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“Pediatric cardiac anesthesiologist, woman, mother, wife, friend, mentor. I can’t remember a time when I wasn’t trying to “work smarter, not harder” to get it all done and feel good about myself, only to begin climbing the mountain with a fresh list the next day. My goals were simple: peace of mind and a sense that I was in control of my life and doing a good job for all the people who needed me. Just a little more effort, better organization, and I would be there.
As a physician coach, I find that the topic of work-life integration is always at or near the top of the list of issues for clients. Reading Oliver Burkeman’s excellent book Four Thousand Weeks: Time Management for Mortals made me do some critical thinking. Although we act as if time is a commodity, it has no tangible essence. It can’t be owned. And though we constantly behave as if it’s unlimited, we know better, especially as physicians. All we really have is the present moment. What is it we’re really trying to manage? And, equally importantly, what sense of failure do we inflict on ourselves with our continuing unsuccessful attempts to fit more than 24 hours of activities into each day?”
Laura Berenstain is a pediatric cardiac anesthesiologist and physician coach.
She shares her story and discusses her KevinMD article, “The new rules of time management.”
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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.
Transcript
Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Rate and review the show at KevinMD.com/rate. Subscribe at KevinMD.com/follow.
Today on the show, we have Laura Berenstain. She is a pediatric cardiac anesthesiologist and physician coach. She wrote the KevinMD article “The new rules of time management.” Laura, welcome to the show.
Laura Berenstain: Kevin, thank you for having me. I’m a pediatric cardiac anesthesiologist, and that’s a really specific area of medicine, but we’ve had a hugely growing population of patients over the last 25 years, so we’ve seen ourselves get steadily busier and busier. I love what I do. I’m absolutely passionate about it. But there came a point where I realized that not only was it taking a toll on me, but that if I stayed in the OR all the time, I couldn’t do anything else, and there were a lot of other things that really mattered to me.
Kevin Pho: Take us through a typical day of what you do and what separates a pediatric cardiac anesthesiologist from the other specialties of medicine.
Laura Berenstain: I think one of the biggest things is that a lot of my patients have one ventricle instead of two. Since they have one ventricle, they’ve been through, or are in the process of going through, some number of palliative surgeries in order to enable them to survive with that one ventricle. That gets complicated, and over time, sometimes those surgeries fail, and then we head toward transplant. So it’s a really rich and complex area, and it’s growing all the time.
Kevin Pho: You alluded to some of the challenges of the profession. Tell me about some of those.
Laura Berenstain: I think some of the challenges are the very things that attract us. We love the fact that we get real continuity with our patients. We see so many of these patients and families through multiple caths and multiple surgeries, and we develop relationships with them. But that’s also one of the real challenges: Over time, many of our patients do well, but a lot of the patients we see come back most frequently, sadly, are not the ones that are doing as well. So I think in addition to the fact that we work long hours, we work with a really critically ill patient population, and we get emotionally involved at times, and that takes a toll.
Kevin Pho: Tell me how you’ve managed that, not only the emotional toll of the profession, but it really sounds like with these procedures and dealing with a critically ill population, you just spend countless hours in the operating room. Tell me how you’ve dealt with these challenges.
Laura Berenstain: Well, I guess on the personal side, as a mom of three daughters who are now grown up, I feel like I managed that in the best way I could, which is to say that at any given moment, I felt like I was juggling about 12 different balls and was ready to drop maybe two of them. I managed to get most of the things done that I needed to get done, but I always felt like I was behind on more than a few tasks, and I wasn’t at a point where I really felt like I was enjoying my life so much as I was just ticking off the things I needed to get done.
Kevin Pho: All right, let’s transition and talk about your KevinMD article. It’s titled “The new rules of time management.” Now, for those who didn’t get a chance to read your article, can you just walk my audience through it and share the story of why you decided to write it?
Laura Berenstain: Yes. I decided to write it; it was almost a spontaneous outpouring. I sat at my computer one night, and I had recently read the book Four Thousand Weeks by Oliver Burkeman, which is wonderful. But as I sat there, I was just needing to put on paper everything that I had distilled over the last few years. Over the last few years, as I decided to pivot my career and spend less time in the operating room and more time in professional development, well-being, and leadership, I just looked at the way we live our lives, and I said, “How can we expect to be healthy when we spend our lives doing and not being?” I felt compelled to write about some of the things that I finally felt, after years, that I was beginning to learn and that I wish I could have accepted earlier.
Kevin Pho: All right, go into more detail. I’m interested in hearing what those specific things are that you learned now that you wish you knew back then.
Laura Berenstain: I wish I’d known, first of all, why we do anything that we do, right? What’s our purpose? What’s our reason for being? What are our values, and why does it matter to us? Are we just following a script that we think we’re supposed to follow? Because I think a lot of times in medicine, that happens to us. We get very good at taking the tests and following the blueprint and looking for whatever the next defined step to success seems to be, and we don’t necessarily stop and ask ourselves, “Is this right for me, and is this what I want?”
So I think along the way to that, I tried to do everything that I could do, feeling that to say no to anything was somehow heresy. This piece that I wrote really sort of embraced the idea that it’s OK, it’s OK for me to say, “Here are my three main tasks every day.” They might be personal, or they might be professional, but these are the three things that are important to me today. This is what I’m going to get done, and as I do those things, I’m going to allow myself to actually be present while I do them. I’m not going to race through them saying, “How fast can I get this done to get to the next thing?” I’m going to actually do it right, which means, OK, these things I’m going to do, but for other things, if I need them to get done today, this is how much time I have, and they may be good enough.
For somebody in my profession, as with a lot of us, there’s this big streak of perfectionism: It has to be perfect. I needed to let go of that. I needed to realize that there are certain things where I just need to say, “This is good enough.” And I needed to be able to say, increasingly at this point in my career and in my life, “What is important to me? What do I want my legacy, my impact, to be? Am I contributing to things that feel important to me?” Because if I’m not, then I need to develop the skill of gracefully saying no to projects, even if they sound good. Maybe they’re not for me.
And lastly, I need to take care of myself, and that partly means being aware of the things that sap my energy, being aware of the things that give me energy, and balancing the two.
Kevin Pho: Was there a specific event or series of events that led you to this point, where you’re able to be present for specific things during the day and where you’re able to gracefully say no to projects? What led you to that realization?
Laura Berenstain: I think you’re asking a really great question, because the important part of the answer is that it was a process. Now, the decision on my part to pivot my career and the way I was living my life, that was very specific, and that happened four years ago, in September. But the implementation and the doing of that is very much a process. I think that’s important, because when you’ve lived the kind of life most of us live, where we are in high-pressure environments, we’re busy all the time, and we multitask, you can’t turn that off instantly. You have to be patient with yourself.
Kevin Pho: What was that process like, and how long did it take you?
Laura Berenstain: Well, it’s a process that I’m still living and probably will be for the rest of my life. I think it started because multiple influences came to me at the same time. I was already involved in efforts at physician well-being. I was the director of well-being at my institution, and I was a mind-body medicine facilitator, and so that had led me to study meditation and to lead groups. But then I also attended a conference, and I heard Amy Edmondson speak, and she speaks about psychological safety. I was also invited to be part of the Women’s Empowerment Leadership Initiative through the Society for Pediatric Anesthesia, and we specifically are coaching women in pediatric anesthesia to help them gain leadership positions.
All of those things were influences on me. All of those things together made me say, “I feel like coaching is an important direction for me to take. I want to help colleagues coming behind me, and I want to do that in a way that allows them to choose professional development that’s right for them and incorporate well-being into their lives.”
Kevin Pho: Now, ever since you’ve made that pivot into more professional development, tell me about the influence you’ve had on other physicians who have looked at your career and looked at your pivot. Have they ever thought, “I want to be more like that”?
Laura Berenstain: That’s a really interesting question too, because I think it’s so hard for us to see ourselves as others see us, and I think each stage of life holds surprises. One surprise is that, for the parents of small kids, yes, my girls are grown, and on average, I still hear from all of them every day. Two of the three this week tried to guilt me about why they hadn’t heard from me more frequently and why I was ignoring them. So I guess there are certain parts of life that we always are going to have a high allegiance toward, and I think part of what’s important to me now is to recognize and accept that and to say that that’s a priority for me. Being able to do that probably looks aspirational to some of the people behind me, because it probably seems like it is easier for me to make that pivot at this point.
I will say that it was still very scary for me last year when I left a full-time clinical position and elected to become a coach and work part time clinically, because in academic medicine, the only model I’d ever known was that you’re all in or you’re not, right? So carving out this new route has felt uncertain and scary to me, but it’s also exciting, and it’s happening.
Kevin Pho: When you made that pivot and took more of a part-time clinical role, in general, what was the reaction of some of your colleagues?
Laura Berenstain: It was interesting. Some expressed a little bit of envy, and I had one person outright say to me, “I don’t see why you don’t turn your back on this and walk away and never do it again.” But the interesting thing is, just as much as I felt passionate about pediatric cardiac anesthesia for the first 25 years of my career, I wake up every day right now feeling just as passionate about the work I’m doing with the ASA leadership programs, the Women’s Empowerment Leadership Initiative, and my own coaching, because I see this as contributing to the future of my colleagues and the future of how we practice medicine, and that’s crucial.
Kevin Pho: We’re talking to Laura Berenstain. She is a pediatric cardiac anesthesiologist and a physician coach. She wrote the KevinMD article “The new rules of time management.” Laura, for those physicians who are listening to this podcast, maybe you’ve sparked a light bulb moment in them, and they may want to do something similar. What kind of advice can you give them? What kind of things should they be considering if they want to make a similar pivot?
Laura Berenstain: I think the first thing is to allow yourself to ask the questions and live what’s in your heart. Listen to what’s important to you, and realize that so much more is possible than we’re led to believe. We have limitless potential, and there are so many more opportunities out there than we necessarily believe there are. But we have to be brave enough to first understand what it is we really want and then ask the questions to start discovering, just one step at a time, what it would take to move in that direction.
Kevin Pho: In coming to those realizations and answering those questions that you asked, did you have any mentors or coaches, or did you come to these realizations on your own?
Laura Berenstain: Absolutely, I did not. No, I’ve had so many wonderful coaches and mentors, and each one of them, in their own way, has been instrumental. So that’s another thing I’d say: Look for guidance everywhere. Look for a coach. Look for multiple mentors. Ask people if they’ll mentor you. Anywhere that you can find help, seek it out and ask the questions.
Kevin Pho: And my final question: What are some of your take-home messages that you want to leave with the KevinMD audience?
Laura Berenstain: My favorite and biggest message, because medicine is something where, from the moment we first say, “I want to go to medical school; I need to take the MCAT,” we spend our lives projecting about the next step and what that will look like, and when we get to that place, then we’ll be set, and then the next thing comes along, right? So the biggest thing I’d say is don’t jump ahead. Live today. This is your moment. Don’t project yourself into the future and spend your life wishing. Live today, and love it.
Kevin Pho: Laura, thank you so much for sharing your time and insight. Thanks again for being on the show.
Laura Berenstain: Thank you.
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