The Sandwich Generation in Otolaryngology

The hardest moments will always be when we have nothing left in the tank. I have shared in prior articles how self-awareness is critical, so we can identify when we reach that point, focus on our own recovery, and continue to care for others.

I was so impressed by Dr. Echanique. She shared that she had her first daughter as a chief resident, operating a full day the day before induction at 39 weeks! She moved to Cleveland with a four-month-old infant to start her facial plastic and reconstructive surgery fellowship. Her parents moved in for weeks at a time during that fellowship year, which allowed her to be a fellow. She had her second daughter as a new attending, 11 months into her new job.

She articulated the challenges of missing her children’s milestones, being sleep-deprived, and carrying a significant mental load. No one knows or hears the immeasurable constant planning, anticipation, timing, and decision making amidst breastfeeding before leaving for work, then pumping at work.

“Maternity leave is NOT a break,” she shared. This is a profound, accurate, and necessary acknowledgement and validation for us all. Immense guilt about optics from taking time off, pressure for success, and duration of breastfeeding, along with constant worry about milk supply, transport, storage, and planning feeding for caregivers—I have never heard our reality so plainly and courageously spoken out loud.

Dr. Echanique shared the definition of “mental load”—the responsibility of remembering, planning, and worrying about what needs to happen—even when you’re not the one physically doing it. When she shared examples of text messages received at work from caretakers asking her about her status, questions about food, and decisions for feeding her infant, I am certain most of us could relate, particularly female surgeons.

Boundaries and Strategies That Work

While none of us on the panel described grand solutions, we did have some recommendations for small adaptations that help: switching call during true crises; planning early rounding on weekends to preserve family mornings and breakfasts; accepting that some days are simply about survival; letting go of guilt entirely—guilt serves no one; allowing partners to support us; setting boundaries; accepting family support; finding dependable childcare; receiving support from department/residency/ Fellowship; outsourcing; choosing texts over calls from our loved ones—family always comes first!

Redefining Success

Dr. Simons and I are in the senior phase of our careers and life stages, and our definitions of success have changed. For me, as I shared with the audience, productivity is a measure; it does not define success. For him, success shifted from academic output to being present for both generations without resentment. Success became quieter, more personal, less measurable.