Residency Diary: Fifth Year—Australia

November 18, 2022

The door-to-door transit time from New York to Sydney was 35 hours. A long journey for a travel elective. As chief residents, we have the opportunity to travel internationally to study orthopaedics in a different environment.

The heroes of the trip were my wife, Anna, and daughter, Clara. Anna, nearing the end of her first trimester with our second child, managed a reasonably uncomfortable seat and a very needy toddler quite well. Clara—20 months going on 13 years—watched hours of Peppa Pig, which kept her calm when she wasn’t eating, sleeping, or making friends with the other passengers. In the few moments when Anna and Clara were both asleep, I watched the animated plane on the screen in front of me as we flew over the North Pole and headed to our layover in Hong Kong. The growing physical distance between us and New York, the center of my life for the last 4.5 years, was a clear visual representation of what I had most looked forward to about this trip: escape.

My fifth year of residency has been great, don’t get me wrong. I love orthopaedics, my coresidents, my mentors, and (most of) my clinical duties. It’s trite, but I’ll say it anyway: It’s a privilege to learn orthopaedics, and I truly would not want any other career. Yet flying to the other side of the world meant that my life, defined so much by the goings-on of residency, was about to take a breather. My hope with this trip, beyond learning orthopaedics and enjoying Australia, was to remember who I was before residency, when I used to travel abroad frequently; learn who I’ve become as a husband, father, and surgeon since residency started; and envision who I want to be after orthopaedic training.

November 20, 2022

Not surprisingly, the juice was worth the squeeze. Sydney did not disappoint. After a day of settling the family in, I took a train to Kogarah, a southern suburb of Sydney, to work with a respected knee surgeon and former fellow at my home institution. Residency is full of transitions, and I’ve always found it stressful to move from one hospital to the next or one service to the next. This time, however, the transition was seamless. My mentor and his team welcomed me with open arms. I felt at home immediately. The frequent team coffee breaks between cases certainly helped both my jet lag and my sense of belonging. I left the hospital on day one thinking, “this was the best decision I’ve made in residency.”

December 1, 2022

As I settled into the flow of life in Sydney, I was reminded that I’ve only seen a narrow slice of the vast orthopaedic universe. Indeed, most of what I know comes from my residency training at the few hospitals in New York where I work. Yet here I was in Sydney, working with a former fellow from my own institution, seeing things done differently. Technical differences, like knee incision placement and workflow with the robot, were valuable and concrete techniques to take back home. Philosophical differences relating to knee alignment targets and indications for cementless versus cemented implants made me rethink what I’ll use when I’m practicing in a couple years.

My first thought was gratitude for being able to step outside my bubble, to be humbled by just how little I know. My second thought was toward the future, wondering if I’ll be able to stay “broadminded” and not pigeonhole myself into my own comfortable, yet narrow piece of the orthopaedic pie. One need not travel all the way to Sydney to learn a different way of practicing orthopaedics, but I hope that when I do settle, it will be with partners and within a community that shows me new ways of doing things.

December 21, 2022

Several weeks later, it was time to say goodbye. This goodbye felt particularly hard. Although my time in Sydney was short, I felt like I had become a part of the team. I will miss not only my mentor and his partners, but the fellows, surgical techs, circulators, nurses, and anesthetists with whom I became close friends. Even the woman who prepared the tearoom every day and the barista at the coffee shop outside the OR will hold a fond place in my memory.

Due to a mix of factors—residency, COVID-19, starting a family—it’s been a long time since I traveled, meaning it’s been a long time since I’ve had to say goodbye. Before medical school, I was fortunate to spend a year traveling throughout South America, southeast Asia, Europe, and Africa. During that year, I developed a keen respect for the weight of saying goodbye. This trip reminded me of what it’s like to part ways, to have the heaviness in your chest that comes from setting roots, even shallow ones, and then uprooting yourself to go home.

Despite only being in Sydney for a month, I felt that my roots there were strong, both professionally and personally. Professionally, I felt like a real member of the team; not just a temporary visitor, but a colleague. Personally, my family found joy and comfort in the city. The numerous playgrounds, free museums, family-friendly public transit, and the general friendliness of the people certainly helped in this regard. We enjoyed Sydney so much that we brought up (more than once) if we would ever consider moving there (we would).

A week later, my family tolerated the 35-hour transit home without any major hiccups. More Peppa Pig, more in-flight diaper changes, fleeting sleep for all three of us, and soon enough, we were back in New York. Walking into our apartment it felt good to be home, but my mind was still very much in Australia.

Did I accomplish what I set out to do? It’s not a black and white answer. Yes, I came back with concrete technical and philosophical learning points. I rediscovered the joy of traveling and learned, for the first time, the joy of traveling with children. I even found time to think about how I’m balancing my roles as an orthopaedic resident, husband, father, brother, and son, and came back with a desire to balance these roles in a better way. Whether I am able to do that, of course, remains to be seen.