Forced Holidays

I've been feeling quite resentful about having only three days of holidays for Christmas this year*.  For the past two years, I've had a full week off, and I've loved having some time to sleep and read and recuperate, in addition to the time spent rushing around celebrating with family.  I can't complain too much, though, as the short holiday was entirely my own doing.  Back in July, when I was feeling crippled by my six-figure debt, I decided it would be best to maximize my income by taking as little time off as possible.  (Big mistake)

Apparently, my body decided this week that it was finished with my busy work schedule that has far too often spilled over into the evenings and weekends.  When I started my afternoon clinic yesterday afternoon, I noticed that my throat was a little sore, and my energy level was starting to wane.  By the third patient, I was starting to feel like death.  By the end of clinic, I wasn't certain that I would make it home.  I spoke with my clerk before leaving for the day, who told me that I had seven new patients in today's morning clinic.  I bravely said "I'll be there" as I left her office, but by the time I made it to my office I had started rigoring.  Who was I kidding?  I called her back and cancelled today's clinic.

After 17 hours in bed, three naproxens, and a good schluck of generic Nyquil, I'm starting to feel human again.  My plan for the day is to spend most of it on the couch catching up on the Walking Dead.  There will also be lots of juice, chicken noodle soup, and maybe some Kraft dinner.  If I feel really ambitious, I'll make creme brulee for Christmas eve dessert.  We shall see.

Wishing everyone who celebrates it a Merry Christmas!  Hope you're feeling better than I am.

*For the people in healthcare and other fields who have to work through holiday, I am truly sorry.  Been there, done that.  I know that three days off is better than many people get.

Ripples

Monday night was a terrible, terrible night during which I tossed and turned in bed, thinking about the 2-hour presentation that I had to give later in the day and the curriculum that still hasn't been redeveloped and all of my sick patients who keep getting sicker.  By the time the alarm went off at 6:45, I was a bit of a wreck.  The evil voice in the back of my head kept telling me to skip the gym and go back to sleep, and it even managed to convince me to hit snooze and roll over.

But as I lay there trying to enjoy my nine minutes of reprieve, I realized that a little bit of extra sleep (if I could even get it) wasn't the right answer.  It wouldn't be enough to make a difference in my energy level, and it would mean one more failure in my attempt to get back to exercising.  So I got myself up, put on my workout clothes, and dragged my tired body through 30 minutes on the treadmill.

Afterwards, not surprisingly, I felt better.  More awake, more energetic.  Vastly less anxious.  The feeling carried me through the day, up until the point where I started my presentation and all of my self consciousness and stage fright came back in one horrible moment of panic.  But that eventually passed (after two hours of being stared at by everyone in the room who was still awake), and I felt okay for the remainder of the day.  And then, last night, I actually slept through the entire night.  Which, to someone with chronic insomnia, feels like a Christmas miracle.

Today, having slept, everything feels easier to handle.  I have a schedule for getting the curriculum done by next week.  I have plans for all of my sick patients.  Life is better.  Exercise is good.

I just need to remember this when I don't want to go for a run tomorrow morning...

Habits - December

I spend a lot of time with my patients talking to them about healthy lifestyles.  I talk about good food choices and how much exercise they need and strategies for making positive changes in a world that is pretty much optimized to make people fat.  And then I go home and sit on my couch eating cheese.

I have the misfortune of being someone who both hates exercising and loves eating (I suspect I'm not alone in this), so my natural tendency is to get larger with every passing year.  Over the course of my nine years of medical training, I gained approximately 30 pounds - over 3 pounds per year!  While that doesn't sound too bad, if I keep up the same slow rate of weight gain until retirement, I will be approaching 300 pounds by the time I get there.  Assuming my heart and my liver and my knees don't give out before I make it to retirement.

The other, and perhaps more important part of the healthy lifestyle equation, is that I simply don't feel good when I spend my life on the couch eating cheese.  Well...I must admit...I feel great at the moment when I'm lying horizontally in my favourite pjs and shoveling gooey cheese into my mouth.  It's the moments afterwards when I feel sluggish and tired and anxious and unable to focus that are less pleasant. 

For years, it's been easy to justify my choices, because I've simply felt so overwhelmed by the stress of medical training.  There were many days in medical school and residency when I felt like it took everything I had just to make it to bedtime, so I allowed myself to do (and eat) whatever would help me get through the day.  Now that I'm an attending, though, things are different.  I have much more control over how much I work, even if I sometimes don't make good decisions with that control.  I do far less call than before, and none of it is in-hospital call.  I finally have the time and the energy to start making some of the good choices that I talk to my patients about all the time.

So...how do I do that?  I've written here many, many times about wanting to make changes in my life, yet so far few of them have stuck.  Most recently, there were my four categories of habits that I wanted to adopt as an attending, which were so unsuccessful that I didn't even get around to blogging about the last two categories.  As I've been thinking about how to make the changes that I want to make, I keep coming back to the piece of advice that I give to all of my patients:  make gradual, long-lasting change.  No complete transformations on January 1 that last for less than a week.  No four categories of habits to adopt when you're starting a new job and dealing with all of the stress and adjustment that doing so entails.  Gradual, long-lasting change.

For me, the obvious first step is getting back to the gym.  I have pretty much the best setup for working out that anyone could have, as there is a gym two floors below where I live that costs me nothing, has brand-new exercise equipment, and is rarely used by anyone else.  My goal is to go three times a week:  Tuesdays and Thursdays before work, as I have no morning clinics on those days, and Sundays while my girlfriend is at church.  I'm not setting any specific requirements for myself beyond 1) getting to the gym and 2) spending 30 minutes doing anything that counts as exercise.  If I choose, I can spend the 30 minutes walking very slowly on the treadmill.  I just have to move. 

I've done okay with this the past few weeks, although today was the first day that I made it to the gym on Sunday.  I'm hoping that by making exercise part of my routine, like cleaning the litter boxes or showering, that it'll just become something I do without thinking about it. 

Wish me luck!

The Most Wonderful Time of the Year

I find the Christmas season stressful.  I'm a person who prefers being undercommited to being overcommited*, so I get easily overwhelmed by the addition of holiday parties and gift buying and dainty making to my schedule.  (But not the dainty eating.  I'm always game for dainty eating.)  Last year was particularly challenging for me, as it was my first Christmas with my girlfriend, and we tried to fit in all of the gatherings and traditions that are important to both of us.  It was too much, and it left both of us (mostly me) exhausted by the end.

This year, I thought I would cut back on my stress level by being on top of my game from the beginning.  I would make all the dainties and buy all the gifts and stock the liquor cabinet early so that once the celebrating began, I would be ready to just enjoy myself.  And I was doing okay, up until the point two weeks ago when I said "Why yes, I'd be happy to revamp the entire curriculum before January"**.

Wait...what?  Who agreed to revamp an entire curriculum in six weeks?  At Christmastime?  It couldn't possibly have been me, because I am a rational human being who recognizes her limitations and doesn't take on utterly ridiculous and near impossible tasks.

Aren't I?

Apparently I'm not.  Because I did take on that task at precisely the time when I most want to be scaling back and enjoying my life outside of work.  And if I could find a way to go back in time and open my mouth and take those words back into it and swallow them whole so that they could never, ever escape my lips, I absolutely would.  Because when I look ahead to the next 19 days, it isn't Christmas spirit that I see. 

*What does it say about our society that overcommited is a legitimate word, while undercommited apparently isn't?

**Back in July, I also said "Why yes, I'd be happy to be on call the entire week after Christmas", not realizing that my girlfriend would have the time off of work.  Bah humbug.

Paris

For days I have been wanting to write here, to share my thoughts about the conference I'm attending in San Francisco and to tell you about the places we've visited and the food we've eaten during the gaps between sessions.  To talk about things that are light and fun and pleasurable.  But I've felt like I can't talk about lightness and trivialities until I say something to acknowledge the recent attacks on Paris.

But what can I possibly say?

This is the third attempt that I've made at writing a post, and every attempt has seemed too....earnest? Cheesy?  Ignorant?  In my attempt to write something meaningful, I've given myself an incurable case of writer's block.  And now that it's late, and given that we have tickets to Alcatraz for early tomorrow morning, I'm going to say something quick to simply get it over with.

All that I'm going to say is the one thought that enters my head every time I hear about the attack on Paris and the resultant escalation of the war in Syria:  we have to find a better way.  As the (purportedly) most intelligent species on Earth, we need to acknowledge that our endless cycles of war are failing.  We aren't making the world safer by constantly responding to violence with more violence; we're simply creating more enemies.  And destroying the lives of more innocent people, both civilian and military.

We have to find a better way.

---

Because this post isn't nearly as good as I would like it to be, here are the thoughts of some other people that I think are worth sharing:

An American college professor's eight ways to defend against terror nonviolently.

SLukettG's thoughts about the need to recognize the tragedies occurring throughout the world, regardless of the skin colour of the people affected.

Feel free to share any other links that you think are interesting/relevant (as long as they aren't racist or xenophobic) in the comments.  Or tell me your thoughts about all of the horrible things that are happening in our broken world.

Status Update

I had no intention of being absent from the blog for as long as I was.  Work got busy; life outside of work got busy; and somehow, in the midst of it, six weeks passed without a single blog post.  Sorry!

A few weeks ago, I was finally starting to settle into the routine of being an attending.  My anxiety about being responsible for all the people was becoming manageable; I was figuring out how to work with my large and diverse group of clerks and nurses and other support staff; and I no longer had moments when I would look around me hoping that there was, in fact, someone other than me who was in charge.  It was refreshing after two months of nearly continuous panic.  Then, two weeks ago, I started back on the inpatient service, and it all went to hell again.

In addition to my entirely manageable schedule of clinics and clinic prep time (so many labs to review, so many patients to call), I was once again dealing with new consults and follow ups and phone calls from remote communities with no access to anything and residents with their own needs and personalities.  And it was nuts.  I would find myself at the end of the day doing the terrifying dance of a three-year-old in need of a potty because I hadn't made it to the bathroom since I left for work in the morning.  I kept cancelling plans with my girlfriend because the work never seemed to end.  I was exhausted.  And stressed!  So stressed that I could think of nothing other than the seemingly endless needs of the patients under my care.

And then, Friday night, after 12 consecutive days of call, I finally got a reprieve.  My girlfriend had forced me to take the weekend off of call because her birthday was Saturday, so I started my glorious 63-hour break from my pager.  It took me the first 24 hours to stop frantically reaching for my belt and panicking that I'd forgotten my pager at home, but it has otherwise been lovely.  We've had a birthday party with friends, gone to explore a new kitchen store*, eaten at a fancy restaurant, and bough $245 worth of booze**.  I am now sitting on the couch in pjs with cats, which is pretty much my favourite way to spend a Sunday.  My girlfriend is off at church, and when she returns we will have a second birthday party, complete with fancy cocktails and cheesy card games.  Life is good.

As long as I don't think about the fact that I go back on call at 8 am tomorrow***.

*Funny story (to me at least):  The kitchen store was selling a chef's knife that I have been coveting for years for 50% off, and we decided that it was too good a deal to pass on.  The only problem was that my girlfriend had been planning to buy it for me for Christmas, which she obviously couldn't do with me standing right there.  I offered to just buy it for myself, which she thought was a terrible idea, because I am a person who wants very few material things and is therefore impossible to shop for.  (I'm also incredibly picky.)  After hemming and hawing for a few minutes, I finally decided that she should just go ahead and buy it for me, but wanting to maintain the illusion of surprise, I loudly declared "I'm just going to walk over to the other side of the store, and I will pay no attention to whatever may or may not happen between you and that knife."  The clerk thought we were nuts.

**I bought my girlfriend a cocktail recipe book for her birthday, and we decided that we needed "a few things" in order to make some of the more interesting cocktails.  We probably shouldn't have gone to the liquor store late at night when we were both exhausted/lacking our usual self restraint, but the upside of the experience is that we are now well-equipped to make pretty much any cocktail that a person could want.  Unless it requires cognac, because I still had enough self restraint to not spend $3 per ounce on the cheapest bottle of cognac.  Hard liquor never goes bad, right?

***Thankfully for only three days.  On Thursday, I head to San Francisco for a conference and a few days of vacation with my girlfriend.  I was traveling in San Francisco when the girlfriend and I started chatting online, so I'm looking forward to showing her all of the places that I told her about when I was first wooing her.

Responsibility

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.

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.

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.

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?

Evening Routines

OMDG posted today about her challenge with evenings, which got me reflecting on my own evening routine since starting back at work.  When I was on holidays, my plans for my work evenings were very ambitious - cook tasty dinners with my girlfriend, clean the kitchen, take care of housework/paperwork, exercise, and read stimulating and erudite books.  Shockingly, the reality has been somewhat less impressive.  Despite not actually working that hard yet (I'm only working about half-time at the moment), I've been coming home mentally exhausted every day, and I haven't been able to motivate myself to do most of the things I would like to.

Currently, my post-work schedule looks something like this:

1)  Arrive home and dump all possessions (lunch bag, purse, backpack, jacket) in the front hallway.  Ignore voice in the back of my head that tells me that I should be putting things in the spaces I created for them.

2)  Cook dinner with my girlfriend.  This varies from spending 2-3 hours making an elaborate dinner (we love cooking) to BBQing hot dogs and eating potato chips from the bag.

3)  Spend way too much time on the computer.  Facebook, blogs, news, repeat.  I haven't mastered the art of turning off the computer when there is nothing good left to look at, so this eats up a lot of time.  On a good day, I write a blog post of variable quality.

4)  Watch something on Netflix with my girlfriend.  Lately we've been watching Human Planet, which is actually a decent and not entirely mind-numbing show, so it could be worse.

5)  Look at the stack of library books on my coffee table.  Decide it isn't worth the effort.  Possibly watch another Netflix show, usually of lower quality than Human Planet.

6)  Feel progressively more exhausted.  Resist the urge to go to bed like a reasonable human being.  Repeat item #3.

7)  Realize it's past my bedtime.  Rush around trying to make a lunch, pack my work bag, feed the cats, and do anything else that needs to be done.  (Feeding the cats is the only thing I consistently accomplish before bed, and that's only because they meow at me.)

8)  Finally get to bed much later than I should.  Realize that eight hours of restful sleep has become an impossible dream.

9)  Lie awake staring at the ceiling, regretting all of the things I didn't do.

This is something I need to work on, because evenings make up a lot of the quality time I have for myself and my girlfriend outside of work.  Looking back on this time of my life, I don't want Facebook and Netflix and a cluttered apartment to be my most vivid memories.

How happy are you with your evening routine?

A Post on Parenting by a Childless Woman

One of my good friends from medical school has three children between the ages of 7 months and 5 years.  When it came time for her to go back to residency after her first maternity leave*, she and her husband were faced with the inevitable question of who would take care of the child.  From a financial perspective, it made much more sense for him to stay home, so they decided to go against the societal norm and make him the stay-at-home parent.

Now three children into the process, it seems to be working very well for them.  My friend thrives on her work as a physician and earns enough to support the family, while her husband (mostly) enjoys being the primary caregiver.  Whenever I visit, he is the person that the children go to first, whether for food or comfort or just to whine about one of their many grievances. 

Although the arrangement is mostly good, it does come with its own set of challenges.  While there is a huge network of supports available to mothers from the beginning of pregnancy onwards (exercise classes for pregnant moms, lactation groups, mom-and-baby programs), there is very little for fathers who choose to stay home with their kids.  There's the constant judgement of women who choose not to stay home with their children.  And then there's the never ending societal narrative that says that women should be the caregivers, not men.  It's present in ads for baby products that feature only mothers, in the language we use to describe parenting (e.g. talking about fathers who "help" with the kids or who "babysit" them when the mother is away), and in the way we label restrooms for parents with kids as "Mommy and Me" restrooms.

Even though I don't have children, and probably never will, these things frustrate me to no end.  They frustrate me because they make it unnecessarily hard for fathers to stay home with their children, even when that's what works best for their families.  They frustrate me because they perpetuate the idea that a woman's role is to raise the children, regardless of whether she would prefer to be in the workforce.  And they frustrate me because they limit us to traditional gender roles, even though two X chromosomes don't automatically make a person a better parent than an X and a Y.

We have to start doing better.

*Unlike in the States, Canada has a great parental leave policy that allows the mother and/or father to take a combined total of 50 weeks of partially paid leave.

Doing the Unthinkable

Yesterday afternoon I left work at 1 PM.

This may not sound all that amazing to you, given that people sometimes leave work early for doctors' appointments or other things that need to be done during working hours.  What made it amazing is that I had absolutely nothing to go to.  I was simply done my work for the day*.

As a fellow, I never intentionally came late or left early; it was completely unacceptable to not be at work for the full day.  The few times I was late because of a missed alarm or unexpected traffic, I was inevitably met by a supervisor who would look at his watch and say "Slacking off, are we?"  It didn't matter if I was finished my work for the day or if I could accomplish my work more efficiently in the quiet of my own home:  if it was between the hours of 9 am and 5 PM**, I was expected to be at my desk or in the hospital.

As an attending, on the other hand, I set my own schedule (within certain limits).  I decide when I take call, I decide how many clinics a week I work, and I decide when to do research (if at all).  The freedom is awesome!  And while I have no intention of abusing this freedom, I do intend to make the most of it.  Before starting work, I decided that I will no longer stay at work just to make an appearance.  If I finish my work before 5 PM, I will go home early and enjoy my life outside of the hospital. 

I don't expect this to happen often, and I'm sure there will be days when I make up for it by staying far past 5 PM.  But on the days when I can go home in the early afternoon, I fully intend to do it.  And I intend to enjoy every minute of the kitchen gadget store browsing/cooking with copious amounts of zucchini/napping that I do with my time off.

*Of course, as soon as I left the hospital I got paged to go back, but such is life.

**If you're a resident/physician/other hard-working person who can only dream of a (mostly) 9-5 schedule, I'm sorry.  My chosen career is awesome.

It Only Took Two Days

As a resident, it used to drive me nuts when I would try to page my attending and he or she wouldn't respond to my page.  It was particularly annoying when it was the middle of the night and all I wanted to do was review a case quickly so that I could get to my call room and possibly be horizontal for a few minutes.  Whenever it happened to me, I would vow that I would never, ever fail to answer my pager as an attending.

Guess which attending woke up this morning to discover that she'd slept right through a middle of the night page?

Choices

Last night, my girlfriend took me to my favourite Ethiopian restaurant for a meal to celebrate my first day as an attending.  We ordered one vegetarian platter and one meat platter, which is too much food for two people to eat, but not quite enough food to leave a good serving of leftovers.  After my girlfriend had given up, while I was still trying to finish off every last tasty morsel, we had the following conversation.

Girlfriend:  "You know...if you stop eating now, we could share a mint Oreo Blizzard for dessert."

Me (pausing while bringing a handful of food to my mouth):  "What if I want to keep eating, but I also want to have a mint Oreo Blizzard for dessert?"

GF:  "Well...you're an adult and you can make choices for yourself.  My only request is that you not vomit in the car on the way home."
 
Me (reluctantly returning the handful of food to the plate):  "You never let me have any fun." 

That Wasn't Horrible

When I was planning my schedule a few months ago, I thought that I would "start off easy" by being on the consult service for the first two weeks and only doing one or two half-day clinics per week.  I spent months (and months and months) on the consult service as a fellow, so being on service as an attending shouldn't be all that different from what I was doing before, and it guarantees me a minimum income to help with the bills that have piled up after seven weeks of vacation.

The only problem with my plan?  I scheduled my first clinic for the morning of my very first day.  At the inner city clinic where I've only worked twice and therefore am unfamiliar with pretty much everything (like the bloody EPR).  The clinic with the very complicated patients who actually require time.

In the end, my two-and-a-half-hour-long clinic took four hours, followed by a full hour of charting and paperwork.  Amazingly, I stayed calm throughout it and didn't once cry or freak out.  And it was actually (dare I admit it) a tiny bit of fun.  My nurse is absolutely amazing with both me and my patients, and she was the main reason why I didn't go insane when my clinic ran horribly over.  It also helped that there was nothing pressing on the consult service, so it was okay that I showed up at the other hospital at 3 PM.

Maybe this attending gig will be bearable after all.

Habits - Work

It's the evening before I return to work, and my feelings are alternating between excited and distraught and absolutely terrified.  It definitely feels like time to go back (there is almost nothing left on my to-do list), but at the same time I'm dreading the first day.  I start with a busy clinic and I'm on home call for the first 12 days, so it won't be an easy return.  But I can do this.

Right?

I'm hoping that, if I start off on the right foot, I can set myself up for long-term success.  With that in mind, here are a few of the work habits that I hope to cultivate from the very beginning.  For those of you who work in medicine, is there anything else you'd add?  Any advice?  (Or just reassurance that I will not in fact spontaneously combust during my first clinic tomorrow?)

Record Billing Information as it Happens:

This seems like a rather greedy thing to be thinking/talking about, but the reality is that I'll be paid fee-for-service, so if I don't bill for things, I don't get paid.  While I have no intention of exaggerating my billings (I spent three minutes talking to the patient...so that counts as 30 minutes of counselling), I do want to get paid fairly for the work I do.  The best way of achieving that is to document things as I go along so that I don't miss patient encounters or forget about things like phone calls and letters and family meetings.

Finish my Dictations Every Day:

So many of the other attendings (can I really say other?) have offices filled with charts and are constantly lamenting how far behind they are with dictations.  Which means so much unnecessary stress!  When I've been on clinic rotations in the past, I've been successful at keeping up with my dictations on a daily basis, and I plan to do the same as an attending.  It just takes discipline, as well as remembering how much longer it takes to dictate on a patient I saw two weeks ago than on a patient I saw earlier in the day.

Devote Time and Energy to Teaching:

Most of my work will be in a teaching hospital, meaning that I'll have medical students and residents and fellows working with me most of the time.  As a recent trainee, I know how frustrating it is to work hard and do all of the scut work without getting some teaching in return.  Even though I find teaching challenging and sometimes stressful, I plan to make it a priority to do some of it every day that I have a learner on my service.  I also plan to take on some of the teaching opportunities (small group sessions, lectures, etc.) that are always understaffed as a way of giving back to the medical school that got me to where I am today.  The bonus of teaching is that it's a great way of keeping up my own skills (and getting some Continuing Medical Education credits so that I can keep my license).

Read for at Least Three Hours per Week:

Medicine changes.  Every day, I get emails from journals about all of the articles that I should be reading.  In order to keep up with at least part of the giant fire hose of medical knowledge, I plan to set aside three, one-hour reading sessions every week.

Research: 

This is worthy of a post all its own.  I don't even know what to say here.  I have a few research projects that I'm interested in pursuing, but I have no funding, time, or salary to support research.  Soooo.....we'll just have to see where this one ends up.  I had hoped to have this figured out by the end of my vacation, but not so much.

Put Patient Care Above Other Considerations:

This is more a work philosophy than a habit, but I think it's important to always remember that my patients are real people, with hopes and fears and people who love them and lives outside of my clinic room.  Their outcomes are more important than how much I bill or what time I leave work at the end of the day.  While I do want to earn a good living (pay off debt!) and have a life outside of medicine, those goals can never be at the expense of providing good patient care.

Ooops

On day 19/21 (yesterday), I somehow forgot to write a blog post.  I spent my day finishing off Barbara Kingsolver's "Animal, Vegetable, Miracle", after which I rushed to get takeout shawarma and pick up my girlfriend from work in time to go to an outdoor movie in a local park.  Amidst all the fun, I forgot entirely about blogging.

Now that the 21 days of consecutive blogging are almost finished, I'm forced to address the question of "What next?".  On the upside, over the past few weeks I've felt much more engaged with the blog, and I've found myself drafting posts in my head while doing dishes and other tedious activities.  I've also written a few posts that I've been happy with, including parts one and two of my thoughts on money, as well as my post about so-called road bump opiates.  On the downside, it's been difficult some days to find the time to blog, and I've often found myself crawling out of bed after 11 PM to whip off a quick (and often uninspired) post.  Some of my worst posts ever have resulted from this forced writing.

I may keep up with the daily blogging for a while just to see where it goes, or I may revert to blogging less frequently.  While the ideal blogging frequency is probably less than daily, I worry that if I lose the regular habit I may stop doing it at all.  Which would be a loss for me - I love the record of my thoughts and activities, the feedback from commenters (even if I don't always find the time to respond), and the sense that I'm perhaps sharing something that will be useful to the next generation of medical students/residents. 

I guess we'll see.  If you're a blogger, how do you balance regular blogging with all the other things going on in your life?  For everyone - what would you like to see from this blog as I start life as an attending?

In Need of Sleep

The past few nights I've found myself lying awake for hours on end, stressing about money and my return to work and anything else I could think about.  Despite the resultant fatigue, today I drove to the country to visit one of my closest friends from medical school.  While we ate cafe food and she nursed her wee babe, I poured out my anxieties and fears for hours.  She, a master listener, absorbed everything I said.  After I had exhausted my deep pool of insecurities, she said simply "It will all be okay".  And because she is always right, I knew it would be.

Now, back in the city, I feel lighter than I have in weeks.  My mind is slowing and my limbs are growing heavy, and it is time to give in to sleep.  I'm hoping it will be a good one.

Summer Bounty

Thanks for all of the suggestions on what to do with our abundance of CSA vegetables.  Tonight we had a CSA feast - grilled zucchini and pattypan squash, roasted beets with balsamic reduction, steamed baby carrots, and a cucumber-yogurt salad (thanks for the idea NOLA!).  The vegetables were so varied and flavourful that the barbequed sirloin steak seemed like an afterthought.

Washing down the meal was a bottle of Valpolicella Ripasso that I had brought back in my suitcase from a trip to Italy in 2013.  The bottle had long been stored at the back of our liquor cabinet, waiting for a special occasion to be opened, and I worried that I might have left it too long.  Thankfully the cork came out effortlessly, and the wine inside was smooth and mellow.

It's amazing to me how good local food can be, whether it's purchased in your home community or smuggled home from a special trip.  With such foods, why on earth would anyone buy flavourless food from Walmart* that has been shipped from hundreds (or thousands) of miles away?

*I hate Walmart, but that's a post for another day.

Day Off Fun

When I started planning my vacation, I imagined an abundance of time with my girlfriend.  We would sleep in late, cook elaborate breakfasts, ride our bikes through our local parks, and head off on adventures in the city and across the province.

I did not imagine weddings.  And multiple family gatherings.  And all kinds of things that involved people other than just the girlfriend and me.  In the end, we've had much less time to spend together than expected.  Until today!  There was no wedding to attend, all of the family has flown back to their home cities, and my girlfriend had a mid-week day off.  Bliss!

We started the day with a very large breakfast at an old-school diner.  The diner is only a few blocks from where I'll be working starting next week, and it's right in the heart of the inner city.  A lot of people avoid this part of my city because it's associated with gang activity and drug use, and they worry that it isn't safe.  While these are definite issues in the neighbourhood, in reality most of the members of the community are good people who are just trying to build their lives under sometimes difficult conditions.

And there's great food available at low prices.  (If you're not familiar with the deep fried pockets of goodness on the right, they're perogies, which are a staple in diners in my city.)

After breakfast, we headed across the street to a Thrift Store to search out some bargains.  My girlfriend found an assortment of $0.50 CDs, including the Sound of Music and a few classical CDs, while I scored big on knitting needles - six pairs for only $0.25 each! 

(Please do not put any needles in here)

While a big part of my motivation for going to thrift stores is to save money, it goes beyond that.  In our wasteful society, I think it's important to look for ways of reusing things and reducing how much we send to the landfills.  It's also a great way to support charities such as Mennonite Central Committee, which focuses on relief and peace-building efforts across the world.  And there's something really satisfying about making a great find (like six pairs of knitting needles for $1.50).

(End of soapbox)

After the thrift store, we went to almost every bike shop in the city to look for a bike for my girlfriend.  She's been using a second-hand bike from her brother for almost ten years, and it's probably well past the time when she should have bought one for herself.  She's looking at a cruiser bike, and I think she's finally settled on the one she wants to buy.  (At least I hope so, because I think I might ram a kickstand through my eye if I have to look at another bike.)

After the bike shopping, we headed to a local farm to pick up our Community Supported Agriculture share.  (I could wax poetic about CSAs for days, but I think the thrift store paragraph was probably enough sappiness for one blog post.)  The people with whom we've been splitting our weekly share are away for the next few weeks, so we have an even greater abundance of produce than usual.  I have no idea how we're going to eat ten cucumbers, five zucchinis, and four bags of kale in the next week.  Any suggestions?

And that was our day.  My girlfriend got a last minute invitation to a free play, so she's off watching that while I read and blog and try to fit copious amounts of produce into our tiny apartment fridge.

Life is good. 

Habits - Home and Hobbies

As I was reading Gretchen Rubin's book "Better Than Before", I kept thinking about habits that I've recently incorporated into my life, as well as habits that I'd like to adopt.  There are so many of them, most of which unfortunately fall into the latter category.  Over the next few days, I plan to write posts outlining the habits I'd like to have in four different broad categories:  home and hobbies, personal, work, and relationships.  (Not necessarily in that order or on four consecutive days.  I'll pick my topics as the mood hits me.)  Because going back to work is going to make habit change challenging, I plan to do a check in on my habits once I'm two weeks in (and finished my first stretch of call as an attending).

In deciding on the habits on which to focus, I'm trying to remember that the end goal isn't to adopt good habits - it's to be happy in both the short and long term.  If these habits aren't making me happier, then I can choose to drop them whenever I please.  (Isn't being an adult wonderful?)

So here we go with habits in the home and hobbies category.  The habits are roughly arranged from what I consider to be least important to most important.

Have two knitting projects on the go at all times: 

I started knitting sometime in the last year after being inspired by the many women (and some men!) at my girlfriend's church who knit.  Some of them knit during the services, and many more of them knit at social events, and I was always jealous when I watched them work.  Since I started knitting, I've knit three infinity scarves (one for myself and two for my nieces), as well as almost one sock and almost one baby sweater.

I love a lot of things about knitting - dreaming about projects and picking out nice yarn, watching a project slowly come together over weeks to months, and having something to distract me when I'm in a boring or awkward social situation.  I also like that it's slightly subversive to be a knitting physician.  Physicians are supposed to be constantly rushing and stressed and short on time, so I love the idea of doing something that is intentionally slow.

This is something that will undoubtedly wax and wane depending on how busy I am, but that's okay.  Knitting projects can sit idle for a long time and then be picked up when needed.  I'm choosing to have two projects going, as it's nice to have something that gives me a bit of a challenge (e.g. a baby sweater) as well as something that is purely mindless and relaxing (e.g. an infinity scarf).

Cook regularly with my girlfriend:

My girlfriend and I both have a huge love of cooking and of trying new foods/recipes, and it's one of the things that brought us together early in our relationship.  We've unfortunately fallen out of the habit of cooking together recently, as my girlfriend's job has required her to stay at work until after the supper hour.  I think our relationship has suffered as a result of us not cooking and eating together, and it's something I want to work on.  Thankfully, starting next month her days will be ending at 5 PM, so hopefully it won't be hard for us to get back into this habit.

Read for pleasure every day:

Have I mentioned recently how much I love books?  I love reading once I get into it, but I sometimes avoid it when I'm tired, because checking Facebook/surfing the internet/watching tv seems easier and more relaxing.  Which it isn't; reading is definitely more relaxing than any activity involving technology.  I want to maintain the habit I've developed this summer of always having a book going and of reading every day.

Keep up with my finances:

I was a bit of a financial disaster during my training.  Not only did I not budget, I also did terrible things like file my tax returns late (really, really late) and occasionally miss a credit card payment.  I've finally gotten on top of everything financial, including meeting with my financial adviser to figure out my get-out-of-debt-as-soon-as-humanly-possible strategy, and I want to keep it that way.  To do this, I plan to deal with financial things (bills, etc.) as soon as they come in, even if that means waiting a day or two to check the mail until I have time to deal with it.  I also plan to set aside time on Sunday mornings (while my girlfriend is at church) to quickly review my bank/investment statements and to do anything financial that didn't get done during the week.

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

This will be a challenge.  A huge challenge.  I've done very well this summer at getting the apartment decluttered and organized, and I've managed to adopt the habit of doing annoying little tasks (like unpacking from our weekend camping/wedding adventure) as soon as they come up.  The apartment is so much tidier as a result, and it facilitates things like cooking and reading and other fun activities.  But doing tasks when they arise isn't my default setting, which means that this will be really hard to maintain once I go back to work.  And my girlfriend is much more tolerant of chaos than I am, which will make it hard to get her on board!

My first strategy for achieving this is to set aside dedicated times for cleaning and tidying.  On a daily basis, this will mean taking a few minutes when I first arrive home to hang up my jacket/purse and empty out my lunch container, as well as spending some time doing dishes before bed.  On a weekly basis, this will mean spending some time every Sunday morning doing laundry and tackling some of the items on my to-do list.

My second strategy is going to have to be talking to my girlfriend.  While I've been on holidays, I've assumed the majority of the household responsibilities, and it's gotten stuff done, but it won't be sustainable (or fair) once I go back to work.  As difficult as it may be to do, we need to come up with a way of dividing up the household tasks.  The big challenge for me will be accepting that we have different ideas of what needs to be done around the apartment; therefore, if I want things done better than she does, I may need to do a bit more of the work.

Hmmm....it seems like I have my work cut out for me.  And this is only day one of four!

The Last Week

As of tomorrow morning, I will have only one week until I go back to work.  It seems like I've been gone forever; I've managed to relax and get stressed out again and return (slowly) back to a relaxed state one more time.  I'm sure more stress is coming, particularly if my license doesn't come through in the next day or two.

Part of me wants to stay on vacation - to enjoy structuring my days as I please (minus weddings) and to sleep in as late as I choose.  But most of me is getting impatient to move on with the next stage of life.  Fingers crossed I'm ready.

This Counts as a Post

I'm three minutes away from our scheduled departure time for a wedding in Middle-of-Nowhere, Canada, so this will be the briefest of brief. 

This is my third wedding of five (one of my family members, one of my friends, three of the girlfriend's friends) this summer, and I'm starting to wish that we had a smaller social circle.  While I have nothing against the idea of weddings (love, commitment, buffets), the actual act of attending a wedding is not my preferred thing.  Too many people (particularly too many people I don't know) for an introvert.

But what to do?  People host weddings, other people attend.  It's the social convention.  So I'll pull out my fancy dress one more time and pretend that I'm having fun, even though I really just want to wear sweat pants and work on my knitting*.

*It's entirely possible that I'll knit at the wedding.  I'm not above that.

The Weekly Hiss and Purr - August 7 Edition

Oh this week.  This week has been one full of angst, coming from a variety of sources.  Even though I'm still on vacation (yay), I feel like I could list a dozen or so hisses without much effort.  Bah.

Angst is soooo overrated.  Take a nap, Mom.

The (Biggest) Hiss - Anxiety:

One of the best things about this vacation has been how relaxed I've been.  Until recently, I was waking up feeling refreshed and looking forward to all the great things the day had in store.  I even looked relaxed - my skin was tanned (as much as my Northern European ancestry permits), my hair was longer and curlier than it had been in years (the word "mullet" comes to mind), and my clothing choices were comfortable, if not bordering on vagabond.  

And then, a week ago, I decided to get my hair cut so that I would look slightly put together for the wedding I attended last Saturday.  And it was as if everything changed.  Going back to my "work hairstyle" seemed to signal that it was time to go back to work, or at the very least to start stressing out about it.  Since then, I've been experiencing increasing bouts of panic as I come to terms with the fact that I will be the one in charge starting August 17.

It doesn't help that there are still major issues up in the air...like my license.  Everything is happening at a snail's pace because it's summer, and despite doing things in what I thought was lots of time, I am still waiting on a number of important documents that are required for me to work.  And I have only five business days left until my first day of work.  Aaaaaah.

(Please be patient while I go and vomit.)

The Purr - Reading:

The biggest thing I need right now to keep myself sane is distraction from thinking about work (and from hitting refresh on my email program to see if anything is happening with my license).  Enter reading!  As I previously blogged about, I just finished reading Gretchen Rubin's book "Better Than Before".  I also have her book "Happier at Home" sitting in my to-read pile, but for a change of pace, I've decided to start with Barbara Kingsolver's book "Animal, Vegetable, Miracle".  This book tells about her family's journey of moving across the country and trying to eat locally for a year.  I'm only one chapter in, but I'm loving her writing style and her exploration of all the issues (environmental, economic, health) related to what we choose to eat.

There are so many more things that I want to read!  I have a giant stack of books from the library on my coffee table, plus a list on Goodreads and another list in my iPhone.  I need more hours in the day!

What are you reading this week?

Road Bump Opiates

Ana from anabegins wrote an interesting post today in response to a post on the Frugalwoods blog.  In the original post, Mrs. Frugalwoods refers to the things we buy to make ourselves happy as "road bump opiates" and argues that these indulgences are barriers to achieving our long-term goals.  For example, a muffin purchased at work may give us temporary pleasure, but will ultimately make us feel worse because it works against goals of eating healthy food and becoming more financially secure.  She further argues that focusing on spending money takes us away from addressing more important questions, such as "How are we fulfilled? Where are we happiest? When are we appeased?".

In Ana's post, she talks about how she was considering going out with her husband in an attempt to feel less "blah".  But then, she felt guilty about this desire after reading the Frugalwoods post, as eating out seemed to be just a "road bump opiate" to "soothe our unsatisfied consumerist souls".  The post made her "feel bad about [her]self and [her] life choices for having the type of life that is prone to having the blahs and [her] immediate desire to use "going out" to fix it".

Reading and reflecting on the two posts got me to wondering - why is taking pleasure in anything that costs money suddenly a bad thing?  Why is anyone made to feel guilty because she wants to *gasp* go out with her husband?

Yes, living within your means and meeting your financial goals is important (I feel like recently I've been a bit of a broken record on this topic).  Yes, it's important to not let spending and consuming replace the more important things in life.  But we're also physical beings who derive pleasure from creature comforts!  Eating in restaurants, going out for coctails, taking in a show, drinking an overpriced coffee-based beverage made by a hipster barista - these are enjoyable things!  If someone wants to do these things and can fit it within her financial plan, then she should be able to do so without feeling guilty about it.  I want to not feel guilty about doing these things, even if it means I take 16 months to achieve a positive net worth instead of 12 months.

Furthermore, sometimes spending money can help us to achieve the grander goals that make life worthwhile.  Money let me go to medical school and become a physician.  Money has taken me to all sorts of exciting places and expanded my understanding of the world.  Money lets me eat in restaurants with friends and family members and maintain my connections with these people, even when we don't have the time or energy for cheaper options like having a potluck.

I think that ultimately, it comes down to recognizing our own personal "sweet spot" for spending.  It's great that the Frugalwoods are happy to never buy new clothing or eat in restaurants, but not everyone feels that way.  For many of us, retiring at the earliest possible moment isn't worth giving up every last bit of discretionary spending.  And that's fine!  We're all different, and we're all allowed to spend in the way that helps us to best meet our goals - even if one of those goals is to drink an $11 glass of Pedro Ximenez sherry at our favourite tapas restaurant.

Patience and Forgiveness

Because nothing says vacation like dealing with your finances, I spent most of my morning today figuring out a strategy for getting myself to a positive net worth*.  Ever since I started budgeting, I've been haunted by the negative on my balance sheet and desperate to get back into the black.

The good news about my strategy session is that I figured out that I can be back to a positive net worth in just 16 months, thanks to having lots of room to invest in an RRSP (Registered Retirement Savings Plan, the Canadian equivalent of a 401(k)).  The bad news is, it's going to take me 16 months.  Which literally feels like forever.

It's hard at times to forgive myself for the financial mistakes that I've made in the past.  There is absolutely no way that I could have made it to this point debt-free, but I know that my burden of debt could have been much less if I'd been more careful with my spending.  And it's even harder to be patient, to refrain from adding more call shifts and more patients to each clinic just to bring my bank balance up.

I have to remind myself, on pretty much a daily basis, that it took me eight years to get to this point.  16 months is entirely doable for getting rid of it.  I just need to breathe.

*My goal is to increase my assets beyond the level of my debt, rather than to pay off the debt itself, because interest rates are currently so low.

Habits

As I've written about before, part of my motivation for taking so much time off this summer has been to catch up on all the things I've neglected over the past five years:  finances, household organization, paperwork (why is there so much paperwork?), and cleaning BBQs, amongst other things.  While I've been spending hours of my precious vacation time on these not so enjoyable tasks, I've been thinking a lot about how to keep up with these tasks on an ongoing basis, rather than waiting until things get desperate to play catch up.  As part of my attempt to figure out how to do things better, I recently read Gretchen Rubin's book "Better Than Before: Mastering The Habits of Our Everday Lives".

This book explores the ways in which we adopt (or fail to adopt) new habits, with a focus on internal and external barriers to making positive changes.  Included in it is a whole chapter on "loopholes", which basically describes what goes on in my mind whenever I try to change myself.  (I'm an expert at coming up with reasons not to follow through on my goals.)

What I found most interesting about the book was Rubin's categorization of people into four groups - Upholders, Questioners, Obligers, and Rebels - based on how they respond to inner and outer expectations.  I would really like to be an Upholder (one who meets both inner and outer expectations; Sarah from theshubox strikes me as a perfect example), but after reading the descriptions and doing the quiz at the end, I had to resign myself to the fact that I'm an Obliger (one who meets outer expectations but not inner).  In the book, Rubin writes of Obligers that "Because Obligers resist inner expectations, it's difficult for them to self-motivate - to work on a Ph.D. thesis, to attend networking events, to get their car serviced.  Obligers depend on external accountability, with consequences such as deadlines, late fees, or the fear of letting other people down."

Difficult to self-motivate.  Yup.  That's me.  I could complete my 21 days of regular blogging just by giving examples of how I've had difficulty self-motivating throughout my life*.  My Master's degree is the perfect example - it took me forever to get experiments done and papers written, to the point where I nearly drove my supervisor crazy.  I actually told her once that if she wanted me to do something she just needed to give me a deadline.  And it worked!  When I had something external to motivate me, I got my work done without difficulty - even if the "deadline" was entirely arbitrary.

Which brings me to a dilemma.  As an attending, I will decide everything that I do.  I will decide how many patients to see and when to do dictations and whether or not to do research (etc, etc).  There will be no external expectations, aside from some very minimal requirements for teaching and clinical duties, which will not be difficult to meet.  How, as an Obliger, do I not allow my life to devolve into chaos in the absence of external expectations?

I still don't know the answer to this one.  Maybe I need to re-read the book.

*And then no one would ever read my blog again.

Procrastination and Accomplishment

There are things I'd like to write legitimate posts about, but early in the day, when I have time to blog, I manage to convince myself that I can put it off.  "I have all day!  I can blog in the evening...the fact that the girlfriend will be home from work won't make blogging difficult at all."  Hence scrambling at 11:17 to get a post written before the midnight deadline.

Every day, I knock one more thing off of the to-do list that has been growing over the past five years.  Today it was "clean the BBQ", which hasn't been done in at least two years; I anticipate that there will be many hot dogs and steaks and grilled chicken breasts consumed during the last few weeks of summer to make up for the long period of time that the BBQ was too dirty to be useable. 

Approaching the end of my to-do list is making me feel like Superwoman.

And it's making everything in life better.  But how on Earth do I maintain this (or even something remotely close to it) when I go back to work in two weeks?

My Favourite Sound

With the weekend drawing to a close, the girlfriend and I are relaxing by spending some quiet time together on the couch.  I'm sitting with my laptop on...well...my lap, and she is reading the book The Language of Baklava.  In the background, last night's wedding song, You Are The Best Thing, is playing on YouTube.

As I struggle to find something from my utterly ordinary day to write about, every few minutes my girlfriend breaks out in laughter at something she has read.  I love when she reads funny books, because her spontaneous laughter is one of the best sounds in the world.  Pure happiness.

I am lucky.

Dancing

It's 11:19, and I just arrived home from too many hours of wedding, and I'm exhausted.  And I stink of bug spray.  So this will be short.

The wedding was lovely - a big, spirited celebration of two young women who fell in love at (of all places) bible college.  It was wonderful to see so many people from a fairly conservative religious community come together for a wedding that not everyone in their community supports.  And the Indian buffet was fabulous.

What stands out most for me about the day, however, isn't something specific to a same-sex wedding.  It's the dancing.  After the ceremony and eating and many, many speeches, the backyard where the wedding was held was turned into one enormous dance floor, and almost everyone got up and danced.  In the beginning, I managed to pass as someone who isn't terrible at dancing, but after a few songs, my energy level began to wane, and my awkwardness became apparent.  I suck at dancing.

I wish I didn't.  I wish I could be one of the uninhibited people who has a great time on the dance floor, instead of the all too self aware nerd who stands on the edge of the group looking uncomfortable.  But that's always been me.  And probably always will be.

The Weekly Hiss and Purr - July 31 Version

Mrs. Frugalwoods, of my new favourite blog Frugalwoods, writes a semi-regular column entitled the Weekly Woot & Grumble, in which she talks about one good thing (a woot) and one bad thing (a grumble) from the previous week.  Because I love stealing other people's ideas needed inspiration for today's blog post have enjoyed reading these posts, I thought I'd give my own Weekly Woot & Grumble post a try.

Given that I'm a cat lady lover, I decided to go for a more feline-themed title, hence the Weekly Hiss and Purr.  (Callie and Hobbes approve.  Or maybe they're just embarrassed to have been caught in such a compromising position.)

The Hiss - Paperwork:

Being on vacation, I really don't have much to complain about.  Should I whine about the difficulty of fitting reading, tv watching, and knitting all into one day?  About having trouble falling asleep at night because I slept in until 10 am?  About my Mom not answering her phone when I'm calling to make plans for a picnic?  I'm sure that all of these things would garner tremendous sympathy.

Really, the only thing causing me any significant distress this week (other than bloody, itchy, wake-me-up-in-the-middle of the night mosquito bites) is all of the paperwork and other details that need to be sorted out before I go back to work.  College registration, malpractice insurance, automatic deposit, new pager, new dictaphone, new identification badge, etc. etc.  It seems like every time I open my email there is another request for me to fill out a form (and usually provide a cheque or credit card number).  The worst part is, no task can ever be completed in a single step.  A request for a cheque reveals that I've run out of cheques, which requires me to open my online banking, which reveals that my online banking address is incorrect, which requires me to email my banker, which reminds her that she has ten things she wants me to do for my new business account, which causes me to bang my head against the wall in frustration while letting out a guttural moan.

Really world, all I want to do is binge watch Arrested Development on Netflix while finishing off the sock I started knitting in February.  Is that too much to ask?

(Yes sock, not socks.  I've only knit one in six months.  Based on the number of times I've sworn at said sock, I may never knit a partner for it.)

The Purr - Organization:

As I've previously mentioned, I forced myself to spend the first week or so of my vacation getting my apartment organized.  Papers from medical school were recycled; ill-fitting clothing was packed up for the thrift store; and similar items were gathered from across the apartment into single locations (Me to girlfriend:  Six boxes of lard?  Why do we need six boxes of lard?  No, I'm not throwing them out.  I'll put them next to the twelve bags of raisins.).

It was a huge amount of work, and I frequently resented it during the process, but I am so glad that I did it.  Multiple times every day I look around the apartment and am amazed by the amount of empty space I can see.  I can find things easily.  I can cook in my kitchen without first having to clear counter space for myself.  It seems like such a small thing, but it fills me with joy on a regular basis.

Now the challenge is to maintain some semblance of organization once I start working again...

What I Have Learned About Money - Part Two

Continuing on from yesterday, here are two more things that I've learned over the past ten months.

Money can buy freedom:

When looking towards my future, I had always just assumed that I would follow the traditional path of working until I'm 65.  It didn't occur to me that there was any other option.  But then I started reading the frugal blogs, and I realized that there is a whole group of people out there who are saving enough money to retire much earlier, often in their 30s.  And while the really early retirement boat has clearly sailed in my case (I'm 38), it is encouraging to think that I could reach the point where I'd be able to retire well before the age of 65.

Not that I necessarily would.  I like my work, and I get a lot of my meaning in life from helping other people, so I don't feel any urgency to get out of the working world.  But it would be nice to have that option, in case my feelings about my job change in the future or (god forbid) I become unable to work before I'm 65.

Even now, I can see ways in which having money and living frugally increase my choice and satisfaction related to my job (and therefore my life as a whole).  Part of my new position, which starts in mid-August, will be to work at an inner city clinic treating residents of the area.  When this job opportunity became available, I was ecstatic, because I've spent a lot of time working in that clinic, and I think the work they do is incredible.  I want to be a part of that clinic.  But when I discussed the job opportunity with other attendings, many of them pointed out that I would make less money there than at a more conventional clinic.  Some even suggested that I turn the position down.

Which is ridiculous.  I've worked hard for 16 years in order to do work that I enjoy and that fulfills me, not to suck every penny I can out of the medical system.  Living below my means lets me make that choice.

Sometimes it is still better to spend money than to save it:

NOLA commented on my previous post that she has "always been frugal but willing to splurge".  After all of my talk about the benefits of being frugal, I think it's important to point out that I'm the same way; I still spend (probably way too much) money on things that are not absolutely necessary but that make my life better.  I still get my apartment cleaned every week, even though it's the largest single variable expense in my budget, because without it I would live in squalor.  I recently bought a new storage unit and ottoman to hide organize the clutter essential items that I couldn't get rid of in my recent apartment purge.  My second largest variable expense in my budget is still eating out, because it's the easiest way of getting together with my friends, and I value my relationships with them more than most other things.

For me, living frugally isn't about constantly saying no to myself or living a life of deprivation.  It's really about being conscious of my spending and eliminating unnecessary things (like bland cafeteria food) so that I can become more financially secure and create more choice for myself.  Because I never want to turn down a job that I love just so that I can make a few more dollars.

What I Have Learned About Money - Part One

As the completion of my training approached, I noticed that people began asking me a lot of the same questions.

"Are you going to buy a house?"  
"Are you going to buy a new car?" 
"Where are you going to travel during your vacation?"
"How are you going to reward yourself for finishing?"

The message being that, now that I'm a "real" doctor, I can (should?) start spending like one.  Looking at my Facebook feed over the past few years, it's obvious that many of my classmates have taken that approach since completing residency, as they've posted pictures of giant new homes and fancy cars and trips to exotic locations (usually complete with shopping at designer boutiques and eating in pricy restaurants*).

If you had asked me a year ago, I probably would have told you that my plans for post-training were similar.  I was definitely dreaming about owning my own home (which in my mind would miraculously not require any repairs or maintenance), and I could think of many places to which I wanted to travel and restaurants in which I wanted to eat.  But then came the unexpected work crisis, followed by the adoption of a budget.  While the initial motivation for putting myself on a budget was purely practical (eliminate crippling debt!), sticking to a budget over time (and reading lots of great frugal blogs) has taught me a lot of unexpected things about money and my relationship to it.

Money isn't necessary to have fun (and can sometimes make things less fun): 

Prior to the "great budget experiment", I did mostly the same three things for entertainment (eating in restaurants, going to movies, sitting in coffee shops/pubs).  While I enjoy all of these things and haven't stopped doing any of them entirely, there was a certain monotony to how I entertained myself.  With the introduction of the budget, I had to get creative in order to have fun without spending much (or ideally any) money.  Some of the things I've done for fun in the last year include potlucks (brunch, supper, appetizers), volunteering at a music festival (free tickets!), volunteering at a theatre festival (more free tickets!), free walking tours of my city, free movies in a local park, cycling (with a discarded bike that my girlfriend repaired for me), reading library books, attending free lectures at a local bookstore, and going to a snake pit to watch snakes mate (perfect activity for a nerd like me).  While all of these free/inexpensive activities were available to me before, having the constraint of a budget made me actually look for them.  I've enjoyed the new variety, and I've met a lot of interesting people through volunteering whom I never would've met otherwise.

More things make me less happy:

The message is everywhere (tv, magazines, websites) that having more things will make us happier (and more fulfilled/more successful/more desirable).  Since starting a budget ten months ago, I've bought almost no things for myself (a bike helmet was probably my largest purchase), and I honestly haven't felt like I'm missing anything.  I've also done a major purge of my apartment and gotten rid of about 10 garbage bags worth of stuff, and it feels wonderful to be free of so much clutter.  Having fewer things allow me to hang my jacket in the hall closet instead of over the back of a chair, to open cupboards without canned food falling on my head, and to actually find my bloody keys when I go looking for them in the morning.  Life is better with less stuff.

It's easy to waste a lot of money:

Pre-budget, I was stopping at Starbucks on most days (sometimes twice), buying all of my lunches at work, and getting takeout whenever I was bored/tired/in a hurry/feeling like celebrating/not interested in the food in my fridge.  I was easily spending hundreds of dollars a month on convenience items, all of which was being paid for with credit.  I've cut out all of these things pretty much entirely (I still spend $1.70 on tea from Tim Horton's on work days), and I barely even notice.

There are more things that I've learned about money, which will have to wait for another day, as it's time to change out of my sweatpants (yay vacation!) and go pick up my girlfriend.

How have your thoughts/feelings about money changed over the years?

*Okay, I'll admit it:  I love eating in pricy restaurants.  I will make a major splurge on a celebratory dinner once I get my first paycheque, and I will enjoy every bite and sip of it because it's been so long since I've visited my favourite restaurant.

Inclusion/Exclusion

My girlfriend is part of a very tightly knit church community; I, as an atheist, clearly am not.  In the beginning, we thought that this might be a major issue in our relationship, but it hasn't proven to be nearly as problematic as we had feared.  The other church members have been almost universally welcoming to me, despite the fact that their faith does not officially sanction same-sex relationships (and is certainly not in support of same-sex marriage).  I've eaten meals with church members, cuddled their children, and even attended a few services without bursting into flames.  All has gone very well.

Occasionally, however, issues do arise.  One of the biggest has been the issue of "small group", which is a group of church members who meet every few weeks to share a meal and discussion of their faith.  This is a major social and community event for my girlfriend, as well as for her family, with whom I've grown quite close over the past year and a half.  Because the group members discuss things that are going on in their lives (including personal struggles and disappointments), the events are closed to "outsiders" to encourage openness and honesty.  Which means that I, the atheist, am not invited.

And sometimes this feels hard.  It's difficult to be excluded from something that is so central to my girlfriend's life, especially when all of the other family members (including my girlfriend's new sister-in-law) are automatically included*.  And yet, aside from my relationship to my girlfriend, I don't really have a right or a reason to be there.  I'm certainly not going to contribute anything to the bible study, and it would only be awkward if the group offered to pray for me after I told them of something difficult in my life.  I don't quite know whether I should just accept the status quo, or force myself on a group to which I may not even want to belong.

Any thoughts?

*Not to mention the food I'm missing out on.  Perogies!  Farmer's sausage!  Baking in all its myriad of forms!  These people are amazing cooks.

21 Days

I had expected my vacation to be laid-back and leisurely, with an abundance of time for sleeping in and reading and doing whatever in the world I wanted to do.  Not so much.  Until now, I've kept myself busy with house and work tasks, with volunteering at our local music festival, and with attending way too many shows at our local Fringe (theatre) Festival.  It has been wonderful to have a change from work, but the time has still felt too busy, and I've often caught myself complaining to the girlfriend about being tired*.

All of that is about to change.  The festivals are over, the majority of the house/work tasks have been completed, and I have an almost completely empty schedule for the last 21 days of my vacation.  Day one of this phase of vacation has so far consisted of sleeping in, eating homemade Mexican breakfast and kale smoothies with the girlfriend, watching Master Chef, and trying to satisfy Hobbes's insatiable need for cuddles.

Why aren't you cuddling me?

My "plan" for this last stretch of holidays is to just....be.  To not have a long list of things to do**.  To not constantly rush from one place to the next.  To not obsessively plan every moment or worry that I'm not making effective use of my time.  To stop being the busy, stressed out person that medicine turned me into and be the relaxed, happy person that I used to be.

My hope is that, if I can remember how to focus on enjoying life instead of just getting through it, I can carry some of that knowledge forward into the next year.  I know that my first year as an attending is going to be a hard one, and that I will be stressed and overworked more often than I want to be, but I really don't want to hate it.  I want to remember to breathe and be present and take time.  To enjoy this stage that I worked so, so hard for 16 years to reach.

To just be.

*Note to self:  It isn't wise to complain to your girlfriend who works on her feet for eight hours a day about being tired while you're on vacation.  Her sympathy is very limited.  And she will expect you to rub her feet as penance.

*The one "goal" that I am setting for myself is to blog daily for the next 21 days.  I have missed the act of regularly writing here, and I have a seemingly constant stream of ideas for blog posts running through my head, so I want to get back into the habit of writing while I have an excess of time.  If there's anything you want to know about me or my experiences as a physician/a previously single person/a queer person/a theatre groupie, leave me a comment and let me know.  I'm sure I'll be looking for some blog fodder by the time the 21 days are up!