Thursday, September 24, 2015


I just had a very long phone conversation with a friend trying to figure out what to do with a mutual patient.  She is the patient's attending, and I the consultant, and we were stuck deciding between two similarly bad alternatives.  Pick option A, and the patient might die.  Pick option B, and the patient might still die.

We discussed whether there were other options for treatment (none that we could see).  We debated the pros and cons of each option (essentially equal).  We tried to think of similar cases we had seen that could possible guide our decision (none that either of us had seen).  In the end, after applying all of our cumulative knowledge and wisdom and experience to the case, we essentially flipped a coin.

And it feels terrible.  It feels terrible that there is no clear answer to this difficult question, and it feels terrible knowing that we are the ones who are responsible for this decision.  There is no longer an attending who takes responsibility for everything.  We are the attendings now.  And at times it is completely and utterly terrifying.

Sunday, September 13, 2015

Money Stress

I spend far too much time thinking about money.

At work, I keep track of every one of my patient encounters, ostensibly to ensure that I'm correctly billing for my work, but in reality as a way of monitoring exactly how much I'm earning.  When spending money, I record every transaction in my iPhone budget and then check to see how much money is left.  At home, I check my bank account, my monthly budget, and my net worth statement over and over and over again.

It's becoming unhealthy.

On the surface, it seems like the motivation behind this is good - I want to live below my means so that I can be back to a positive net worth by the end of 2016.  Looking deeper, however, it's clear that there are other, less positive, driving forces.  The main one is fear.  I'm afraid that something will happen to me before I'm able to repay my debt and I won't be able to support myself.  I'm afraid that I won't have enough money for retirement.  I'm afraid that I'll always have to watch my spending and will never be able to stop thinking about my budget.

There's also shame.  From the time I was a child, I was a person who saved money.  I saved for my first camera; I saved for university; I saved for my first car.  Prior to starting medical school, my only debt ever had been a small line of credit from my undergraduate degree, which was paid off within a few months of starting graduate school and getting a regular paycheque.  The monstrosity that is my medical school debt (over $210,000 at its worst) looms over me like a reminder of my past sins.  I hate that it's there, and I hate that I'm responsible for how out of control it got by the end.

So.  How do I stop obsessing about money?  The first step is clearly to acknowledge that I am okay.  I'm employed.  I'm earning a good income.  I'm taking steps to save for retirement and repay my debt.  As long as I earn the amount that has been very conservatively estimated for my income*, which I have been from the very beginning, then I can keep my current budget and be out of the red by the end of next year.  I also have a girlfriend with a stable job who would do everything possible to make sure I was okay (we were okay) if something happened.  I am okay.

The second step is to stop thinking about it so bloody much.  While I need to have some awareness of my finances, I don't need to know the precise details on a minute by minute basis.  To this end, I'm restricting how much I can look at my financial information.  Once a day, I can access my spreadsheet of income to enter my billings for the day.  I can look at my iPhone budget only when I'm entering a purchase.  And I can only look at my monthly budget and net worth statement once per week on Sunday mornings when I'm doing paperwork.  No more checking my net worth every few hours to make sure it's still okay.

I'm hoping that stepping back from my finances will make me happier.  My goal, ultimately, is to put my finances on autopilot so that I can focus on the much more interesting business of living this wonderful life that I am blessed to have.

*I'm working fee-for-service, so my income is entirely determined by how much I work.  Which doesn't help with my anxiety.

Monday, September 7, 2015

The Weekly Hiss and Purr - September 7 Edition

I knew from the beginning that I was unlikely to write a "Hiss and Purr" post every week, but I was hoping to do it a bit more frequently than monthly.  By comparison, slukettg at This Liminal Space has been writing her "Weekly Hiss and Purr" literally every week and has lapped me in a very short time.  (If you haven't read her recent post about substance abuse and privilege, you should do that now.  It's way better written and more important than anything I'm going to come up with today.)  I'm going to try to write these posts more often, as they're a relatively easy way to get some of my thoughts out and to keep up with the habit of blogging.  I don't, however, promise weekly.

The Hiss - Insomnia:

Insomnia has been a lifelong enemy of mine, and for some reason it has decided to be particularly bad lately.  Most nights I wake up in the middle of the night to go to the bathroom, and then I lie in bed afterwards for anywhere from one to three hours, completely awake.  On bad nights, the timing of falling back asleep corresponds to the timing of the cats crawling into bed, and then there is no additional sleep for me.  The interrupted sleep has left me profoundly tired - on Friday night, I started whining about needing to go to bed at 9 PM, which is very unusual for a night owl like me.

The strange thing is, I don't know why the insomnia is so bad.  Usually I suffer from insomnia when I'm under stress or unhappy about something, but I don't feel like either of those things are the case right now.  Yes, there is some stress associated with starting work as a real doctor, but it feels very mild compared to what I'd feared.  And I'm not unhappy!  I'm enjoying work even more than I had expected; the girlfriend and I have been doing lots of fun things in our spare time; and I'm getting better about avoiding the trap of staying up too late at night.  I just don't get it!

I've been exercising again recently (more about that later in the week), and I'm hoping that will help turn things around.  Because I'm tired of staring at the ceiling when I should be asleep!

The Purr - Long Weekends:

There is something so unbelievably luxurious about having three days off in a row.  I love having one day for fun things and one day for necessary things and then yet another day for whatever I choose to do.  This has been a particularly good long weekend, as we haven't had any weddings to go to (I am so done with weddings).  I've finished my book (more about Chasing the Scream in a future post), finished knitting my first sock (and started my second), introduced my girlfriend to Treme in honour of the 10-year anniversary of Hurricane Katrina, played board games, tried four different hamburgers for Burger Week, and eaten an amazing celebratory dinner at my favourite tapas restaurant.  And it's not over yet!

At the moment, I'm still in pj's, and I'm keeping my girlfriend company while she makes zucchini loaf.  We have an oldies station playing in the background, and we're chatting about everything from the tragedy of the Syrian refuge crisis to the awkwardness of junior high.  It's everything I need in life.

Wednesday, September 2, 2015

Check In - Home and Hobbies

About a month ago, I wrote a post about my goals for "Home and Hobbies" and promised to check in after starting work to let everyone know how things are going.  Here's the update:

Have two knitting projects on the go at all times:

I've been using knitting as a way of relaxing in the evenings (when I'm not mindlessly surfing the internet), and I've made some good progress on my knitting projects.  I recently finished knitting a baby sweater for a friend, and I just need to sew the hood and sleeves for it to be completely finished.  Her son is now seven months old, so it's a good thing I opted for the 18-month size!  I'm also almost to the end of knitting my first sock, which has been a six-month-long exercise in frustration; I may never knit the second one.

Now that I've finished knitting the baby sweater, I've essentially only got one knitting project on the go, so I need to find something else to work on.  I'm thinking maybe something mindless, like a prayer shawl (maybe a Christmas gift for my Mom?), or something big, like a cozy sweater for myself.  Ravelry here I come!

Cook regularly with my girlfriend:

This one has been fairly successful.  We have a ton of produce from our CSA share (too much zucchini), so we've been doing a lot of cooking in an attempt to avoid wasting the beautiful organic vegetables.  I also finally got our BBQ cleaned off, so we've been eating a lot of charred meat.  I feel a bit like a caveman.

Read for pleasure every day:

This one got off to a very slow start due to exhaustion and my unfortunate technology addiction, but it's starting to pick up.  After starting a few books that didn't hold my interest, I finally found "Chasing the Scream", which is a fascinating book about how the prohibition of drugs has led to the worldwide drug war.  If you have even a passing interest in drug laws or racism or gang violence, you should read this book.

Now that I have a good book, I'm finding some time almost every day for reading.  Unfortunately, I'm approaching the end of this book, so I'm not sure what I'll read next.  Any "must-read" books that you'd suggest?

Keep up with my finances:

I've probably been doing too well with this.  I've continued to track my budget on my iPhone, and I've started tracking all of my billings in an Excel file so that I can confirm that I'm being paid properly for the work I do.  All of the monitoring has made me a bit obsessed with money, and I'm finding that I get unreasonably anxious whenever I spend money or drop below a budget surplus that I've arbitrarily decided is "enough".  I'm hoping that the anxiety will wane as I get a better sense of my income and as I make progress with paying off my debt.

Spend time daily and weekly on keeping the apartment clean and organized:

Remember when I said "This will be a challenge.  A huge challenge."?  I was correct in my assessment.  Cleaning and tidying have been the lowest priorities in my life lately, so the clutter and disorganization are starting to return.  It's been made even worse by the fact that my girlfriend has been going through her own work transition, leaving her with neither the energy nor the motivation to help out much.

We have been doing a few things right, thankfully.  We've been keeping up with the dishes and cleaning the kitchen semi-regularly, which means that there is usually space in the kitchen for cooking and eating.  I've also been doing laundry every Sunday morning, so my laundry pile is small and I always have clothing to wear.  I've also been filing my mail as soon as it comes in, which is keeping me more on top of bills and other important things than I usually am.  So all in all, not a total failure with this goal.

Any goals that you've been working on lately?  How are they going?