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    Resilience, Self-Care, and Running the Long Race

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    Ruth D. Williams, MD

    By Ruth D. Williams, MD, Chief Medical Editor, EyeNet

    I learned a lot from running marathons. Like much of life, the preparation, the training, and the discipline are as im­portant as the event. I admired and studied elite runners like Paula Radcliffe but most valued the friendships forged on the trail with my Ethiopian coach Emmanuel and my running partner Jenna. I learned that the body can be trained to obey the mind and that perseverance trumps speed. I also learned that marathons don’t get easier: Every race had its own difficulty, and each time was harder than I’d remembered. I’d heard about “hitting the wall” and the magic of the last 6 miles, but the first time those “6 miles of truth” happened to me, I was astounded. After crossing the finish line and qualifying for Boston by 6 seconds, I wept. (Then, a race worker handed me a medal and a beer.)

    As it turns out, a marathon is a lot like the COVID pandemic. This pandemic is long, and we are weary—and, hopefully, we’re now running those last 6 miles. One of the most impactful sessions of last November’s annual meeting was David Parke’s interview of Saul Levin, MD, the CEO of the American Psychiatric Association. Saul pointed out that physicians live with chronic stress and have done so since medical school—and that the pandemic has overloaded our usual coping mechanisms.

    The most common symptom of burnout I’ve heard from ophthalmology colleagues is extreme fatigue. Most of us now find our work—which is usually fulfilling and even fun—exhausting. Our patients and staff are on alert, and while we all muddle through, communicating and breathing with half our faces covered, they look to us for guidance and leader­ship. We, the physicians, need resilience more than ever. What is resilience? According to the American Psycholog­ical Association (APA), it’s “the process of adapting well in the face of adversity, trauma, tragedy, threats, or significant sources of stress …”1 The Stanford Medicine WellMD site identifies resiliency as one of the most important qualities a physician can have—and notes that it can be learned and supported.2

    In this period of chronic stress, it is essential to recognize that highly stressful events are “normal” occurrences in life. It’s the narratives that we create around the events and the actions that we take—as opposed to becoming disengaged—that support and strengthen our well-being.

    As the APA notes, one of the most important strategies we can use to build our resiliency is to make self-care a priority, including advice from the Academy ( Much has been written about self-care these last 12 months. During the early months of the pandemic, many ophthal­mologists made the effort to walk, garden, bake, do yoga, and spend more time with their families.

    But now that it takes a greater amount of time to see the same number of patients, and providing their care is more cumbersome, self-care is more challenging. At this point, I think self-care includes giving ourselves permission to relax in the evening after a day of seeing pa­tients instead of continuing with our usual drive for constant productivity.

    Leaning on community is another aspect of resiliency, and the psychology experts emphasize the importance of family members, friends, and local organizations as support structures. I include the ophthal­mology community in this web of support. During AAO 2020 Virtual, each session included a chat stream, and the common refrain was how much people missed being together. We are more cognizant than ever of the importance and value of our commu­nity, and I really can’t wait to see you all in person.

    Most significantly, resiliency is related to having purpose, and this is where we shine. One of the reasons I love oph­thalmology is that our raison d’être is so tangible: to improve and preserve vision, thus giving our patients quality of life.

    What a marathon!