Joy in moment of revelation: a cure for burn-out.

More than midway upon the road of my professional life, deluged with multiple unmet deadlines, I turned to The Lancet for inspiration. There I began reading an article that focused on redesigning the research enterprise. In the article was a table listing the positive and negative motivations for an individual conducting research, and I noted this brief statement of one of the positive reasons, ‘‘Joy in Moment of Revelation.’’ (1) It struck me. Poetic truth, stripped of definite articles, nouns building from one syllable to two to four, the melody from sonorous to cacophonous/caesura to mellifluous, the meaning from a human emotion, ephemeral, to eternal truth, utilizing words that resonate with the holiday season (when this Lancet article originally appeared), all of ancient Latin origin, but also firmly established in our English usage for close to a millennium. Joy is still there, both joy from the rewards of patient care (the gratitude of a couple achieving a pregnancy and having a baby is unmatched in medicine); teaching (having a student or resident look up a question and cite to you the evidence always brings a smile of pride); and conducting research (submitting a grant, abstract or paper summons a Snoopy dance moment). However, these daily joys can easily be overwhelmed by the increasing drudgery of the profession, such as the ceaseless demands of the electronic medical record (why do I have to reconcile medications every visit and check so many boxes to send a Pap smear); the ever increasing number of mindless administrative emails requiring an answer (yes, I will attend the meeting, do the review, participate on the task force); the never ending required mindless online courses to maintain my job (yes FIRE for fire and yes I will avoid the active shooter and yes I will complete compliance training by the deadline); the constant certification and recertification of skills and knowledge (I think I know what yeast look likes on a wet prep by now and why can't I ever get all the American Board of Obstetrics and Gynecology answers right on articles that I have written); the increased demands for face to face teaching (yes I will spend six hours teaching a handful of medical students how to perform a pelvic exam and sit around waiting when one doesn't show up); the constant grant rejections (at least give me a score); and the increased regulatory burden (why can't we do an institutional review board application without 100 online screens, and let me count the number of times and variety of forms on which you can report conflict of interest). So yes, there are a variety of joys and a number of moments, some good and some not so, but there is a paucity of revelation. It is the revelation that may ultimately be the most necessary prerequisite for a long career. Admittedly these have been the rarest and most fleeting of moments, though I remember them as clearly as I remember the birth of my children. Often years separate these moments as the research I now conduct exists mainly in five-year cycles and often must wait until the last pregnancy is delivered to be complete. Those moments when the data from a study are un-