The Sandwich Generation in Otolaryngology

Dr. Simons described taking phone calls about his parents’ health between cases, then going home to help his own children navigate their next stage of independence during adolescence.

Dr. Echanique described mornings where daycare drop-off was followed immediately by a full operative day, only to return home to toddlers who do not care that you operated for eight hours but need their mom’s full attention and presence.

There is no balance! There is only continuous role-switching or serving dual, triple, or more roles simultaneously.

Dr. Simons shared a brilliant conceptual framework, in which, instead of the typical career versus family simple two-sided scale, he sees balance as a pentagon that represents our daily demands (Figure 1).

Figure 1

When It Is Hardest

The hardest moments for all of us were not logistical; they were the times when we didn’t have any reserve and experienced high demands both at work and at home.

For me, the most difficult times to balance were when I was not okay. Burnout. Physical exhaustion. Health consequences. When bandwidth disappears, caregiving in either direction becomes overwhelming and not sustainable.

Dr. Echanique spoke about the emotional fatigue of being a young surgeon trying to prove herself professionally while simultaneously being needed intensely at home by very small children. She acknowledged her husband, live-in nanny, and the two sets of grandparents, particularly her mother, for their support.

Seeing photos of her husband bringing her young infant daughter to see her while she was on call brought back a flood of memories of my own early career after having Claire. Given that neither my parents nor my in-laws ever lived in the same city as us, we relied on close family friends and our social network for support. Of course, full-time nannies during early childhood years, transitioning to part-time nannies during elementary school years, helped. Dr. Simons shared how lucky they were to have the same nanny for almost 17 years. She is truly a family member and still a big part of their lives.

He reflected on the emotional weight of watching parents age while still carrying full professional responsibility without pause. He acknowledged the emotional burnout of juggling countless leadership roles across professional societies, the Academy, and his job. As he shared photos of his beautiful wife, their twin daughters, and their travels, along with one showing him dancing with his mother at the girls’ bat mitzvah, I saw the joy, pride, and love reflected in his smile and voice.