Trapped?

I followed a very straight path to get to where I am today. I studied hard in high school to get into a good college. In college while others were having fun on a Thursday night, I would hide in the stacks and study. That helped me get into medical school where I continued my tradition. I would take notes during lecture and separate notes on the reading and by hand combine them into a single set of notes which I would copy several times to learn the material. You get the point; I strived to do well to help myself get to the next step- residency, fellowship, a faculty position and academic promotions. Don’t get me wrong- I had fun along the way and I actually take a lot of joy in learning and being better. But I have followed a very straight line of school, marriage, career, kids without any real detours and fortunately few set backs.

I think back to myself as a child. I recently pulled out photo albums from my childhood. I tried to recognize the person in the pictures and what they were thinking. Did I imagine being a doctor and having a family and living in Ann Arbor, Michigan? I always loved writing and reading. In high school, I was in speech and debate and acted in plays and musicals. I considered myself more of an artist than a scientist. My parents supported me but in the background was always the expectation of practicality and having a stable career. My parents grew up with a lot of uncertainty and they craved certainty for my brother and me.

We start our lives with unlimited possibilities. Every new person that enters the world carries innumerable possibilities. I know it’s not great to talk about Dr. Seuss now but his book, Maybe You Should Fly a Jet; Maybe You Should Be a Vet spoke to me as a kid of the world of possibilities that we as individuals could contribute to society. But these possibilities narrow as we become older. Our choices or indecision, our successes and failures, who we know, where we grew up, and so many other variables narrow our limitless possibilities to finite realities. For those with privilege like me, these realities are driven by choices but for so many others, systemic racism and bias block peoples’ path leaving fewer and fewer doors open.

I’ve recently being watching a show called Shtisel on Netflix. This Israeli series follows the lives of an Ultra Orthodox Jewish family living in Jerusalem. Like other very religious groups, their lives are dictated by very rigid rules and social expectations that direct every aspect of their day. One of the underlying themes is showing how this life traps everyone in particular roles and paths. Studying the Torah ( the Bible and other religious texts) and following the commandments are the most important achievements a man can have while marriage and children define the expectations of women. Those who try to take different paths not only risk shame and potential insecurity but also ostracism from family, friends, and the only way of life that they know.

The question before us is what takes more bravery- sticking to the path that honors commitment and expectations or taking the risk to chart our own path and risk losing security and other things we hold dear? I feel that there are distinct generational views on this subject. The “Greatest Generation” that fought in WW2 might argue that it takes strength and courage to commit to a path that was laid out by higher powers. Sacrifice, service to others, and follow-through are the hallmarks of integrity and courage. Contrast that with millennials who view following their inner voice as a road to success. The courage lies in listening to that voice.

Generations are not monoliths and as a GenX, my generation falls very much in the middle and on a broad continuum. I recently watched Dead Poet’s Society with my daughter and the arc of Neil Perry in this movie summarizes the tension between expectations and commitment and following your own dreams. His parents placed terrible pressure on him to succeed academically to go to an Ivy League University and become a doctor while his teacher, John Keating encouraged him to follow his inner voice and Seize the day ( Carpe Diem). The outcome was the tragic end to Neil’s life when doors were closed by overwhelming expectations.

I don’t want to ride the fence on my answer but the answer like many things in life is nuanced and gray. COVID has shrunken most of our worlds this past year. We have all been trapped in our homes, away from friends and family, prevented from engaging in many of the things we love. Nurses, doctors, other healthcare workers, and frontline essential workers have been burdened and trapped with the commitment of keeping services going at the expense sometimes of their own safety and wellbeing. Many have honored that commitment and that has taken courage. Many have quit because of burnout and fear demonstrating the terrible cost of this trap.

Others have flourished freed from the daily grind of commuting and spending hours in the office allowed to work from home. This freedom has allowed some to continue to work while pursuing other activities and options. For those who received payments from the Government, this financial support provided security and safety to live as well as pursue opportunities. With increasing demand in the labor market and some people who accumulated wealth during the pandemic through a combination of income and decreased spending, the media is predicting a wave of people having the courage to leave their jobs and try something new. The mobility of our society has always been viewed as an asset and the ability to take risks reaps the potential rewards of new possibilities and innovation. While the financial buffer helps some, it still takes courage to leave behind the known for the unknown. I don’t want to ignore the fact that while many people have been provided this opportunity, there are still so many others who don’t have this opportunity because of systemic racism and bias.

Neither the burnout of commitment nor the potential chaos of leaving it all behind benefit our society and the systemic bias and racism continue to harm our country in so many ways. The answer lies in being able to take a risk while being held to our commitment. There is already a model for this. Many academic institutions allow tenured faculty to take periodic sabbaticals. Sabbatical comes from the biblical Sabbath. In the Bible, G-d commanded his people to not work the fields every 7 years just like the requirement to rest on the 7th day. Many Universities and some companies especially in England offer employees the benefit to take extended paid time off to pursue other activities. Many academics spend time at other institutions or pursue activities that are innovative but are high risk. Our society values innovation and risk and broad adoption could allow people to take risks while honoring the commitments they have by ultimately returning to jobs that provided this benefit. The government could do something similar by offering sabbatical like support to people that serve in some way. This would provide opportunities for those who historically have been trapped in lives of poverty or hemmed in by bias and racism. I genuinely believe that this could help fight burnout amongst many physicians, nurses, and other professionals. Given a chance, I have many things that I would want to try that I have relegated to my bucket list. I know this sounds crazy and there are many practical things that would have to be sorted out to operationalize this but how much missed opportunity have we had in healthcare by people who have been burnt out and trapped that could have been saved to continue to care for others in the future if just given a chance to explore other possibilities?

Historically sabbaticals have only been offered to tenured faculty but the distinction in work between tenured, non-tenured, and non-academic physicians is becoming increasingly blurred. If I drill down and think about my group, I would argue that we have capacity to absorb one person taking an extended leave at a time. Most people would be willing to work a little harder if they knew they would get their turn. A greater challenge especially in medicine is the implications around quality and safety for those who have not worked in their specialty for an extended time. While most organizations have processes to return people to work through focused professional practice evaluation, there would likely need to be extra focus on people returning from sabbatical. However, I would argue that in many ways, time away could refresh individuals, build new skills, and engender innovation through the cross pollination of exploring other areas of interest. In the end, the person returning from sabbatical is refreshed and re-engaged.

I know this seems impractical but different ideas often seem difficult to implement to start. I believe we could extend the productive careers of many by offering sabbaticals more broadly. Instead of resolving ourselves to a trapped life or taking a huge risk and losing valuable effort that was spent building a career and skills, a sabbatical offers an individual to explore the greener grass on the other side while still being able to return home maybe making their home grass just as green.