During my second year of fellowship, I witnessed numerous events that hit me close to home. All seemed clustered together, multiplying my grief, which left little time for thoughtful reflection. When I interviewed for my fellowship and was questioned about how I planned to cope with all that I might experience, I knew the answers. We all do. But now it wasn’t just a simple interview question. It was real life and I realized that I was not coping well with the turmoil that surrounded me.

Just like my patients, I needed to develop a solid plan based on tried and true guidelines. So, I did what we do best and researched treatment options. Seeking the advice of those I greatly respect, I developed strategies that I now use in my own life and in clinical practice to help me deal with those disappointing events that we all will occasionally encounter.

Removing the judgment from who should or should not have X Undesirable Disease is imperative. It is not uncommon to ask, “Why me?” We certainly don’t always have the answers, but if we’re honest perhaps the question should be, “Why not me?”

Horrible things happen to young people, old people, people we like, and people we find more challenging to like. Our human bodies are not perfect. If we allow ourselves to think such thoughts as “Mrs. Jones should not have this cancer, she is too kind!” then we have personalized her condition in a dangerous way. Yes, death or other undesired outcomes do happen. But we must also remember that life and cures happen!

If we would honestly keep track, the good events we witness could far outweigh the bad, though it is easy to let our focus slip and momentarily think otherwise. When an undesired outcome does occur, we can still find joy in helping each patient reach their individual goals. Perhaps it won’t be through providing a cure to a patient, but we can direct our efforts to help our patients accomplish something they may deem as equally important—whether it is ensuring that our patient makes it to their child’s wedding or helping control symptoms so he or she can enjoy a family vacation.

When a patient does die, often writing a card or talking with the patient’s family can bring important closure. Despite anything else going on with our other patients, we must always remember that when we enter the next patient’s room and the door closes, our feelings and thoughts about other people and events must wait outside. We must focus all of our attention on that single patient, provide the care that they need, and avoid spreading ourselves too thin emotionally.

Lastly, though it may sound obvious, patients do rely on us to be their doctors. There will always be a proper place for holding someone’s hand and sharing tears, but if we become excessively involved to a point that we cannot professionally guide or care for them as a doctor should, we will be unable to provide the quality care that prompted them to seek out a physician in the first place.

We have all worked hard to get where we are now. However, this pattern of “Work harder, get a better grade” or “Spend more time reading, know everything for the test” doesn’t apply to life outside the classroom.

Although we hate to admit it, we do have limits. We must learn to set realistic boundaries, know when to ask for assistance, and be willing to do so to avoid complete exhaustion which would make us incapable of helping those with whom we can really make a difference.

Joining a practice with colleagues who share similar styles of patient care is important so that we can fully trust others with the patients that we care so much about. This also allows us to occasionally take much-needed time off. Along this same line, some may find it important to seek balance in their practice by maintaining a certain number of patients with benign rather than all malignant conditions. Although physicians tend to be very giving by nature, we must also set personal boundaries with our time. Not even the most well-meaning colleagues or patients will usually ask you to stop spending time with them so that you can accomplish other necessary tasks.

Developing a list of both short- and long-term professional goals can help. Although there are many cases with which we may like to be involved, we simply cannot do it all. Although we should all seek to lend a hand to others whenever possible, we do have physical, emotional, and time limitations, and acknowledging our finite resources is healthy practice.

Finally, finding a mentor or other colleague within a similar field with whom we can occasionally discuss what we experience is also important. Just as we may not be the best sounding board for someone in a field in which we are not proficient, it is frequently difficult for those in other lines of work to fully relate to the struggles we frequently encounter.

Since beginning fellowship, have you ever had a headache and wondered if it was reflective of a brain tumor? If so, you’re not alone. The things that we are surrounded by on a daily basis are frequently the conditions we fear, and may assume we have, when we don’t feel well. Just like our patients, we should seek appropriate medical care when needed.

However, acknowledging this pattern of thinking can be enlightening. We must realize that we do have a life outside of work, and there are certain places in which we are truly irreplaceable. Although it may be hard to hear, if we’re honest, another physician could take over our practice if needed. That is why we continue to train new physicians each year.

Where is it that you are truly irreplaceable? Is it as a child, parent, friend, or spouse? Make an effort to embrace and maintain relationships where there simply could never be another you and intentionally share special moments on a regular basis with those people or events that matter the most to you. Lastly, participate regularly in a hobby outside of work that you enjoy.

If we are intentional about creating and practicing guidelines for our emotional health early on, perhaps we really will be able to enjoy a balanced lifetime of practice and be capable of making a difference for generations of hematology and oncology patients, just as we all hoped to do when we joyfully began our journey in medicine.

Marci Allen, DO, is a hematology/oncology fellow at University of Kansas School of Medicine.

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During my second year of fellowship, I witnessed numerous events that hit me close to home.

Marci Allen, DO

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Maintaining Balance