Not the vague idea of balance we all nod along to. The actual pieces.
I kept writing and crossing out until the list stopped changing. I landed on eight.
The eight spokes
I think of them like the spokes of a wheel. Here they are.
- 1. Financial independence. The point where your income no longer needs you in the room. Not rich. Independent. The W-2 becomes a choice instead of a requirement.
- 2. Time freedom. You decide where your hours go. Call shifts, holidays, that extra day you picked up because the schedule had a hole in it. Time freedom means the calendar answers to you.
- 3. Life beyond the OR. An identity that holds up when the badge comes off. Interests, projects, a version of you that exists outside of anesthesia. Most of us have let this one get thin without noticing.
- 4. Physical health and longevity. We know the data better than anyone. We counsel patients on it every day. Then we eat lunch standing up in twelve minutes and sleep five hours before a 6 a.m. start.
- 5. Relationships and community. The people who know you as a person, not a provider. Spouse, kids, friends who are still there after years of you being too tired to show up. And a community of peers who get it.
- 6. Mental health. Clarity. Steadiness. The absence of that low hum of dread on Sunday night. This spoke rarely fails loudly. It just goes quietly soft.
- 7. Purpose and growth. The feeling that you are building toward something and getting better along the way. Clinical skill plateaus. Growth as a person does not have to.
- 8. Joy and rest. Real rest, the kind that restores. And joy that is not a reward you earn after enough suffering. Just joy. Scheduled on purpose, protected like a case.
Why a wheel
You do not need a perfect ten in every spoke. Nobody has that. You need a wheel that is reasonably round, because a wheel with one flat side creates drag no matter how strong the engine.
Most of us are running a very strong engine on a very flat wheel.
We pour everything into one or two spokes, usually the career and the income, and let the rest go soft. Then we wonder why more money and more hours never seem to fix the feeling.
Here is the part that took me the longest to accept. The flat spoke is almost never the money. CRNAs are some of the highest paid clinicians in the building. Income is the spoke we have been reinforcing for years. The drag is coming from somewhere else.
Most of us are running a very strong engine on a very flat wheel.
The honest exercise
Read those eight again.
Give yourself a quick score on each, one to ten. Do not overthink it. Do not grade on a curve. Your first instinct is the right answer.
Write the numbers down. All eight. Side by side.
The point is not the number. It is noticing which spoke went flat while you were not looking.
For most of us there are one or two that come in low and surprise us. That surprise is the whole exercise. You cannot fix what you have not looked at, and you have not looked at it in a long time.
Where it starts
I did this exercise at my kitchen table and did not love what I saw. A few strong spokes. A few I had been coasting on. One I had quietly stopped counting.
That noticing changed what I built next. It changed what I said yes to and, more importantly, what I stopped saying yes to.
That noticing is where everything starts.
Keep your eight numbers somewhere you will see them again. Come back in ninety days and score yourself a second time. The spoke that moved is the one you paid attention to. The one that did not move is the one still creating drag.
Round the wheel. The engine is already strong.