Christina and James Wright are spine surgeons. They are married and completing their fellowship—together at the Cleveland Clinic in Cleveland, Ohio, USA. The couple first met during residency interviews. We all know being a spine surgeon is tough. Does two in a pair make it more so? AO Spine is always curious to learn about our members, and this sounded like a unique situation with peculiar advantages and challenges to explore. AO Spine North America set to find out and talked to Christina and James Wright about how they balance each other both at home and work.
Christina: “I grew up in Washington, DC, in a pretty close-knit family and spent most of my youth and college years playing competitive soccer. Before med school, I spent a year traveling and working in Southeast Asia which was a formative experience for my perception of healthcare, neurosurgery, and now the delivery of spine care. In my spare time, I enjoy running, yoga, cooking, soccer, armchair activism, and hanging with our two-year-old son and our two pitbulls.”
James: “My background is of a pretty typical middle-class upbringing in Georgia. I wasn’t one of the lucky ones that always knew I’d be a doctor and thought I would end up in a career in business. I gravitated more towards the sciences in undergraduate and just never got away from it and kept going. I’m a huge sports fan, enjoy international travel, the outdoors, and spending as much time with my family as I can.”
Christina: “For me, spine was the perfect mix of biomechanics, procedural diversity, and functional restoration. I also think that it is a field with great potential to do as much harm as we do good. So, to me, spine is one of the most challenging fields because not much is very straightforward. I think there are huge knowledge gaps in the field that warrant exploration and I’m excited to engage with less commonly explored topics such as spine psychology, alternative medicine, and creative ways to improve quality measures in spine surgery.”
James: “Between the first and second years of medical school I was lucky enough to be accepted to complete a summer internship on the general surgical trauma service. I had an interest in trauma early on but wasn’t sure at that point exactly what I wanted to do. An experience with a patient during that internship left a lasting impact. I was involved in the care of a young man who presented after an ATV rollover with a cervical fracture-dislocation, spinal shock, and tetraplegia. I was drawn in by the complex multidisciplinary management required to get this kid, not much younger than I was at the time, and his family, through this horrible experience.
I found the prospect of being involved in all aspects of a patient’s care from the emergency surgery required at the time he presented, complicated postoperative critical care of spinal cord injury, to the long-term relationship built with these patients and families very difficult but rewarding. I’m maybe a little atypical for a spine surgeon in that I’m also board eligible in neurocritical care, but those were the types of patients that drove me to this career.”
Christina: “We were in the same residency program for six years so to us it’s not that different. I transferred to UH/Case Western my PGY2 year from California. Perhaps to others it may seem a little bit unusual but in general I think it’s been advantageous. Given we’ve been in Cleveland for six years and have a core group of co-residents that we consider family still here, it was both a convenient and awesome opportunity to complete a fellowship just down the street.
But our personalities are very different, and we have our own individual ways of operating and working with people. It’s great to have James as a sounding board and from each faculty we work with we share the different tips and techniques we learn with one another. As a team we like to think we function in a synergistic manner with regard to collaboration, research, building a community. We operate together on occasion, which is always fun, but we have to pre-emptively decide who is the lead to avoid any domestic disputes across the operating table!”
James: “I think there are some pros and cons, as with anything, but on the whole we both have benefited tremendously by being together through residency and now fellowship. We don’t ever have any disagreements about scheduling or unrealistic expectations for how many nights a week we might be able to have dinner as a family. We very much understand the complexity of our lives, that things are going to be unpredictable, and that emergencies happen. It probably is a bit of an advantage for us to be able to talk about what birthday presents we’ll get for our son one minute and then bounce ideas for what the other might do for a complex spinal trauma the next. We certainly have strength in number.
The other major advantage is that we had the option to get what we wanted out of fellowship without having to separate. I don’t think I could be away from my family for a year, and I really feel for those that have to make that decision.
The only disadvantage that comes to mind from completing the same training programs is that we lack some diversity of background with regard to what we’ve been exposed to. I’m a big believer in that the more diverse the training experiences of the team, the stronger the team. We’re lucky in that the fellowship at Cleveland Clinic is a combined ortho-neuro program and all the staff bring something different to the table.”
Christina: “It’s pretty unremarkable and I’m sure similar to other residents and fellows with kids and dogs…always on the tipping points of chaos! The best thing about our lives and this job is that it’s never typical. I am currently at MetroHealth at our Level I trauma center and I’m learning from several fantastic surgeons right now. Spine trauma is pretty complex, and I enjoy the mental calisthenics involved in the decision making. When not operating or rounding, I try to spend a few minutes or hours on research, reading, and exercising. It truly depends on what the toddler, dogs, and life will allow!”
James: “On the whole I think we’re up by 6 a.m. most days of the week and out the door pretty quickly. The Cleveland Clinic is interesting in the number of different rotations that the fellows go through, so we’re exposed to diverse pathologies and decision-making. Most rotations entail a couple days of outpatient clinic, a day or two of 2–4 routine cases, and a day or two of more complex procedures.
We certainly take advantage of the later clinic mornings and earlier evenings when we can. Most days we’re home between 6–8 p.m. and do everything we can at that point to throw together some type of dinner and spend some family time before our little one is off to bed.
We have a few days with dedicated time for academic conferences and clinical research/medical student labs that we’re involved with at both Cleveland Clinic and University Hospitals/Case Western and we devote at least a few hours a week to our work as section editors of the Early Career Forum that we started at World Neurosurgery.”
Christina: “I’d probably have to say that it’s all relative. Nothing is ever more out of balance than during chief year, so fellowship has truly allowed us to breathe. We have had a lot more time to spend with our toddler and our dogs as well as resume some extra-curriculars we neglected for the past few years. With regard to how, I’m sure for anybody in medicine with kids, life always feels like it’s moving 100 mph, I’d have to say constant communication, persistence, afternoon naps when feasible, and prioritization. I play soccer Thursday and Friday nights which is probably a poor decision at my age, but I still can’t let it go! James is way better at saying no, delegating tasks, and prioritizing so he probably feels a little bit less like he’s drowning at all times. But we’re incredibly lucky to have grandmas intermittently living with us so I really can’t take much credit for how our household survives.”
James: “I think this is hard and I don’t think we’re ever perfectly balanced, like most. Most days are some sort of controlled chaos and I’m sure any two-physician family with a small child can relate, it may be a little exaggerated given the difficulty of neurosurgery residency and now fellowship, but the challenges are the same. I think I might be the lazy one in the relationship, but I’m fortunate that Christina really is the force that keeps our family moving. We’re always tired, but she finds the energy to will us out to some adventure every weekend and I think having that time together is immeasurably important.
The thing that has changed for me the most was efficiency of time management after we had our son. There are certain sacrifices that I learned to make and things I learned to do more quickly, because that short period of time at the end of each day with all of us together is important for me and keeps things in perspective. I’ve also found that it’s much easier to get through a tough day at work when there’s something at home that you just can’t wait to get back to.
We were also fortunate in that we also trained with such a wonderful group of people, in both residency at Case Western and now in fellowship at Cleveland Clinic. If I could give any piece of advice to those who come after us, it would be to surround yourself with good people and do everything you can to not let spending time with them become a second-tier priority.”
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