I want to start off with a question, and this is a little bit of like, what am I thinking? Most anthropologists and archaeologists will identify one tipping point in human civilization where we went from being one type of people to another in terms of the one thing that really changed our evolution as human beings. So I'm going to ask you to try to think with me as to what that might have been. Anybody want to make any suggestions? Come on. It's not that late in the day. You have to offer me something. Creation of the wheel. No, it wasn't the creation of the wheel. So I threw one out. Come on. Jim? Come on. What do you think? Oh, okay. Writing. Okay, writing. That's not a bad idea. Anybody else want to toss anything out? Agriculture. Agriculture. Okay. Anybody else want to toss something out? Art. Anything else? Fire. Fire? Okay. So those are all great ideas. The person who said agriculture gets the prize, so congratulations. And cultivation and being able to domesticate animals is what most anthropologists will say tipped over civilization. And the reason for that is because we went from being hunter-gatherers who were constantly in the fight-or-flight and survival mode to being able to have that crucial thing. It's called free time. Free time, okay? Free time is what anthropologists and sociologists and whatever say enabled everything else. It enabled creativity. It enabled cities to develop. It allowed culture. It allowed us to do writing and to write plays and to write music and to paint and to come up with all of the things of the Industrial Revolution and computers and all the rest of it. The key is that it was free time, okay? Because without free time, human beings are almost incapable of being creative. And that's a little bit of what I'd like to almost leave you with, is that you feel that you're very busy and many of you have already expressed to me that it's almost impossible to think about setting your goals and all because you're constantly going from one thing to another. And what I would offer to you is that as you carry on in your career, you need to find that balance because it's not just a matter of for yourself and for your loved ones. But if you don't have it, you're actually not going to be effective for your patients. And if you're an academic, you're not going to be able to have that creative process to write your manuscripts and to come up with your new ideas. Somebody once said to me, actually a colleague of Bill's, Bill and I, that we all make choices in our life, okay? The only thing that you can control is whether those choices are active or passive, all right? So when my daughter was two and a half and she fell and she split open her chin and her daycare was on the campus of where I was a resident, I said to my fellow resident, you're covering me because I'm getting her, I'm taking her to the ER and I'm going to make sure that she gets stitched up right. I could have said, do I have permission? And maybe somebody would have told me, no, you can't leave now. There wasn't anything crucial going on. I was going to be downstairs in my own ER. My husband's a scientist. He would have never been able to navigate the system the way that I was for my daughter. That was a decision I decided to take into my own hands. There are many decisions that we just allow to happen for us and somebody says, oh, can you take call from me? I can't do it. And you say, well, it's my son's baseball championship game and they say, well, you know, whatever. And if they make the decision for you and you allow that to happen, then you're allowing decisions to be made passively for you. Another lesson that I had to learn the hard way is that my work is never done. I never have left my office with everything that I wanted to get done done. Bill, have you left your office with everything done? Jim? Okay. So what do you get to choose? You get to choose when you leave because you are always going to leave something undone that you really wanted to get done, you really thought you were going to get done that day, you really hoped you were going to get done that day, that your chair thought you were going to get done that day. You're not going to leave a patient with an epidural in the emergency room because that's a different sort of thing. But there's lots and lots and lots of work that I carry on from a day-to-day basis because I've never done my work. So the one thing that I can do is control when I leave. And that's going to get a little bit to the keys to a flexible balance. We have demanding jobs, but I will tell you that the studies have shown that if you take two equally capable individuals, the one that works 12 hours a day is actually going to accomplish less than the person that works nine hours a day. And study after study after study have shown this. I'm not talking about the 80-hour work week and I'm not talking about residency stuff and all the rest of it. I'm talking about beyond that, our efficiency does deteriorate the longer we're at work. But there's another component to it. What they found was that those people that were working 12 hours in a day and were accomplishing less than the people that were working eight, nine hours a day was because the people who were working eight, nine hours a day were actually working those eight, nine hours, whereas the people who were there for 12 hours were only working six or seven hours out of that 12 hours. There was a lot of time during that long day that they weren't actually working. And many of us have fallen prey to a lot of distractions. You get on the internet and you're surfing the internet. And then you're not getting home because you didn't get certain things done for your patients. So there are a lot of distractions during the day and a lot of distractions in our life. And so you can accomplish a lot in a shorter period of time by being more efficient. And you have to decide which of these things is more important in creating the balance in your life. There is this great myth that there are superhuman beings. There's supermen, there's superwomen. I can tell you I have never met a superwoman. I am a mother. I am a wife. I raised two kids and I had both of them while I was a resident. I think I've been a reasonably accomplished neurosurgeon. I mean, I do 12,000 to 15,000 RVUs a year, which is probably in the 75th or 80th percentile. I have risen to positions of leadership. I've published a few papers, written a few things. I'm not a superwoman. I can't do it all. I mean, I didn't go to every single one of my son's baseball games. I didn't go to every single one of my daughter's tennis matches. I didn't go to every single one of their school conferences. But I chose the ones that were critical. I went to the championship games. I went with my daughter when she split open her chin. But I couldn't be the best mom and the best neurosurgeon and the best researcher and the best everything. I couldn't do it. I couldn't do it. And probably Bill's one of the people who comes the closest, but even he can't do it. And I can attest to that. He's really good at a lot of things. But he's made choices as well. So what are some of the keys to flexible balance? First is honesty. You have to be really honest with yourself about the choices you're making. You have to be really honest if you have a spouse or a significant other. You have to be honest with your children. I mean, I didn't tell my kids, you know, one thing. I said, I can't come to this because I'm operating today and my schedules could be late. I didn't, you know, kind of mess around with it. And we were very, very honest in our family. And I think that that's important. I've already touched on efficiency. I mean, you have to be efficient and kind of remove some of those time-wasting things if you want to keep balance and have time for the various things in your life. You have to be flexible and you have to constantly reassess things. And we did that as our kids aged and we wanted to be able to have dinner with them. At first, we had somebody and we got home at a certain time and did things a certain way. And as they got older, we wanted to spend different kinds of time with them. So again, just like your goals in your life, you have to reassess what's important to you. I mean, I already told you I was really bad at writing manuscripts. There's a time in which I really had to say, I have to find the time to do this. I have to eliminate something else so that I can spend four hours every week writing manuscripts. And I had to make that my priority because that was something that I hadn't been given a priority to that I really needed to do at that point in my career. It's helpful, I think, if you have routines that drive your balance. And I'll give you my own personal examples and hopefully you can think of things for yourself. In my family, we decided that dinner time was seven o'clock. So dinner went on the table at seven o'clock and all four of us were expected to be there. That meant my kids, my husband, and myself. And I had to have a really good reason if I wasn't there. An epidural, a meningioma that I hadn't finished taking out, that was okay. I had to ask permission if there was an evening meeting, a faculty meeting, a guest professor, whatever. I had to ask the family's permission to be excused from dinner. And if I showed up at 10 after seven, no one talked to me the entire dinner. If I showed up at two minutes after seven, no one talked to me for the entire dinner. And if I showed up at 7.20, my dinner was cold. And at first I didn't get it because I used to always show up at 7.05, 7.08. My husband jokes that I knew exactly how long it took for me to get from Westchester Medical Center to my house. 22 minutes, 21 minutes if I was speeding, and 25 minutes if there was traffic. And so I would leave my office at 22 minutes before I had to be home. Of course, the fact that I could transport myself from my office down the stairs, across the parking lot, to my car, get out of the parking lot, didn't count. 22 minutes, it was from when my car left the campus. So I had this magical thinking that I could somehow transport myself home. So I was constantly arriving home five, six, seven minutes late. And my kids, at that time they were like seven and eight, they called a family conference and they sat me down and they just said, you can't do this anymore. And so I finally got it. We set the routine and even then it took my thick skull quite a while. So I actually started leaving my office 30 minutes ahead of time. And you know what? That meant that I just got that one fewer thing done that day, but it was still there for me when I came back the next day. So you can set these routines. Maybe it's gonna be your tennis game on Saturday morning. I know somebody who went to yoga every Sunday morning. I think for 30 or 40 years of his career, he went to yoga every single Sunday morning. He just rounded after that on Sunday morning, Saturday mornings he rounded early, Sunday mornings he rounded late because he went to yoga. So if you have things that drive that routine and that balance, I think it's helpful. You do have to set boundaries. You have to know when you can say no to your kids, to your spouse. And as my career progressed, I would say things like, I have to go to these national meetings twice a year. I mean, that was never an easy time for my husband, especially when my kids were young, that I would disappear for four or five or six days, leave him with a three and four year old. But I had to say, this is part of what you bought into. You knew you were marrying a neurosurgeon and you knew I wasn't a shy, retiring neurosurgeon. So this is part of what you bought into and we set those boundaries. But then there were other things that I didn't do. You do need to be good to yourself. I want you to all look at yourself tonight in the mirror and say, it's okay to relax. Okay, repeat after me. It's okay to relax. Come on. Okay, to relax, right? It's okay to watch stupid television. I will share with you that Katie Arrico really likes tiaras and what is it, toddlers in tiaras. We all have our stupid television shows that we watch. It's okay. We need that kind of downtime. It's okay to have fun. What you need to make sure you attend to is fitness. If you're not healthy, the work we do is physically very demanding. And I can tell you, some of you don't know, I used to be 250 pounds. It was much harder for me to work in the operating room when I was like that than when I am now. It's so much easier for me to get through the day. So your own fitness and wellbeing is really, really important and you have to find the time to carve that out. Your health, for years, I never got my checkups. I never went to the gynecologist. I never went to the dentist. Everything else took priority. My kids always did, but I didn't. I would implore you, get regular checkups. Get your whatever they are. Your colonoscopies. We won't go into it. Other things you need to get. But anyhow, get it and do it because if you're not healthy, then you're not going to be there for your patients or your family or whoever else you want to be there. Take vacation. Take at least one two-week vacation every year. One week doesn't allow you to relax enough. Two weeks is really important, at least once a year. Even if you don't go anywhere, even if you can't afford to go anywhere, but if you can afford to even just go down the street, that's often very good. But take vacation because they really do rejuvenate your spirit. And if you do it with your family, as we did regularly, my daughter just wrote an essay that she's applying to graduate school and she just says, I can remember everything about every vacation I ever took with you guys. It was the highlight of our family life together. And romance, I think that that's also an important part. If you have somebody that you want to be romantic with, you have to make sure that you make just a little bit of time for that or else years are going to go by and you're going to have your career and your kids will be grown up and everybody's going to be gone and then you're going to be by yourself. So anyhow, those are my closing comments. I think I'm going to turn the program over to Bill.

tipping point

human civilization

human evolution

agriculture

domestication