and uncontrolled pages add to the confusion. Bringing studentsinto the operating rooms to observe the fourth carotid endar-terectomy does little for the patient or for the learner.

Academic services can be efficient. It’s always interesting tonote how much more efficient a surgeon becomes when he orshe graduates from the residency and becomes a private practi-tioner. Suddenly, the hospital duties can be discharged in anhour, communications improve sharply with the nurses, and

dictations are completed in time with little effort. There is timefor golf and other hobbies. And most attendings manage to behome on most evenings. Perhaps it’s time we learned from ourstudents.

Please read those three essays again. I think they’ll convinceyou that the eighty hour work week is not the final answer.

doi:10.1016/j.cursur.2004.03.001

Lists, Lists, and More Lists

Akuezunkpa O. Ude, MD

Department of Surgery, Columbia Presbyterian Medical Center, New York, New York

How do I manage life outside the hospital? A variety ofadjectives popped into my mind—slowly, chaotically, system-atically, sporadically. . . . Is there life outside the hospital? Yesthere is, and my real answer is that I try not to manage my lifeoutside the hospital, but I cannot help it. I confess, I cope withmy life outside the hospital much the same way I handle my lifein the hospital: by writing lists and filling in empty boxes.

Like all other residents, I strive for efficiency. I try to fill inblocks of time with the little tasks that need to be completed. Asmy patient is being interviewed by the anesthesia team, I writethe shell for my operative note and my postoperative orders. Atmorning rounds, I anticipate who will need daily labs and writethem up. To assist with organizing the multiple tasks of the day,I write lists with little empty boxes in front of each line. WhenI complete a particular task, I shade in the box on front of it.Some tasks merit three boxes. For example, chest x-ray (CXR)gets 1 box for writing the order, 1 box for when the film is done,and 1 box for checking the results. All of this gets written on thesacred patient list that becomes my guide for the day.

For my duties/chores/tasks outside of the hospital, a.k.a.“life,” I write my lists on a yellow legal pad. The yellow is softerand more pleasing to the eye, and I can distinguish cold, hard,“work” duties from soft, yellow “life” duties. The rules of theyellow lists are the same as for the white list, but they are some-what more flexible. I do not have to finish the yellow list by anyparticular time, and the repercussions of not doing so are not asgreat. Some of the items can be postponed until the next weekwith little ill effect on anyone, especially me. Here are a few sampleentries on my life list and how I can postpone them until later:

A typical heading on the yellow list is “laundry.” I can forgoa week of laundry by buying new clothes, underwear, or socks,

or by dipping deeper into the “dry clean only” part of the closet.“Food shopping” is another common entry. Here in New YorkCity, I can get any type of cooked food delivered to my doorsteparound the clock. I know residents who have not turned ontheir stove since they moved to the city. (I personally have notcooked for about 3 years. I was recently informed that boilingwater for Ramen noodle soup does not count as cooking.) An-other typical chore is “hair”—now this is a touchy thing for ablack woman. I have perfected the art of the ponytail in all itsvariations—bun at the nape of the neck or a little higher on myhead (ballerina style), long single braid, and free bushy ponytail.As for the front—no part, a center part, side parts, or justslightly off center—the combinations are endless. As far as I amconcerned, there is nothing that hair gel and hairspray cannottame. I have been compared with a librarian at times, but as myhair is covered whenever I am in the operating room, who cares?

As time has progressed, the personal list has come to includeitems like wedding, apartment, loan officer. . .things that aremore difficult to postpone. Fortunately, other tasks on my listhave now been passed on to the relatives—mother, sister,

Correspondence: Inquiries to Akuezunkpa O. Ude, MD, Department of Surgery, ColumbiaPresbyterian Medical Center, Milstein, 7th floor, Room 313, 177 Fort Washington Ave-nue, New York, NY 10032; fax: (212) 305-8321; e-mail: au38@columbia.edu

Akuezunkpa O. Ude, MD

CURRENT SURGERY • Volume 61/Number 2 • March/April 2004 181

brother—with whom I live. As they eat 3 meals a day and do nothave the option of wearing scrubs and have coworkers whonotice when they wear the same outfit twice in the same week,I let them be in charge of laundry and food shopping.

So my rules for the yellow list are as follows:

● Write it down, but don’t beat yourself up if you don’t get toit

● Rely on your family● Unscheduled, time is a rarity, enjoy it and learn to be

spontaneous.

How do I manage life outside the hospital? I manage my lifeoutside the hospital by trying not to.

doi:10.1016/j.cursur.2003.11.006

Rules for Success

Anne M. Conquest, MD

Department of Surgery, Brody School of Medicine, Greenville, North Carolina

When asked to participate as a writer in Current Surgery’sRipples section, I was in the usual state that one often findssurgical residents in—groggy-eyed, sleep-deprived, and enter-ing that out-of-body type state we experience with extremeexhaustion. How could this be, you might wonder, in light ofthe recently mandated 80-hour workweek? With shortenedhours and postcall reprieves, residents should rarely if ever de-teriorate to this level. In fact, it was not my clinical duties thatbrought me to this familiar state. I was recently relieved frommy clinical duties as a fourth-year resident. In fact, I had takena new job, which demanded even longer hours and a degree ofstress commensurate with that of a surgical residency—mother-hood. With some trepidation, I agreed to participate, all the whilewondering how I could fit this assignment into my schedule.

The roles I play outside the hospital are multiple. Besidesbeing a new mother, I am a wife, a friend, a dog owner, achurchgoer, a long distance runner, a fiction reader, and amovie buff. The biggest challenge I face each day is how tonurture these roles in the midst of a long and demanding sur-gical residency training program. By developing and following afew simple rules, I have been able to successfully manage lifeoutside the hospital.

My first rule is: “set the bar low.” I know this sounds strange,considering most of us as physicians have been overachievers allof our lives. It is the most difficult rule for me to follow. How-ever, when I attempt to play all my roles at once, I inevitablybecome frustrated and disappointed with myself. It is unrealis-tic to expect that after leaving the hospital each evening, I will beable to walk the dogs, go for a run, bathe, feed, and play with myson, have a quiet dinner and conversation with my husband,visit with friends, and read a few chapters as I fall asleep for a

good night’s rest. By choosing to play only a couple of roles eachevening, I end my days happy and fulfilled. Although demand-ing less of myself on a daily basis means prolonging the length oftime needed to achieve certain goals (finishing the book, run-ning the marathon), it spares me feelings of failure and guiltover shorter term goals not met.

My second rule is: “hire lots of help.” My husband and Iloved the acre of land our house sat on when I started residency.We were not feeling the love by the time the second summerrolled around. It routinely took us a day to decide whose turn itwas to do the yard work and another to actually do it. I hate theidea of spending what precious little time I have away from thehospital performing the picayune details of everyday life. Byhiring a yard service, a cleaning service, and occasionally a shop-ping service, arguments regarding domestic duties cease to exist.

Correspondence: Inquiries to Anne M. Conquest, MD, Department of Surgery, BrodySchool of Medicine, 600 Moye Boulevard, Greenville, NC 27834; fax: (252) 847-2366;e-mail: conquesta@mail.ecu.edu

Anne M. Conquest, MD

182 CURRENT SURGERY • Volume 61/Number 2 • March/April 2004