Dr. Demian Szyld (@DebriefMentor) first contributed to ALiEM when he was a resident at the University of Pennsylvania. He went on to complete the Fellowship in Simulation and Education at STRATUS, the Center for Medical Simulation at Brigham and Women’s Hospital, and a Masters degree at the Harvard Graduate School of Education. He works at NYU Langone Medical Center where he is the Medical Director of the New York Simulation Center for the Health Sciences (NYSIM) and directs the Fellowship in Simulation and Education. Once a week he is an attending physician at Bellevue Hospital in New York. Demian teaches simulation instructor courses locally and internationally, does research, and speaks intenationally about teamwork and debriefing. On top of that, he publishes a monthly podcast connecting the Spanish-speaking simulation community. And he still manages to keep well. Check out how he stays healthy in EM!

Name: Demian Szyld, MD, EdM

Demian Szyld, MD, EdM Location: New York City

New York City Current job(s): Medical Director and Fellowship Director, NYSIM (www.NYSIMCenter.org), Assistant Professor, Emergency Medicine, NYU School of Medicine Faculty, Institute for Medical Simulation (www.harvardmedsim.org), Co-Host and Creator, Simulación de Sur a Norte Podcast (www.mundodesimulacion.com)

Medical Director and Fellowship Director, NYSIM (www.NYSIMCenter.org), Assistant Professor, Emergency Medicine, NYU School of Medicine Faculty, Institute for Medical Simulation (www.harvardmedsim.org), Co-Host and Creator, Simulación de Sur a Norte Podcast (www.mundodesimulacion.com) One word that describes how you stay healthy: realistic-moderation

realistic-moderation Primary behavior/activity for destressing: Connect with family and friends via Skype or FaceTime

What are the top 3 ways you keep healthy?

Eating. I start out with a small breakfast (fruit and toast or cereal) and a double skim cafe latte that I make at home. I pack a lunch the night before, to keep AM stress down and give me more time with my daughter. Lunch is usually a salad, which keeps me in control of what I put in my body. I like arugula, cucumber, cherry tomato, bell pepper, and avocado. I keep good salad dressing in the fridge at work. I rarely snack at work but I’ll have a fruit or toast in the afternoon at home between work and dinner. Dinner is where I eat meat in the following ratios: 3:2:1 for fish, poultry, and beef respectively.

Drinking. I try to drink at least 1 alcoholic beverage per night and rarely more than 3. When I drink I make it something special. Liquid calories are too precious to not be discerning about it. When family and other priorities allow, it is nice to combine post-shift debriefing with colleagues at the bar.

Sleeping. I make sure I get enough. I don’t require much, but I am unhappy when I don’t get enough of it. 6.5 hours is my minimum, but 7 and 8 are much better for me. When I get my sleep, I’m a lot more patient, helpful, happy, and productive. In order to maintain sleep hygiene, I avoid caffeine after 2pm and alcohol consumption 1-2 hours prior to sleep. Occasionally life calls for a shorter night… when that happens I triple my morning coffee, stay well hydrated, and make sure I get more sleep then next night.

What’s your ideal workout?

It is really hard to make time in our busy lives to add exercising to our schedules. Since the equation is [Calories In] – [Calories Out] = [Weight Gained]. I have focused on keeping my caloric intake in check. Moderate exercise during several days of the week is my reachable goal. One thing that has been working for me is to integrate exercise into my commute. I try to walk or bike a few times per week. One recent trick I have discovered is to bring my bike to work on the ferry in the morning, this keeps me from breaking a sweat in the morning and needing to change clothes. In the afternoon I change into my riding gear and ride hard for 20-30 minutes.

Do you track your fitness? How?

I track my steps on my Pebble, but I don’t stress over it. Going on walks with the family or just taking the baby out is a great way to add steps.

How do you prepare for a night shift? How do you recover from one?

Preparation: I prepare for nights like I do for international travel. (Switching days to nights is a lot like jet lag). I’m fortunate in that these days I do more travel than night shifts. Nonetheless, here are some principles. Starting out without sleep debt really helps me rally. I avoid adding an extra meal just because I’m awake longer so if I’ve been up all day at my day job, then I have dinner before the night shift, but I won’t pack a meal. On the other hand, on a string of nights it’s reasonable to have lunch or dinner mid shift.

Recovery: Recovering involves not going to bed stressed or angry. I avoid sunlight as much as possible (hat, sunglasses, subway, shades down), try to relax at home, and have breakfast before bed, as I don’t want to wake up from hunger. I get up after 4-6 hours and keep my coffee to a single espresso macchiato. Post night I avoid driving or big mentally taxing situations, as I know I’m not as sharp. I never use sleep aid medications when transitioning although it is tempting sometimes. (For fighting jetlag I do find melatonin useful in both directions).

How do you avoid getting “hangry” (angry due to hunger) on shift?

I eat meals rather than snack and I try to fit them in as early as possible. On morning shifts it’s after rounds, seeing everyone and handling the first wave of patients before the afternoon glut. On evening shifts between seeing everyone and the evening rush there’s usually a time when there isn’t as much movement. Prevention is the best form of treatment here too.

How do you ensure you are mentally in check?

Debrief with work colleagues, and debrief with your family too (maintaining HIPPA of course). You can’t stay in check by keeping it all in. Also, it’s unlikely that one will learn from experience alone, so processing, reflecting, and discussing experiences help us make sense and gain lessons for the future.

Another important aspect to staying mentally in check in my view has to do with who you work with. A department leader or medical director (or residency/ fellowship director for that matter) that you trust and respect and you believe has your best interest in mind is really critical. Similarly, when building teams or choosing workgroups, be sure to select individuals who will contribute and who you will enjoy spending time with, talking with and learning with each other. Life is too short and too precious to spend with people you don’t admire or get along with.

What are the biggest challenges you face in maintaining a longstanding career in EM? How do you address these challenges?

As a full time educator and part time ED doc, my challenge is to keep on prioritizing and protecting my clinical time. I’d say that at least once per year, I have to ask myself if I still enjoy clinical work and if it remains a priority. Taking care of patients and teaching at the bedside is a privilege and gives me great joy, so I constantly renew my commitment to the field and to patient care.

On a practical note, while on shift I make sure I take care of my team and myself: safety first, universal precautions, offer task assistance and mutual support. I suspect that we will be performing procedures and ultrasounds and documenting on computers for at least 30 more years, and that our work environments will probably remain suboptimal (crowded, poorly designed from an ergonomics point of view, and larger and larger spaces). So invest in yourself and slow down. Evaluate your posture and prepare ergonomically for procedures. You have a choice when wheeling around the ultrasound machine to roll up the cables to avoid tripping and push it gently with two hands, rather than pulling it behind you like a stubborn child. At the bedside, elevate the bed, lower the bedside so that you can remain standing. Not only will you last longer in EM, but you’ll also have fewer musculoskeletal aches and pains. It can be hard to know when one is not being safe or ergonomic, so let people on your team know when you’re seeing them work in these ways.

Best advice you have received for maintaining health?

Avoid chronic weight gain! In our 20’s and 30’s we may not think that gaining half a pound or a pound a year is significant… but over 30 years… those ounces add up and can become a risk factor! Also, don’t diet! Make lifestyle changes that work for you, your family, and your environment that will stick for the long haul.

Who would you love for us to track down to answer these questions?

Brian Lin

Matthew Fields

Ambrose Wong

