course had started years before.

La Sierra, although structured as an exercising program produced results similar to a therapy session. Yes, it focused on weight training, Fitbit numbers and measureable values such as vitals and lab work but it also led to a healthier husband, both physically and emotionally. It was the emotional part that was surprising to me. I noticed that within the first month of initiation, my husband's energy level had drastically improved and along with that he was happier. We looked for excuses to exercise together whether it was walking our Yorkie for the Fitbit challenge completion or riding bikes along the beach to burn a few extra calories following dinner. The focus became less and less about the exercise and more about the experience. And this shift occurred not only in our relationship but also in the relationship with his co-residents. There were more get-togethers, more co-resident joint date nights, and meet-ups for doggy play dates. The program helped to give an outlet to a demanding profession.

The world of neurosurgery will always be arduous and test the limits of the work-life balance. For that reason I am grateful for “La Sierra”. It planted a seed early on in my husband's career to truly invest in himself, his health, his happiness, and the relationships that make life worth living so that he could go on to be the phenomenal neurosurgeon he was always created to be.


 » Program Director's Spouse Top


My background is in nursing and I worked as an registered nurse at the University Hospital at an esteemed tertiary care center for several years. This was in the time before the duty hour reform. The residents were overworked and absolutely miserable; they were very unhappy, spending all of their time in the hospital. It was obvious to all that it was not a healthy environment, having nothing outside of the hospital to draw upon for support or to decompress. One had the sense that it negatively impacted patient care. However, nobody really questioned the conditions or their effects on the resident physicians at the time – it's just the way it was.

When my husband and I started dating towards the end of our undergraduate studies, he was completing an arduous and competitive premed curriculum. Although I knew there would be hardships ahead for both of us, I knew that it would all be worth it in the end and that we could get through it together. After all, this was his passion. During medical school, the schedule got worse but he was always heavily involved in team sports. This activity was crucial as a stress reliever and I was glad to see that he was trying to maintain a balanced lifestyle with involvement in both academics and athletics.

'We' (my husband) then started residency. Internship in general surgery wasn't too bad although it was q3 call (call every third night). There was a rhythm about it and that year he would meet up with his co-interns, playing basketball and socializing quite often. Once we started our PGY2 year and full-fledged neurosurgery residency started, there was a major difference. All team sports, athletics and any social activity ceased overnight. He was at the hospital at all hours. He seldom made it back home before I was asleep. He woke up so early in the morning every day to head in for rounds, we used to joke that it was actually middle of the night. I recall a weekend off in the fall, we were both noting the changing foliage in our backyard. He then turned to me and asked, perplexed and somewhat upset, “what happened to summer?”. He had missed an entire season without doing a single activity any of us would associate with summertime.

It is definitely not the part of our marriage that I look at most fondly and we each led our separate lives for the most part, intersecting on occasions. As a spouse, you were alone; yes you had a husband but he was not around 99% of the time. We had our first child, our eldest daughter, towards the end of third year of residency. He missed all of her ' first' activities including first steps, first words…etc.

During training, we certainly didn't have a lot of time together. He had two modes; either at work or preparing to return to work, which meant the major objectives were resting and recovering to head back in. When he wasn't at work, at any given point, we could be anywhere and he could fall asleep; once he made it home for dinner around 9pm and fell asleep right on the table. His ability to take care of himself went away because there wasn't any time, or energy. He went six years without seeing a dentist or a primary care physician. In a 3 or 4 year residency program that may not be as intensive, residents can probably get away with it, but a 7 year period is too long to neglect your personal health. If you do not take care of yourself for that long of a time period, you are much older than when you began as a 25 year old, now into your 30s, and it is harder to pick up the pieces and get yourself back in shape.

Neurosurgery training required a complete sacrifice of all things outside of the work. But he never complained about it to me. As he would tell me, 'I signed up for this'. My husband was proud to be embarking on this epic journey. He was willing to accept all the sacrifices, but is anyone truly aware of what all those sacrifices entail?

People need to be active and work out their bodies. They also need to fuel with the proper diet to perform at a high level, as is expected of them. The wellness program that has been started for our current residents creates a better environment for them and I think it is great for team building. It is very important that physicians learn to take better care of themselves, not just for themselves but also to improve their home environment and deliver better care to their patients. It is crucial that they do self-care so they can support other people. They need to take care of themselves before they can take of patients.

”You can't pour from an empty cup, so take care of yourself.”

Acknowledgements

We would like to thank the Medical University of South Carolina Wellness Center for graciously donating their time to work with the La Sierra wellness program. In addition, we would like to thank Alyssa Pierce for reviewing and editing this article.

Financial support and sponsorship

Nil.

Conflicts of interest

Dr. A Spiotta: Penumbra Consulting, Honorarium, Speaker Bureau; Pulsar Vascular Consulting, Honorarium, Speaker Bureau; Microvention Consulting, Honorarium, Speaker Bureau, Research; Stryker Consulting, Honorarium, Speaker Bureau



 
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    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8], [Figure 9], [Figure 10], [Figure 11], [Figure 12], [Figure 13]



 

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