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Editor's Corner: It Takes a Village

December 30, 2021
Elizabeth Brém, MD
Assistant professor of medicine at University of California Irvine Medical Center in Orange, CA


"How do you do it all?"

This is a question I have been asked often. It is a good question: I work full time, have two young kids, and I presume I give the appearance of having it somewhat together.

The short answer? I don't.

Since that won't suffice for what is my final "Editor's Corner" (my term as associate editor of ASH Clinical News comes to a close later this year) here's the long answer: I have a lot to be grateful for.

I am lucky to have excellent help at home. While I am at work (whether at the hospital or hiding in the corner of the bedroom/improvised home office), people I love and trust are helping my 6-year-old with virtual school and making sure my 2-year-old doesn't destroy everything in sight.

The focus at home is on making sure the kids are OK and that everyone is fed – certainly not on maintaining a picture-perfect home. If you came to my house, you would find Play-Doh petrifying in the corners, Matchbox cars parked everywhere, walls in need of a scrub, and shelves that have quite possibly never been dusted. I discovered grocery delivery services when our older son was born, so we almost never go food shopping. I am lucky to be married to a great cook, but pre-made Trader Joe's meals are still commonplace. Friday is pizza night, partly to guarantee one night per week when no one needs to think about what to have for dinner. Nearly all clothing and shoes are ordered online from retailers with free shipping and return policies. I would like to express deep gratitude for automatic bill pay, without which I can all but guarantee my payments would be overdue every month.

I would also like to give a huge shoutout to my community-based colleagues who see patients four or five days per week and stay up to date on the entire breath of hematology and oncology. I don't know how you "do it all"!

While working in academia has its own expectations and responsibilities, it also allows some flexibility. I have clinic 2.5 days per week. Even pre-pandemic, I often worked from home on my nonclinical days to spend more time with my kids. Sometimes, I will take the afternoon off to go on a small adventure with the kids, then catch up on whatever emails I ignored or notes I need to finish after they go to bed. I still struggle with time management occasionally, but I feel lucky to have a reasonable amount of control over how I spend much of my time.

Again, I want to emphasize that no one actually "does it all." Aaron Gerds, MD, expressed this nicely in "All Those YESterdays," his May issue editorial, reminding us that, despite the internal and external pressures we feel to say "yes" to everything, it is not always the right answer.

Various career development workshops I've participated in have stressed the importance of learning to say "no." I recommend finding a few trusted people to help you triage "opportunities," especially at the beginning of your career. I have turned to my division chief, mentors, and my spouse to help empower me to say "no" at times. The more you do it, the easier it gets: As an attending, I have declined invitations to join committees and write book chapters that I would not have been comfortable turning down as a fellow. I aim to help my fellows learn this skill so that they feel comfortable saying no, at least to me, if they have too much on their plate.

My other tricks for "doing it all" are about surviving as best you can. For me, coffee is hugely important. While I feel guilty about the waste, I bought a small pod-based espresso maker for my office when I became an attending that gets frequent use. My freezer is stocked with breakfast burritos. I try to bring my lunch most workdays (typically leftovers or frozen entrees), except for when I am on inpatient service. I have learned that, on those busy days, it is much easier to go to the cafeteria and have one less thing to think about. I am also a connoisseur of wines under $10. The primary component of my exercise routine these days is walking the few blocks between clinic and my office, plus the occasional yoga video or Zoom dance class.

As I write this, I am thinking about some of the attendings that amazed me while I was training. One in particular stands out: She had a productive lab, was part of international research collaborations, ran the Boston Marathon multiple times, and attended her son's soccer games. At the time, I was convinced that she just didn't sleep. Maybe she didn't, or maybe she was surrounded by amazing support, had learned how to effectively use her team, and had developed fantastic time management skills.

No one is perfect. No one "does it all." We just do the best we can – and that is more than enough!

Elizabeth Brém, MD
Associate Editor


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