Lessons learned from being very busy

0:00 Welcome to the Clinician Researcher podcast, where academic clinicians learn the skills to build their own research program, whether or not they have a mentor. As clinicians, we spend a decade or more as trainees learning to take care of patients. When we finally start our careers, we want to build research programs, but then we find that our years of clinical training did not adequately prepare us to lead our research program. Through no fault of our own, we struggle to find mentors, and when we can't, we quit. However, clinicians hold the keys to the greatest research breakthroughs.

0:40 For this reason, the Clinician Researcher podcast exists to give academic clinicians the tools to build their own research program, whether or not they have a mentor. Now introducing your host, Toyosi Onwuemene. Welcome to the Clinician Researcher podcast. I'm your host, Toyosi Onwuemene, and what an absolute pleasure it is to be talking with you today. Thank you for tuning in. Today I'm talking about lessons learned from being too busy. Lessons learned from being too busy. And I'm so excited to share this episode as a learning lesson for myself in my life right now.

1:23 Okay, so why do I bring you this episode? I bring you this episode because recently I've gotten into a place where I can say, you know what, I'm too busy right now. I'm doing too much, right, this moment. And why do I say that? Well, so in general, I want to take a step back and say in general, I tend to stay on the side of, err, on the side of busy. I have a strategic plan I made at the beginning of a quarter, of the quarter, and I say these are the main things I want to accomplish. And these are usually my research and writing goals, not counting the things that are already on my schedule. So I said yes to a webinar a few months ago that's going to be happening. I said yes to this. So, so there are other things that are already on the schedule. And then I say, well, with all those things that are happening on the schedule, these are the things I want to accomplish.

2:08 Okay, great. And then that's, that's usually not my usual schedule. So it tends to, it's busy. I always have things to do. And my strategic plan, contrary to the way I was taught to do it, I'm supposed to just put a few things on there and then accomplish those few things and then celebrate the few things I accomplished. But I tend to do this, but a lot of things and just see how much time I got done exactly. And I'm not saying that should be our strategy. I'm just saying that I really love that game of saying, well, I said I would do seven things and I accomplished five. And in reality, I should have done three. I'm so excited that I got five done. So I really do enjoy that. But anyway, that's my usual schedule.

2:50 So a couple of weeks ago, we had a conversation with a program officer. It was a great conversation. And the program officer said, ah, your ESI status is running out. You should put in a grant for this next cycle. So we have a grant that's already under review and we're thinking, we're thinking it's going to be funded. And so this person recommended that we actually submit a grant, an R01, before the next funding cycle. I mean, before the next submission cycle. So here's the thing, though. It was five weeks from the deadline when the person said, or five weeks from when we would have to turn in the grant from when the person made the recommendation. And so my co-investigator and I are looking at each other saying, we're going to take up this opportunity.

3:32 It is an opportunity. Should we do it? And we also knew it was like, well, when it comes to grant writing, you create space for grant writing. You clear the table to be able to write grants. At least that's been my experience. And I had not cleared the table. I don't know if she had either. But we decided we were going to take up this opportunity. We thought it was a great opportunity that we shouldn't miss. It was not on our radar. And we were going to take advantage of it. But at first, though, we needed to try to get some other loose ends tied up so that we could move this work forward because I tend to be a person who always has a project on hand. And it's important, again, one of the reasons it's important to me is because when people come with their projects that they want me to work on, I want to be clear about the projects I want to move forward.

4:18 So I don't let somebody else's great ideas, which are always great, get in the way of the work I actually want to accomplish. So this is why I keep a running list of work to do so that I'm not confused about the fact that my schedule is already full. OK. But then if there's a greater priority thing that comes up, usually there isn't. But if there is, then I can say, OK, well, why don't I move my work so that I can get this other work accomplished? But this was one of those situations where this grant was a real opportunity. And let me share the real opportunity. So although I have other funding, as a clinician, it takes time really to build up. And your ESI status is your ESI status.

4:59 That's 10 years from your terminal degree. Most of us in medicine, our terminal degree, if it's a residency, it takes a long time to get to your faculty position, to build up your faculty position, to learn to be able to do the research, to then get to submit the R01. And there are benefits that come from your early stage investigator status. So there is this clock that's ticking from a perspective of NIH that gives you an advantage. You get a couple of points towards your score. It gives you an advantage in peer review because you're an ESI. For physicians, it takes you longer to get to your first R01 or to get your first R100 relative to, say, our PhD college. So let's just say that it is important and it does help to be able to have this ESI status.

5:43 But for physicians, the clock tends to run out a little bit sooner. Anyway, so I say that to say that my clock was running out, but I wasn't too worried about it because to be honest, I like not to be bothered by these kinds of things. I'm like, yeah, I know that's important. Is it going to kill me to get there? Not going to do it. Okay, so this came up where the program officer said, well, you should submit anyway. And here's the benefit of submitting. Even if you are not funded, you still have a window to be able to turn around and resubmit and still keep your ESI status. Now that was really, really helpful counsel. And we knew that we needed to take advantage of it. So for this particular situation, we're submitting a grant as two ESIs. And so at least at the time at which we were submitting two ESIs, they get a special consideration as opposed to one ESI and the other person's not an ESI.

6:33 So because we knew we were going to submit this application, at least in the future as co-PIs who are both ESIs, we knew it was important to take care of this. Okay, so that meant that on top of my very busy schedule, I added now an R01 grant, which takes a lot of time. And maybe if you've been writing R01s for 20 years, maybe it doesn't take you as much time, and you have a whole team that writes it for you. Not there yet. So let's just say it definitely took time. Okay, so on top of that, I'm also rounding on service the week it's due. Okay, so that means busy, busy, busy time and not really realistic for getting a bunch of grant writing done. Oh, and in the midst of that, I'm moving.

7:19 So I hope it's coming together to help you understand how busy a season it is. I should say has been, but it's not over yet. It has been and it still is right now. And it's been one of those seasons where I am literally just moving from one space to the next, trying to like cut corners to make things happen. For example, when I say cut corners, hopefully it's not terrible cutting corners. But for example, I went around at... Oh, and okay, so the other thing that comes up is that it's the end of the semester for kids who are going to school. So I have kids in elementary and middle school. And this was the time of year where it's like, oh, this is the band end of year band party.

8:01 And this is the end of year celebration. There were a lot of end of year things. And I was determined to attend all of them. Yeah, yeah, it's getting crazy and crazier as I talk about it. But so this particular day, I'm trying to explain to you the shortcut and I need to get to the points of this particular episode shortly, but let me just set it up. I go to the end of the year party because my daughter wants me to be there and I do want to honor her and be there. So I go and then I go and continue my writing and then I go round. And then instead of seeing the patients after rounds, I stop and I do my writing and then I go see patients. So I actually am the person who is going around at 8 p.m. still seeing patients.

8:44 And I run into a couple of my anesthesia colleagues or one anesthesia colleague who was finishing a cardiac surgery. He was like, are you here at 8 p.m. seeing patients? And I'm like, yes, I am. But it's that kind of season. Okay, so busy, busy, busy. And I want to just share learnings from being super busy. I don't want to say too busy because at the end of the day, who defines what's too busy? I certainly feel as if right now it's a little busy. But I want to share learnings from being super busy. And you know, sometimes people we talk about how, you know, you shouldn't be and all the things you shouldn't do. But I want to talk about what is important from seasons of being too busy, what you learn.

9:25 It's five things. So the first thing I want to share is that it tells you very quickly what you prioritize, very quickly, because a lot of things, the fact that you have so much on your plate means that there are things that are not getting done. It's just the reality. You have so many things on your plate. There's things that are not there, things not getting done. But the things you prioritize are clear in your priority list. So clear. So looking back on this week, and all the channel or I should say it was last week, because this is the beginning of a new week at the time I'm recording this. But when I look back, I see the things I did get done all through last week. And I'll tell you, one thing I did get done is we got the grant submitted.

10:05 We did. And what does it tell me? It tells me that I prioritize my research and writing. I absolutely do. I got the grants that we got the grant submitted. And you know, it might be to you like, oh, okay, great. So you prioritize the grant application. Whoop-de-doo. It's not a big deal. I'm not saying it's a big deal. I'm just telling you that I learned a lesson of what I prioritize. If I go beyond the fact that it was a grant submission I prioritized, I think what is clear to me is that I prioritize the academic things I'm supposed to do. So let me tell you why I do prioritize grant writing. I really enjoy creating the future through my writing. And that's how I see grant writing.

10:46 It's a creation of a future that does not exist. And it's built on the potential. It's built on reality. I hope it is. But to some extent, I'm making some stuff up. I'm like, yeah, if we do this and we do this, then we're going to discover this and then we're going to move on. We're going to do this. And I'm creating a future that's not yet. So I really, really, really, especially in my area of interest, I love grant writing because I'm well aware that I'm creating a future that does not yet exist, that will not exist unless I declare its existence. And the grant may not get me to, I may not get the funding from the grant, but what it's doing, it's laying for me a very clear understanding of how I move forward to make this future possible.

11:29 I really enjoy that. I enjoy the benefits that come from that, enjoy the fruit that come from that. Now, do I love all the other parts of the grant that are not like the background and significance and the approach? Not necessarily. They're the things that get me to where I want to be. And the grant deadline is a forcing function. It's like, well, you can think about the future when you have time or there's this deadline and why don't you create the future right now? And so I do prioritize that because I love the idea of creating a future that does not yet exist. So you learn about the things that you prioritize when you're super busy because these are the things you do not let fall even when other things fall.

12:10 The other thing I didn't share that I prioritize that I maybe have came through in the story is that I prioritize being there with the children. I did. I absolutely went to the end of year party. Now was I required to be there? No. But I enjoy being there because the skits that they put on are so funny and it's a great laugh and to be honest, it's so lovely in my life to be able to sit and do something that has nothing to do with my work. And so I prioritize family time and I prioritize the rest that comes from doing things that are so unrelated to my work. So yes, I have more than one priority because I can and you can too. But I recognize that as I look back on the week and how I spent my very busy week, I definitely had those two things rise to the four things that I prioritize.

13:00 Okay. Number two is that it shows you the things that you do not prioritize. So I know that that feels a little circular like, okay, great. It shows you the things you prioritize or the things you don't prioritize. How great is that? But what I'm saying is that there are things that are at the bottom of your list that tells you that you actually don't care for. You're like, you know what? The skin fall and I don't care. This is important because remember we always talk about, I talk a lot about the 80-20 rule, but it's the 20% of things you do that really move you forward versus the things that you do that don't move you forward. And very quickly, when you get into a season where it's super busy, you recognize the things that you let fall to the bottom and you're not even bothered that they fell to the bottom.

13:46 Now here's the thing. They may be important things, but you're letting them fall to the bottom. It shows you that you don't value them at least to the level that you say you value them. And so this particular scenario helps you recognize, well, so should I care about those things and what can I change in my life so that those things rise to the core? For example, maybe what you let fall to the bottom was your family and you're like, oh, well, yeah, I guess I don't prioritize them at all. And you can decide that's okay for you or you can decide, well, I don't want that to be the case. I want a scenario in which I prioritize family. And then you can choose.

14:26 Right? So it shows you things. It doesn't judge you. This is not a judgment. It just shows you things. It's like, oh, when you were super busy, you let X, Y, Z fall to the bottom of your list. What does that say? What would you like it to say? How would you like your priorities to look like to you? So what it helps you do, it just helps you level set. It's not to judge you. It's not to say you're a bad parent or it's not to say you're a bad this or that's not about good or bad. It's just about, hey, when it gets super busy, we can see what you bring or what you prioritize and we can see the things that you let fall. Is this how you want it to be? Now I will tell you just in case I'm making it up or it's appearing as if I'm great at prioritizing family and my grant in the same week.

15:13 I did not exercise. I exercise daily. I let exercise fall to the wayside. Until your second thing, I let fall to the wayside. I did not sleep well. So I'm not doing great in those two areas. I want exercise to be one of my highest priorities. I want sleep to be one of my highest priorities. And what it showed me in this past week is that I let sleep fall to the wayside. Now some of that is that I'm on call and if they call me at night, here I go. I get up and I make that happen. But I said that's not a priority. Whether that is that my work made sleep not a priority or that I made sleep not a priority. It was not a priority on my list last week. The other thing that was not a priority on my list last week that showed is that I did not, I did not, I took out sleep.

16:01 Oh, exercise, my goodness, I let it fall to the wayside. I've said, and when I look at my list, I've said exercise is optional. And it's not optional. I don't want it to be optional. I want exercise to be one of my highest priority items daily because it makes me feel good. And I love the benefits that come from exercise, all the health benefits and the good feeling benefits too. So it's at the bottom of my list this week. I can tell because I see what I did, but I don't want it to be there. So it's just telling me that, KLC, you want exercise to be a priority, but it's clearly not. How can you change that? That's the gift that being super busy gives you is that you're able to align the things that maybe you do want to be higher priority list, but they're not.

16:47 And what do you want to do about them? All right. Number three is that you discover the limits of your sanity. What do I mean by that? You discover what triggers you a little bit more easily than in scenarios where everything is cool and calm and not so busy. And I want to bring this up because to be honest, I'm talking to an audience that gets really busy and you've had your busy weeks. And it's funny, you've had busy weeks where you're like, it could never get busier than this. And then of course next week comes and it's like, oh, this is crazy busy. Oh my gosh. Right? So you, you've had busy needs, sir.

17:28 This is applicable to you, I hope. There are times where you are so busy that it does not take much to push you over the edge and it will happen a lot more when you're so busy. So you recognize that, okay, this is how I behave when I'm triggered. This is how mad I get. Or maybe you're not triggered. And that's important to say, wow, the work you've been doing is paying off. This didn't trigger you even when you were super busy. And why is that important to understand the limits of your sanity? Okay. You know, you work with people who, if you're in academic medicine, you work with trainees and it may be okay for you to get super mad around your college and you probably know better about, you know better not to do that.

18:14 Or it may be okay to get, it probably isn't okay to get mad when any significant amount of weight around your division chief or your mentors, right, you know, better. But sometimes you feel like your guard is let down and you might get mad in front of a trainee and now that's the problem, right? That's a problem. Maybe the trainee does something and you suddenly snap. Oh, that's a problem, right? That's a problem. And you want to be aware of the limits to which being so busy pushes you so that you can decide that number one, you're either going to dial it back or, you know, do what it takes to exercise the kind of self-control that no matter how busy you get, you're still pleasant and kind and respectful to everybody around you.

18:58 And so this is very important because then you learn very quickly what your limits are and then you can choose in a non-judgmental way how you're going to respond to that. And maybe you find that, hey, no matter how busy I get, I'm still kind of courteous to everybody. That's beautiful. So you're doing the work that helps you continue to show up as your best self even when things get super busy. But if you're finding out that you're snapping, you're yelling at people, people think you're a monster, okay, maybe dial the busy list down. That's hard to do in that lesson. Or do the work, the internal work that's needed to show up in a way that's respectful and honorable to the people around you even when you get super busy.

19:42 So you learn when you're super busy the limits of your sanity and the things that trigger you. Okay, number four, you learn what it is you still need to learn. Now that's how it came back to me in my example where I cut out exercise and I certainly was not getting enough sleep. I want those things to be a priority. So I'm learning in this experience of being super busy what I still need to help myself learn as high priorities. So what I'm seeing in the way I behaved or the things I didn't prioritize is that I've decided that exercise is optional. I don't want that to be the case. I want it to be fully required. And so what work do I need to do to tell myself to help myself learn that no, no, no, this doesn't fall aside.

20:30 So I learned the things that I need to learn. I'm learning that I need to work hard to prioritize exercise in my mind so that it's something I do consistently. How about sleep? One of the things I've learned is that I want to be able to continue to do this work no matter the work I have to do in the hospital. And so maybe this clinical work I do that keeps me up at night is not what I want to do. Right? So now I have the opportunity to say, well, how do I want to structure my clinical work so that I'm not waking up in the middle of the night? And I can do that because I'm building my career as I'm moving forward, building my career as I'm living it, and everything I do is optional.

21:13 And I need to decide how do I live? So I'm doing clinical care. Clinical care is still part of what I do. How do I do the clinical care such that it doesn't interfere with my research and writing? So for example, maybe what I do is I sign up for the Fellows Clinic because I know that the Fellows Clinic does not involve overnight call. So it just shows me different strategies that I can use so that I can prioritize sleep even when things get super busy. It's hard to prioritize sleep when you're being paged in the middle of the night. And I recognize that that's extrinsic to me. But the choice that I make is whether I continue to show up in the space that limits my ability to sleep in times of busyness. So that's one example of the way I'm thinking about it.

21:57 So you learn things that you still need to learn or you learn about opportunities to adjust things in your life so that you can show up the way you want to. Okay? All right, wonderful. You learn that only you can stop the train. So can I be honest and say that I'm really busy this week where I'm falling asleep while having conversations with people? That is really crazy busy. And I think it's a little too busy. And in reality, I'm the one. Is nobody making me busy? It's not the clinical work. It's not the grant. I chose, right? I chose to keep my schedule the same. I chose not to take time off in the middle of a move. I am choosing. And so the train is mine.

22:39 If I'm like, wow, this train is going at a really high speed, that's because I'm driving the train. And if I want the train to slow down, guess who slows the train down? I do. And if I want the train to come to a crash and stop, guess who does that? I do. I do. I choose. And nobody can stop the train of busyness except me. And I have to say that when these kind of scenarios come up where things get super busy, it really is a great opportunity for rest and reflection and to say, hey, what does it take to not be so busy? What does it take to not let things that should be a priority not be a priority? What does it take to make the priorities, to fix the priorities so that the things you want to prioritize are the things you're prioritizing?

23:24 And so I recognize that I fully have the power to make change happen. And so am I going to exercise my power? Of course I'm going to because this is crazy. I also recognize that it's for a very defined period of time because by this time next week, my life is over. And so it's gone. But I also recognize that what I have is a pattern. What I have also is to some extent, it's a structure for busyness and only me can dismantle the structure and create a structure for sustainability over time. So I invite you to think about it for yourself too. So if I didn't judge me, other people certainly are judging me.

24:08 But it is important for me to think about my own experience so that I can change my experience. I invite you to do the same. Or maybe you don't want to. And it's easier to just sit and judge me about it. Please do. Because if it helps you, please do it. But you could consider maybe sitting down and looking at your own experience and saying, well, I exercise power and control in my life. How do I change it for me? And yes, we have choices. And yes, we're always making them. And no other people are not making choices for us. We're making choices for ourselves. And I invite you to think about how you can learn yourself from being too busy. So I talked about five things.

24:48 Number one, you learn what you prioritize. Number two, you learn what you don't care for or what you deprioritize. Number three, you learn and discover the limits of your sanity. And before you learn what it is, you still need to learn what opportunities are available for you to make your life the life you actually want it to be. And number five, you learn that only you can stop the train and you get to choose whether you want to or whether you don't. All right. It's been a pleasure talking with you today. Thank you so much for tuning in to the Clinician Researcher podcast. I look forward to talking with you again next time. Thanks for listening to this episode of the Clinician Researcher podcast, where academic clinicians learn the skills to build their own research program, whether or not they have a mentor.

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