My Anti-Consumerism Christmas

I've written before about how much I dislike gifts.  It's not that I intentionally want to be a Scrooge, it's simply that I don't have a lot of material wants and needs (by privileged North American standards), and those that I have are easily met on my physician salary.  What I want far more than a sweater that someone else picked for me or another gadget for our overflowing kitchen drawers is time.  Time to rest, time to read, time to do the 1000-piece puzzle that I ordered from Amazon.

For years, I've been trying to convince my family members to simplify Christmas by giving fewer gifts.  And for years, I've been met with a desire to maintain the status quo of everyone giving gifts to everyone else.  This year, however, possibly as a result of my years of wearing down rationally discussing my views with my family members, people have finally agreed to cut back on gift giving.  Success!

Here (in case this is interesting to you) is how it is all working out:

Girlfriend (M):  M is the one person I enjoy giving gifts to, because she has a long running list of things that she wants, which makes her really easy to buy for.  And, unlike me, she loves getting gifts.  Last year I took this way too far, to the point where it was awkward for me to give her gift after gift in front of her family members.  This year, we are giving just one larger gift and one "stocking stuffer" to each other.  Our cluttered apartment will appreciate the (relative) self restraint.

Mom:  Normally my Mom gives everyone multiple gifts, many of which end up being returned or donated to the thrift store because she bought them months earlier to "save money" and they can no longer be returned.  This year, she is planning on one physical gift for each person (maximum ~$30) and one gift card to a preferred store.  Some of the physical gifts are still of questionable quality (sorry M), but at least they are smaller, and at least the gift cards will get used.

Because I hate shopping, I once again bought my Mom season's tickets to our local theatre.  We go to the theatre six times per year, and it's a great way for us to spend some dedicated time together and to do something we both enjoy.  Way more valuable than anything I could find in a mall.

Brother and Sister-In-Law:  I consider this my biggest win of the year!  My brother and sister-in-law have crazy busy lives, which have gotten even busier since bringing home a new puppy, so I managed to sell them on the idea of no gifts between couples.  I'm far happier to spend an hour or two more with them than I would be running around trying to find them a half decent gift.

Nieces:  When I suggested to my brother that we not exchange gifts, his first reaction was "But you'll still get the girls something, right?"  To which I sighed.  Because my nieces have everything.  There is literally nothing in the world that either of them needs.  Clothes, makeup, music, movies, ski equipment, a new puppy.  They have everything.  For their birthdays this year, I copied my idea for my Mom and gave them both season's tickets to our local children's theatre.  But for Christmas?

One of the things that makes me sad about my nieces is that neither of them really reads for fun.  When I was a kid, my single favourite thing was to visit the bookmobile that would come to our neighbourhood once a week.  I would return home with shopping bags full of books, which I would then proceed to binge-read until my parents forced me to turn out the bedroom light and go to sleep.  (Sadly, I didn't own a flashlight for reading under the covers.)  I really want to get my nieces more into reading, so once again I decided to get them books for Christmas.  I was very successful with Chris Colfer's book last year, so they will probably always get books from me.  Whether they want to or not.

 And that's it.  Christmas shopping done with only two trips to the mall.  Success!

If you celebrate Christmas, how are you doing with your shopping?

Edited to add:  Ummm...or Hanukkah.  Of course.

Gathering my People

This has been a really, really rough week.

Really.

I didn't expect it at all.  I finished call at 8 am Monday morning; I had lots of uncommitted time in the evenings to relax with my couch and my cats; and there didn't seem to be anything unusually stressful in my calendar.  It was supposed to be a good week.

And then we had a department meeting.

There are changes happening at my university, and while logically I expect that the changes will all be fine (if not actually good), they do create a lot of uncertainty.  And as an anxious person, uncertainty is not my friend.  I've spent the whole week calculating how long I can survive off the money in my bank account, wondering what I could do if I was no longer a physician, and being tortured by my sensitive GI system*.  It's been miserable.

While lying awake on the couch in the wee hours of this morning, wishing that my cats would consent to me squeezing them like a security blanket, I realized that I needed to do something differently.  I can't live with this level of anxiety for the ten years or more until I've squirreled away enough money to retire.  This isn't working.

Thankfully, today was a paperwork day, so I had lots of time to figure things out.  And what I figured out was that I need a support system.  People who have been through what I'm going through who can offer me some advice.  Unfortunately, in Medicine this is a really, really hard thing to find.  We are supposed to all be perfect and to not need anything from anyone, so finding someone with whom we can discuss our challenges and vulnerabilities isn't easy. 

Coincidentally, just last week I had run into an attending who, years ago, had given a talk to my residency program about the challenges she had faced as a resident and young attending.  When I realized this morning that I need more people, my brain went "Ah-ha!".  That was who I needed.  Except...she is an attending that I don't know personally.  And I run into her about once every 3-6 months. 

So, going against every instinct of mine to be shy and quiet and never ask for anything, I emailed her to see if she would meet me for coffee.

And she said yes.

And then I emailed another attending.  Who also said yes. 

Suddenly, after a week of feeling alone and scared, I don't feel so much of either.

*For the record, none of this is rationally necessary.  Everything is going to be fine, one way or another.  This is just anxiety.

How Am I Doing So Far?

This week was my first week of call since I wrote my post about how to not hate call so much.  (I've been on call for 21 of the past 42 days.  Too much call.)  As the week approached, I tried very hard to say no to anything but the most essential of activities.  I deferred dinner with a friend until next week.  I said no to doing anything with my Mom.  I was ruthless with turning people down.

And then the week arrived.

Monday night a group of medical school friends whom I only see a few times a year were getting together for dinner, and I couldn't say no.

Tuesday night my girlfriend's parents invited us over for a birthday dinner.

Wednesday night a friend was visiting from Egypt and wanted to meet for dinner.

Thursday night we decided to go see a new house that had just come onto the market.

Friday night was trivia night at my girlfriend's church.  And I love trivia.

Over the weekend, we have seen three more houses, gone out for breakfast twice, gone for an impromptu coffee with my Mom and brother, watched my niece in a volleyball tournament, shopped at two craft markets, seen Romeo Dallaire speak, and gone for another birthday dinner with my girlfriend's friends*.

I apparently am incapable of just saying no to anything.  If it sound remotely interesting, and especially if it involves food, I am there.  Regardless of how tired or extroverted out I may happen to be.  Regardless of how much I need to just be quiet and still after the stress of a call week.  Regardless of what I say in my blog posts.

And yet...somehow this week worked for me.  I gave myself the option of saying no to things, but when it came time to exercise that option, I never wanted to.  I got to do a lot of fun and interesting things with people whom I love over the course of the week, and it felt pretty good.  I'm not quite sure why it was okay this time when it wasn't the last time I was on call, but somehow it was.  Maybe it was knowing that I could say no to things without guilt?  Maybe it was only being on call for one week and knowing that I would have a long stretch of recovery afterwards?

I haven't the foggiest clue, but I'm very glad it did.  And I'm hoping that it will continue to do so when the next stretch of call comes around.

Ignoring Money

As a medical trainee, I pretty much ignored my finances.  Having been a disciplined saver of at least 10% of my earnings since I turned 18, it was depressing to watch my savings first disappear and then turn into a six-figure debt.  So I didn't.  I stopped looking at my bank account, I stopped filing my taxes*, and I essentially pretended that money didn't exist.

I existed in this world of willful ignorance for eight years, until a scare at work made me question whether I was going to get to be a doctor.  Suddenly the debt that I had thought would be easy to repay grew monstrous, as I imagined paying it off without a physician's salary.  So I started paying attention.  And budgeting.  And slowly I got myself to a point where my net worth went up a bit every month.

And then I got my adult job.  And suddenly my net worth was going up a lot every month.  Within 10 months of starting as an attending, I had saved enough money to repay my debt.  It felt pretty awesome.  But it also felt pretty obsessive.  Every day when I came home from work, I would check my bank balance and my credit card balance and my payment owed balance to figure out how much I was worth.

Every single day.

It got to the point that I was attaching too much of my self worth and feelings of security/insecurity to a single number.  On days when I'd have a good clinic (or, even better, have a good clinic and be on call), I'd feel happy, confident that I was moving towards a future of security and happiness.  On days when I'd pay my rent or my car insurance, however, I'd be miserable.  Any downward movement in my net worth felt like a failure.

So I stopped looking.

For all of October, I kept my net worth file closed and simply ignored it.  I kept tracking my earnings and my spending, and I must admit that I tried to mentally estimate my net worth a few times, but I didn't check my net worth obsessively.  And it felt so much better.  I didn't get angry at patients who failed to show to clinic, viewing them as a lost revenue stream.  I didn't get upset when I had to, or chose to, spend money.  I knew that, regardless of what was happening day to day, overall my net worth was going in the right direction.

I was going to be fine.

Ironically, October had the second biggest net worth increase of any month since I started working.  This was in no way related to my behaviour, and in every way related to the 15 days of call that I worked, but it was still really comforting to know that I could let go of my hypervigilance about money, and it would still be okay.

Now that October is over, and I can check my net worth as often as my heart desires, I'm trying hard to not fall back into my old patterns.  I don't want my happiness to be tied to money.  I don't want to be anxious on the days when my spending exceeds my earnings - which is every single weekend day.  I don't want to be constantly comparing myself to all the personal finance bloggers and feeling inadequate.  I want my money to be in the background, slowly growing, while my much more exciting and fulfilling life goes on in the foreground.

*This is a really, really dumb thing to do. 

---

Wondering what my November goal is?  ABSOLUTELY NOTHING.  I'm feeling burnt out at the moment, and all I can think about is spending four days this weekend at a cabin with my girlfriend.  And books.  And nachos!

Self improvement will have to wait for December.

Surviving Call

When I wrote my most recent blog post, I was feeling a little bit smug about how well my life was going.  I was exercising, I was feeling calm, and my relationship was in pretty much the best state it has ever been.  I was happy.  I was about to start an 11-day stretch of 24-hour-a-day call, but I felt ready for it.

I've got this, I thought.

Except I didn't.  It took less than one day of teaching residents, and rounding on inpatients, and answering outside calls (all while still running my normal outpatient clinics) for me to return to my usually high stress level.  I went to a movie with M and a friend the evening of my first day of call, and I spent the entire time stressing about work and feeling annoyed that the two of them were calm and actually enjoying themselves.  (How dare they?)  After weeks of respite, my mind was back to ramped-up panic mode.

And that's where it remained for most of my 11 days on call.  I worried and obsessed over the decisions I was making.  I felt stressed by the increasing pile of undictated charts piling up on my desk.  I lay awake at night rehashing everything I had done and questioning whether I was, in fact, good enough.  As it often is, it was awful.

And of course, my life outside of work suffered.  My relationship that had, until that point, been ticking along nicely, suddenly struggled.  I was short-tempered.  Everything she did seemed wrong and irritating.  I had moments of panic that I was making the wrong decision about staying with M, even though a few short days earlier everything had been going really well.  Also awful.

In the past, my approach when I've felt this way on call has simply been to count the days until it's over and to feel thankful that I'm only on call for 10 weeks a year.  Now, having been through some counseling, I realize that there are things that I can do to make the tough parts of my life better, and I'm no longer happy with the grin-and-bear-it approach to call.  I want my life on call to still feel okay.

So I've been thinking a lot about the things that I can do to make call less awful.  This is what I've come up with so far:

Undercommit:  I am about as introverted as introverts get, and as a result, I need a lot of time to rest and recover from activities.  Evenings on my couch with a book and my cats are as essential to me as vitamins.  This is particularly true when I'm on call and I'm dealing with a lot more people, decisions, and uncertainty than I do in my ordinary life.  Unfortunately, I have a bad habit of making just as many plans when I'm on call as when I'm not, even though I know that my work life will use up most of my capacity to function in the world.

The other downside to making plans when I'm on call is that I hate disappointing anyone.  Somehow the pager always goes off when I'm getting ready to go out with M, and I hate making her wait for me or (worse) do things without me.  It makes me feel like a terrible partner, even though she is incredibly patient and supportive and never says anything that even implies that she's disappointed that I got paged and our plans had to change.

I'm not saying that I won't ever make plans when I'm on call, but I do need to be very cognizant of my limitations.  I need to plan much less than I often do, and I need to leave enough couch time to recover from my days.

Keep moving:  It always comes back to this.  Exercise is good.  I need to do it.  Regularly.  End of story.

Talk to M:  I have a really good partner who is loving and supportive and a good listener.  I always feel better after talking with her, and I need to get better at being open with her about how tough my work life can be.

Let things go:  The low point of this week was on Tuesday night, when I really needed to just relax and recharge, but I had a slow cooker of pork that was waiting to be turned into pozole.  I normally love cooking, but I resented every minute I spent chopping and frying and pulling pork instead of reading a book.  And the resentment was completely unnecessary, as there are clearly foods that are much easier to make than homemade soup!

I need to let go of the idea of myself as someone who always cooks elaborate whole foods from scratch.  I can eat a fried egg with toast or a frozen fish fillet and the world will not end.  Pozole can wait for a week when I'm not on call.  As can many other things.  Call weeks should be about doing what is necessary, not what is perfect.

Recognize my irrationality:  I am an anxious person, and I am only now starting to realize just how detrimental a role anxiety plays in my life.  When I'm in the extremes of my anxiety, it can lead me to think really irrational things.  Like that my relationship may not be a good one.  Or I'm not cut out to be a doctor.  Or I'm going to end up on the street if I don't hoard every penny I earn.  Thankfully, I'm learning to distinguish between true facts and crazy anxious talk, and I'm learning not to listen to the latter.

Keep going to counseling:  I am somewhat amazed at the difference that six counseling sessions made in my life.  It probably saved my relationship with M.  It certainly made work better.  It was worth vastly more than the $480 it cost, particularly because the cost was covered by our provincial medical association.

Unfortunately, the medical association only pays for six sessions, so I stopped going after the sixth.  Which is UTTERLY AND COMPLETELY STUPID OF ME, because I can still afford to go.  I spend $80 in restaurants without batting an eye, so I can spend $80 on a counseling session.

UTTERLY AND COMPLETELY STUPID.  (I'm looking at you when I say that, Solitary.)

For now, call is done, and I am recovering on my couch with my computer/books and Callie.  It is taking all of my self restraint to not add 85 other activities into my day (dishes! groceries! laundry! coffee with friends!), but I know that I depleted all of my reserves over the past 11 days, and I need to replenish them.

Hopefully my next time on call will be better.

Movement - September Goal

Oh exercise, how I struggle with you.  With just a quick look through the blog, it's easy to find multiple posts in which I'm either committing to exercising more or lamenting the fact that I've failed at exercising more (see here, here, here, here, and here for just a few examples).  It's not a habit that comes easily to me.

The problem, for me, is that there are so many things that I would rather being doing than exercising.  Reading, blogging, cuddling with my cats and/or girlfriend, eating out, cooking at home, etc. etc.  There is no shortage of things that I want to do, and it is always difficult to say no to them in order to do something that doesn't really appeal to me.

But I know I need to.  For my stress level, for my health, for my happiness.  Everything is better when I get exercise.  So this month, I set myself the goal of exercising three times a week.  I didn't set any specific requirements for how long or what type of exercise or anything else, I simply had to move.  And I'm happy to report that I was almost perfect.  In the entire month, I only missed one workout, and that was due to the fact that I had such bad sciatic pain that I could barely walk.

In addition to working on the habit, I wanted to observe myself and figure out what helped me/hindered me when it came to exercise.  I want to better understand why I've failed in the past so that hopefully I can do better at making this a lifelong habit.  If nothing else, it will be much more interesting for the blog if I can set a monthly goal for myself that isn't exercising!  Here's what I learned over the past month:

Variety:  I've tried in the past to just run on the treadmill in my building three times per week, and it gets boring very quickly.  (Not to mention the bloody sciatic pain.  My borderline obese body was not designed for running.)  This time I've been trying to do more variety - walking outside, yoga classes, aerobics classes, elliptical - and it's definitely easier to stay motivated.

Planning:  I do much better if I sit down at the beginning of the week and plan out my exercise than if I just try to wing it.  Not surprisingly.  (I didn't promise that these would be profound observations, just observations.)

Changes in Schedule:  I have been aiming for a Tuesday/Thursday/Saturday exercise schedule, which is great when it works, but terrible if I happen to have an extra morning clinic or something else that interferes with my plans.  Going forward, I'm going to have to get better at dealing with the things that throw me off of my schedule.  (Case in point:  I have an 8 am lecture to attend tomorrow, combined with our local LGBTQ film festival in the evening, and I have no idea how to deal with it yet.)

Mood:  My mood has been vastly better over the past month than it has been in perhaps ever.  While I think the counseling and the improvements in my relationship have played a huge part, I certainly don't want to discount the role that exercise is probably playing.

So, for the first time in ever, let's call this month of exercising a success!

---

As for October (quick comment before rushing off to Thanksgiving dinner #2), my goal is to not look at my net worth.  Not once.  I normally check it on a daily basis and think about it pretty obsessively, so going 31 days without looking at it is a big step for me.  But one that has been good so far, and one that I think is necessary for my happiness.

Happy Thanksgiving to everyone in Canada!  Hope you enjoy your turkey (or Aloo Gobi, which is how we're celebrating this year). 

The Time I Failed At Meditation

A few months ago, when I was struggling with my recent breakup, I had the brilliant idea that meditation would make me feel better.  I searched around a little, found a legitimate-sounding course on Mindfulness-Based Meditation, and paid $500 to sign up.  The orientation session was last night.  It went somewhat like this:

Shit.  I'm late.  These things never start on time though, right?  

(Enter room in which people are sitting in a circle with their eyes closed and their hands in their laps.)

Crap.   

(Noisily take the one remaining chair at the front of the room.  Drop bag on floor, causing multiple people to open their eyes.)

Okay.  I can do this.  Close my eyes.  Ommmmmmm.  Do I smell like McDonald's?  Can the people around me tell that I just ate a Filet-O-Fish?

Ommmmmmmm.

Is it morally wrong to eat a Filet-O-Fish before a meditation class?

Ommmmmmmmmmm.

"Good evening class.  My name is <weird New Age name that I would bet money she made up>.  I will be your leader for the next ten weeks."

Ten weeks?  Shit.  

I'm not sure I can do this for ten weeks.

(Notice that the instructor is barefoot.  With her bare feet on the classroom floor.  Try not to be grossed out thinking about the number of feet that have touched the floor and are now contaminating her feet.)

Okay.  I need to pay attention.  What is she saying?

"...homework requiring approximately 45-60 minutes..."

Homework?  I didn't know there was homework.

It's okay.  I can do 45-60 minutes of homework per week.

"...per day..."

WTF?  45-60 minutes PER DAY?  Who has time for that?

Do these people not work?

(Look around.  Notice that many of the people in the class appear to be under the age of 20.  Suspect that they all live in their parents' basements and do not in fact have to work.)

(Notice really smiley girl across the room who is listening intently to everything the instructor is saying.  And nodding enthusiastically.  And smiling as if she took really good drugs prior to meditation.)

"Everyone taking this class will feel differently about the process.  It's important that you use your inner wisdom to guide you to your best possible outcome."

(Snicker at use of phrase "inner wisdom".  Notice that smiley girl is nodding as if the instructor is sharing truly profound insights into the nature of the universe.  Uncertain if I should be feeling vastly superior or inferior to smiley girl at this moment.)

"...inner wisdom..."

OMG.  I can't listen to this woman talk about "inner wisdom" for ten weeks.  I will kill her.

"...inner wisdom..."

AAAAAAHHHHHHHHHHH.

(Look around to see if anyone else is losing their mind like I am.  Notice more people smiling and nodding at the instructor.   Am now convinced that the instructor handed out drugs while I was stuffing my face with fries in my car.)

"And now we will work together to develop our guidelines for supporting each other through the next ten weeks, as we learn more about meditation and about ourselves.  Who wishes to suggest the first guideline?"

No.  OMG no.  Are we five?  This is what I used to do with the kids at the summer program I ran as a teenager.  THE KIDS WHO WERE FIVE.

(The woman next to me speaks)  "I think it's very important that we respect each others' inner spirits.  Because we're all here to make our inner spirits stronger, and if we say hurtful things, it can weaken our inner spirits."

(Officially hate woman next to me.  And do not ever want to hear the word "inner" used in any context ever again.)

(Notice that the name tag of the woman next to me says Beaghan.  Because her parents were clearly crazy.) 

(Smiley girl talks)  "I just want to say that I feel really lucky to be here.  So, so lucky."

Unnnngggghhhhh.

"I feel like the universe has presented me with a gift of wonderful people to learn from and to grow with."

UNNNNNNNNGGGGGGGHHHHHHH.

Shit.  I hope that noise is just in my head.  Am I making that noise out loud?

Do I smell like french fries?

"Alright class.  This is an excellent list!  I can tell that the next 10 weeks are going to be a joyful experience of learning and growing..."

No they aren't.             

"...and sharing..."

I'm not sharing anything with you crazy people.

"...inner wisdom..."

Stop saying that.

"...inner spirits..."

 Now you're just fucking with me.

"Now, some people decide after the first class that they simply aren't ready to take this journey that we're about to embark on."

Oooh...me!  That's me!

"Maybe their lives are too busy, or maybe their inner spirit just isn't in the right place to undertake a spiritual quest at this time."

Or maybe they think you're nuts, you barefoot hippy.

"If you are feeling this way..."

Yes!  Me!  I AM FEELING THIS WAY! 

"...you can receive a full refund on your course fees until 4 PM tomorrow."

And that is how I failed at meditation.       

Hope

When I watch the election coverage coming out of the States, I am left fearing that the world is becoming an increasingly intolerant and hate-filled place.  This morning, however, I had a brief glimmer of hope that maybe things are actually getting better.  One of my friends, an open lesbian who is married to another woman, got ordained as a pastor this morning.  Surrounded by representatives from multiple Christian denominations and multiple churches, she was welcomed not only into life in the church, but into life as one of its leaders.  To the best of my knowledge, she is the first openly gay pastor within her denomination in Canada. 

Her denomination is not one that is commonly associated with progressiveness or open-mindedness, and I know that her journey to this point hasn't been an easy one.  There were people who resisted her advancement at multiple steps, and I suspect that there are people who will leave her congregation because they can't see past their bigotry to how fortunate they are to have her as their pastor.  For the people who remain, even the ones who are hesitant to be led by a lesbian, my hope is that they will see how utterly ordinary her relationship with her wife is.  The genders may be different, but they experience the same love and companionship and struggle of any heterosexual couple.  Different on the surface, but fundamentally the same underneath.

I hope too that Americans will come to their senses and not vote a dickhead for POTUS.

Missing the Blog

I think about this blog frequently.  Post titles pop into my head while I'm showering.  Entire lines of text write themselves in my mind while I'm examining patients.  I am the type of person who is constantly trying to understand life, to fit it to a logical narrative, and this blog feels like an integral part of that process of understanding.  And yet, I don't make enough time for it.  Days or weeks go by without a post until I return, overwhelmed with things I want to write about, only to write a list of bullet points.

I've been working a lot lately on habits - finishing up my work efficiently, getting to the gym, staying connected with friends - and I think that blogging is going to be the next one I try to work one.  I'm finding that if I just leave things to chance that I never seem to get to them, but if I make a regular commitment of time, then I tend to get things done.  So hopefully if I make a plan for blogging I will start logging more than one or two posts per month.

Any suggestions on how frequently I should post?  If you're a blogger, how do you keep up a regular posting schedule?

Revisiting the Budget for the Millionth Time

I started writing a post about the emotional impact of medicine (thank you counseling for digging up all the painful memories and for making me feel all the feels), but it was too much for a late night blog post, so I thought I would write briefly about budgeting (yet again).

I thought I had finally solved my budget dilemma by simply increasing my daily allowance, but when I tried to put it into practice, it just didn't feel right.  I found myself alternating between feeling stressed about essential purchases like cat litter because they would put me over budget and searching for frivolous things to spend money on because there was suddenly room in my budget.  I am constantly looking for balance in my life, and the budgeting system I had used for the past two years was starting to feel very unbalanced.

(Physician On FIRE wrote a good blog post about this phenomenon here.  Definitely worth a read.)

The problem came to a head over the long weekend, when I had a nice chunk of money sitting in my budget, and I decided to spend it on a massage.  Not a utilitarian therapeutic massage, of course, but an over-the-top, self-indulgent spa massage.  Complete with a complimentary robe and slippers, assorted spa snacks, and a post-massage relaxation room to allow me to "slowly re-integrate into the outside world".  It was more than twice as expensive as any massage I'd ever had, and it made for two of the most pleasant and relaxing hours of my entire life.  Pure bliss.

But then it was over.  And after handing over a ridiculous sum of money, I was left with nothing but the memory of Renaldo's hands massaging all of the stress out of my body.  And while that is a lovely memory, it doesn't get me any closer to financial security.  Later in the day of the massage, as I was following the endless rabbit holes of the Internet, I stumbled upon a blogger's Philosophy of Money.  And one section really stood out for me:

"I want to live in such a way that I minimize the number of years that I have to work for money. I’ll have a modest house, car and lifestyle and will never spend more just because I earn more. I’ll invest any surplus so that I can live on my own terms sooner than later."

Yes.  Exactly.  Just because I'm finally earning my doctor's salary doesn't mean that I want to inflate my lifestyle to the typical doctor's lifestyle.  I want to live reasonably and modestly so that I can save any extra money and be in a position to retire early(ish).  I want freedom more than I want complimentary spa snacks.

I will never spend more just because I earn more.

So I'm revisiting the budgeting yet again.  And instead of trying to stick to a defined spending limit, I'm trying to focus on maximizing the value I get from my spending.  Whenever I make a purchase, if it isn't something I clearly need (Cat litter - yes.  Wine - kind of?), then I try to determine whether it's something that is going to enrich my life more than the time off that I could buy with the money.  Going back to the ridiculously expensive massage, I could have lived for two days at my current spending level for the cost of the massage.  If I'd invested the money for ten years, it could have bought me four days of freedom.  When viewed in that way, the decision is easy:  I would always choose two days off of work over a massage.  No matter how perfect Renaldo's hands may be.

Interestingly, this approach to budgeting seems to be working better for me so far.  I recently had to buy cat litter*, and I didn't panic over the fact that it put me over budget.  I'm currently sitting significantly under budget, and I'm not looking for things to spend money on.  I'm just trying to focus on the things that really make my life better, which can very rarely be purchased.

*Why do my cats have to eat the most expensive cat food and poop in the most expensive cat litter?  If I didn't love them so ridiculously much I could be much better off financially.

So Many Things

You know how something happens and you think "I should blog about this", but then you don't have make the time to do it, and then something else happens that you want to blog about, but you can't because you still have to blog about the first thing, and then it happens over and over again until you have ten things you want to write about and you haven't blogged in almost a month?

Yeah.  That. 

So...because I can't decide which of the major life events I want to leave out of my blog post, and because no one wants to read a brief autobiography disguised as a blog post, here is the last month of my life in bullet points:

1. I got back together with my (no longer) ex-girlfriend.  After the breakup, I don't think I went more than four or five days without seeing M*, and I definitely didn't go that long without talking to her.  I missed her.  We started out doing the "we're spending all our time together but not dating" thing over a month ago, and we declared ourselves dating again a few weeks ago, and so far it seems to be going well.  We're doing our best not to repeat some of the mistakes we've made in the past, and it definitely makes for a healthier relationship.  We shall see where this goes...
2. My grandmother died.  My grandmother was 94, slightly senile, and diabetic, and yet I was convinced that she would live forever.  A few weeks ago, I got the call that she had had a heart attack and been made palliative, so I headed out to her small community as prepared as one ever is to say goodbye.  When I arrived at the hospital, she was asleep in her bed, but she quickly roused and demanded to be taken home.  By the time we got her back to the PCH, she was back to her usual feisty self, showing no signs of what had happened.  Unfortunately, a week later she fell and broke her hip (for the third time), and that was the beginning of a very rapid end.  My grandmother was the most resilient of the resilient Depression era farm women, and so it's still amazing to me that she's gone.  I still have moments when I feel guilty for not visiting her, so I don't think it's quite sunk in yet.
3. I decided what to do with my budget.  The comments on my previous blog post were fascinating to me!  It's interesting how everyone has their own unique way of being financially responsible, many of which are different from my own.  In the end, I realized that my current method of budgeting is actually working pretty well for me, except for the fact that the amount of money I was allowing myself didn't fit with the amount of income I was bringing in.  So, I threw $500 at the budget to get myself out of the black, and I increased the regular amount in my budget by 1/3.  Since the change, I have bought Threadless t-shirts and Happy Socks, taken a thankfully not sick cat for a very expensive vet visit, and booked a luxurious spa day for the long weekend.  So I'm over budget again.  But enjoying spending some of my hard earned money instead of just hoarding it in the event of future catastrophe.
4. I started counselling.  I wrote before about how I had seen a psychiatrist through a service at work, but what I've never written about was how abysmal the whole experience was.  I went in looking for some coping strategies and maybe some cognitive behavioural therapy for anxiety, but what I got was someone who wanted to put me on medication and explore all of the supposedly traumatic events from my childhood (um, no thanks).  It was a terrible match.  I put off looking for someone else until M and I got back together, and then I decided that I needed someone external to help me navigate the waters of rekindling an old relationship.  I've met with the counsellor once, and it seems like a better fit so far, so I'm hoping that something good will come out of it.
5. I started exercising again.  It has become abundantly obvious to me that everything is better when I exercise.  Not in a future oriented "I won't have a heart attack when I'm 50" kind of way, but in an "I'm less of a psycho hose beast when I exercise" kind of way.  Exercise is definitely good for my stress, my energy level, my sleep, and my all round happiness.  My goal for September, in fact, is to restart the habit of exercising three times a week.  It will likely consist of me running on the treadmill on Tuesday and Thursday mornings, as I have no clinics those mornings, and then doing something else on Saturdays or Sundays.  I may alternatively do an exercise class at work on Thursday afternoons, as there's one that starts after my work day ends.  This week I'm planning to go to yoga on Saturday morning, as my sciatic pain has flared up from the running**, but I may be more creative in the future.
6. I signed up for a meditation class.  This terrifies me.  I've been reading books about how wonderful meditation is (like 10% Happier and Full Catastrophe Living), and I'm fully convinced that it can make me a happier and more productive person, but I absolutely hate the idea of having to actually do it.  Sitting with nothing but my thoughts?  Breathing exercises?  Walking meditations?  All of that sounds terrible.  And yet, starting October 5 I will be doing it every Wednesday evening.  

And that is my life.  How is everyone else doing?

*I'm giving her an initial, because it's far too tedious to keep typing "the girlfriend" or "the ex-girlfriend" depending on my current relationship status.  Also my hands are sore from typing chart notes.

**When did I turn 80?

The End of Budgeting?

My budget is currently sitting at $294.13 in the red.  A year ago, when I was just starting to work and I was trying to dig myself out of nine years of medical school debt, this would've caused me to panic.  Or more realistically, I never would've gone $294.13 into the red.  I would've eaten rice and beans and said no to get togethers with friends to keep myself from ever going over budget.

Now, I barely notice.  When I hit a positive net worth, my stress level about money dropped, and I have gradually gotten less and less worried about money as my savings have climbed.  Slowly, I've reintroduced things into my life that I've forgone over the past two years:  fancy drinks in restaurants, expensive cheeses, clothing of any sort.  And it feels really nice.

I'm not entirely sure what to do about budgeting at this stage.  Even with being over budget, I'm saving over 2/3 of my earnings, so I am more than meeting my financial goals.  I don't really have to budget anymore; and yet, there is part of me that doesn't want to abandon budgeting altogether.  Part of it is for the reasons I outlined in a long ago post about why I continue to be relatively frugal.  But it's more than that.

I think a huge part of me worries that I'll go back to my terribly consumeristic ways if I stop budgeting.  Before I started budgeting two years ago, I had developed an almost instinctual habit of buying whatever I wanted.  Whether I was shopping for clothes or eating in a nice restaurant or ordering books online, I would simply buy whatever appealed to me in the moment with the knowledge that it was going on my line of credit and I wouldn't have to pay for it until I was an attending*.  I would take whatever boredom or loneliness or exhaustion I was feeling and try to spend it away.  Always unsuccessfully.

Starting to budget made me much more mindful of my spending.  It made me realize that I often wasn't looking for a new thing when I went shopping, but rather for some feeling that I was missing.  A lot of the time, the best thing I could do when I felt like buying something at random was to just go have a nap, as I've been chronically tired since my first day of medical school in 2006.  It also made me focus on non material ways of being happier, rather than on buying a new pair of happy socks.  (Although I really love happy socks.  And am now searching their website thinking about placing an order.  Well done, me.  You've clearly learned your lesson.)

I guess what I'm looking for is some way to be intentional with my spending while not feeling constantly constrained by my budget.  I want to take advantage of the fact that I'm earning ridiculous amounts of money for a single woman with no dependents, without thinking that I can somehow buy happiness.  Balance.  The endless search for balance.

Any ideas?

*Thank you very much, past me.  You are an asshole.

---

To update you on my habits from a few weeks ago, I've been doing surprisingly well with them.  I have completely resisted the cans of Coke in my fridge, and I've passed on pop multiple times in restaurants.  I am allowing myself to have pop in mixed drinks (something I decided to do in the beginning but didn't mention in my previous post because I was lazy), but in total it's been about one can of pop since I started.  I almost always put my things where they belong when I get home, which has made leaving in the morning much more efficient and peaceful.  I've also started putting my keys/wallet/phone in specific spots in my bag (my bag has about 8 different spots, so searching for something can be frustrating), and that has also been a huge improvement.  Finally, I have planned out my weekly schedule every Sunday night, and it has given me a bit more awareness of the week and a big more structure.  It also saved me from missing dinner with a good friend this week (I thought it was on Thursday, but it's actually on Tuesday), so that is also a win.

Well done, me. 

Back to Work

I've taken a lot of vacation already this summer.  In May, it was Egypt/Greece/Jordan with my (now ex-) girlfriend.  In June, it was Chicago with my family.  This month, I spent a weekend in New York City for a wedding and then took a week off at home so that I could go to our local theatre festival, which is pretty much my favourite thing in the world.  Unfortunately, today was the last day of the festival, and tomorrow I go back to work.

There is actually a small part of me that is looking forward to going back.  Despite my Facebook posts to the contrary*, I mostly enjoy my job, and I am happy to have a bit more routine in my life again.  The past month and a half has felt very unsettled, and I'm hoping that being back at work will help me to feel more grounded.  More like myself again.

As I prepare to go back for a long stretch with no vacation in sight**, I have been thinking a lot about happiness - specifically, about things that I can do to be happier in both the short and the long term.  Find a new girlfriend seems to be the one that pops into my head most readily, but I'm well aware that I'm not yet in a place where I should start dating again, so I will just try my best to ignore that thought for at least a few more months.  Beyond that, there isn't one single thing that comes to mind; rather, there's a long list of small things that might help to make my life easier and better.  So...I'm back to trying to make some small habit changes. 

At the moment, there are three things that I'm trying to work on, which I will discuss very briefly, because it is suddenly late, and I have to set an alarm clock for the first time in 11 days.

Stop drinking pop: 

I know that I need to make healthier food choices, and I also know that sudden radical changes inevitably lead to failure, so I'm going to start small.  I gave up pop for the month of April, and I was really surprised by how little I missed it.  At the beginning of the month, I though about drinking it periodically, but the cravings for it always passed quickly, and by the end of the month I didn't even think about it.  I was actually a few days into May before I realized that I could start drinking pop again.  Which I wish I hadn't. 

Put my keys, wallet, and cell phone in the same place when I come home:

I am ashamed to admit that I spend a lot of time searching for my keys, wallet, and cell phone.  I frequently switch them between my purse, my work bag, and an assortment of backpacks that I use when I'm out at festivals or other events, and I can never seem to find them when I need them.  Not to mention the fact that my cell phone is rarely charged, which is inconvenient given that I recently gave up my land line.  A few days ago, I moved a storage unit into my front hallway and put a wicker basket on top of it, and I am trying very hard to put my things into it whenever I get home.  Except for the cell phone, which is getting attached to the charger.

Review my schedule on a weekly basis:

I'm pretty good about entering events into my calendar, but I'm not the best at subsequently looking at the calendar and remembering what I need to do.  So far I haven't missed any major appointments (in recent history, at least), but this leaves me with a bit of an unsettled feeling all the time.  My plan is to spend a bit of time every Sunday reviewing my schedule for the week (work and home) and to make a few work/personal goals for the week.  I will never come anywhere near sarah (SHU) in my organizational skills, but I am hoping to slowly improve them.

And that's it.  Three small habits that will not radically change my life but that will hopefully make things a bit better.  And once I've adopted these habits, there can always be more! 

*My Mom freaked out when I recently posted on Facebook that I preferred being at the theatre festival to being at work.  What would your patients think if they saw that?  Um...that I'm a normal human being who sometimes likes vacation more than being at work.

**Any ideas of fun things for single people to do on vacation?  The thought of booking a holiday without my (now ex-) girlfriend makes me want to vomit in my mouth a little, but I know that I will eventually need to go somewhere without her.  Or just work all the time.  Also an option.

In the Gloaming

Given the recent end of my long-term relationship, you probably won't be too surprised to hear that my emotional state has been a bit volatile as of late.  One moment I'm feeling excited by the freedom and possibility that being single brings; the next moment I'm overwhelmed by sadness at everything that has been lost.  While I have still managed to do all of the things that I need to, getting through the days hasn't always felt great.

Tonight though, things were momentarily really good.  I had to bring my bike home from my ex-girlfriend's parents' house, where I had stored it over the winter, and I just happened to do so right at dusk.  The temperature was warm enough to be comfortable but cool enough that I didn't break a sweat; the air was still; and the clear sky transformed from pale blue to pink to indigo as I rode the bike home.  My out of shape muscles enjoyed being challenged, and my constantly busy mind reveled in being able to shift down a few gears.  It was as close to perfect as life ever gets.

I have gotten through the past few weeks by constantly reminding myself that things will get better.  Tonight though, if only for a brief moment, things already were.

Taking the Real World with You

When I went to Chicago for the first time in 2012, I had just finished my first month as a senior resident in a Medical-Surgical Intensive Care Unit.  That rotation was one of the most difficult months of my entire training.  My medical knowledge and patient management skills were challenged beyond anything I had ever experienced, and I lived in constant fear that my ignorance and/or incompetence was going to kill someone.  With only three residents in the unit, we were forced to take call every third night*, such that I was making difficult patient care decisions through a haze of severe sleep deprivation. 

And then there were the patients.

Because the unit was home to the sickest patients in the hospital, death was a constant presence.  The worst night of my training happened in that unit:  over the course of a 15-hour overnight period, I admitted or ran a code on eight patients, not a single one of whom survived to the morning**.  At 8 am, one of my co-residents walked into the unit, looked at the near-empty patient list, and nonchalantly commented "Oh, looks like you had a quiet night".  In another situation her comment would've made me bawl, but I was too emotionally drained to do anything more than put my head on the desk and moan.  It was a hard month.

My ICU rotation was followed by two weeks of vacation, which I had initially planned to spend relaxing at home and visiting with friends and family.  But as I dragged myself through the too-long days of ICU, subsisting on digestive biscuits and ice cream cups that were intended for patients, I knew that I needed something better to look forward to in order to make it to the end of the rotation.  So, a few days before I was finished with ICU, while lying nearly immobile on my couch in a post-call stupor, I booked an impromptu trip to Chicago.  Leaving at 6 am on the first day of my vacation.

It was an amazing trip.  Chicago was a beautiful city filled with interesting places to visit and a seemingly unending list of great places to eat.  The weather was perfect.  I lucked out and got a great hotel room on the 22nd floor that looked directly towards the Chicago River and the Wrigley Building.  And for one week I didn't have to take orders or give orders or feel people's pulses slip away as I held my hand over their femoral arteries.  It was the perfect escape.

I had hoped that my trip to Chicago this past weekend would be just as amazing.  And I will say that it was mostly fun, lest I seem ungrateful for having the good fortune to be able to travel to such a remarkable place.  I got to show my Mom a city that I love; I got to meet Carlos from Top Chef season 11 and eat in his amazing restaurant; and I left the pressures of work behind for four days.

But.

My family is not always easy.  My Mom is going through a difficult period, still struggling to cope with the death of my father six years ago, and there was understandably a lot of time and attention devoted to what she's going through.  She also snores.  Loudly.  And unpredictably.  I spent the first night on the couch to get away from her, and the second night I severely pissed her off by making her sleep in my brother's room.  Thankfully he is so perpetually exhausted that he can sleep through anything.

And then there's my brother.  While I love him (really...I love him), he and I see the world through very different lenses***.  I am an unapologetically left-wing, environmentally minded, socialistic granola cruncher.  My brother takes ten napkins at Chipotle and throws out nine unused ones.  If we could simply agree to disagree, we would probably get along much better; however, we both think that we have all the answers to the world's problems, and we are determined to share them with each other.  So there was some conflict.  He said I was judgemental.  I may have called him an asshole.

The good thing about family is that they are always your family.  Even if you call them an asshole.

*The resident contract in my province stipulates that residents cannot take call more than once every four days, on average; however, in situations where "patient care would otherwise be compromised", that rule can be overlooked.  Hence the one-in-three call.

**I refuse to believe that this reflects on my skill as a physician in any way.  The patients were simply that sick.  Most of them didn't make it to the end of the code blue.

***Thankfully he isn't a Trump supporter.  There are some things that I cannot forgive, even when it's family.

Escape

By the time I left on my recent trip, I was in desperate need of a break.  I needed to not have to make life or death decisions and to not carry a pager and to not have to be witness to the inevitable human suffering that accompanies medicine.  I was spent.

Unfortunately, the Middle East is not the most relaxing place to visit*, and traveling with one's soon-to-be-ex-girlfriend and her family does not make the experience any easier.  At the end of my trip, I felt just as stressed as I had been at the beginning, and things have only gotten worse as a result of 1) the subsequent breakup and 2) a very long and busy week on call. 

Thankfully, I'm spending this upcoming weekend in Chicago.  My Mom turned 65 last December, and my brother and I decided to mark the occasion with a family getaway**.   We leave at 8:30 tomorrow morning, and I can't wait to be away.  I am ready to see beautiful architecture and eat tasty Top Chef winner cooking and not worry about anything.  All of the problems of the real world are just going to have to wait until Monday.

*Particularly as an LGBTTQ person.

**We deferred the trip until the weather was likely to be good and until my brother's and my call schedules aligned.  Bloody call.

Afterwards

Life is a strange contrast at the moment.  I am on call for the week, so my days are run-off-my-feet busy between my regular clinic schedule and the added inpatient service.  I am constantly scribbling notes in a chart while balancing my cell phone on my shoulder, or listening to my resident present a patient while I not so inconspicuously scan blood work on the computer.  I start my days anxious and I finish them overwhelmed, uncertain of where I will get the energy to do it all again tomorrow. 

And then I go home.  My pager is relatively silent most evenings, my apartment even more so.  My dining room table is empty, the jacket and wallet and keys that used to live there now scattered across the dining room table at my ex-girlfriends' family home.  Beyond feeding myself and the two cats, there is nothing that I have to do.  I read for a few minutes, then watch tv for a few minutes, then stare at the cats willing them to be better conversationalists.  Occasionally they purr, and I tell myself that they are trying to make me happy, although I am well aware that cats are inherently assholes.

I don't know what to do with myself.

For two years, my life was filled with her and with the bustle of activities that filled her restless, extroverted life.  The first day after the breakup, my introverted self reveled in the stillness of her absence, but as time passes stillness transforms into tedium.  There is no shortage of things I should do - the not quite unpacked suitcase from our trip is still on my bedroom floor, and there are always dishes - but I am longing to want to do something.  I am five-year-old me, whining at my mother: "I'm bored".

"Clean your room," she replies, and the answer is as unsatisfying now as it was 34 years ago.

Zero

Two major events happened last week.

First, I finally hit the zero point on my net worth.  After two years of budgeting and frugal(ish) living, I finally dug myself out of the hole that medical training and lots of careless spending created.  I feel a little bit lighter and a little bit less stressed, but it hasn't been quite as momentous an achievement as I had hoped.  Now that I am officially worthless (ha ha), I want to actually start accumulating some money.  An emergency fund!  A down payment on a home!  Apparently I'm incapable of being satisfied with where I am in life.

Second...I broke up with my girlfriend of two years.

It's hard to know what to say about this, because there are so many things at play in a breakup, and they never quite fit together into a coherent story.  It's inevitably messy.  I can say that it was my decision, that I had a sense it was coming for a while, that I'm doing okay.  That it is very strange to watch carloads of her things disappear from my small apartment and to see my old life emerging from underneath them.  That the worst thing in the world is hurting someone you love.  There is so much more.

For now, one of the many songs that I'm listening to, over and over again.

Home

Wow, that went by quickly.

After a day and a half of lying in bed, never far from the bathroom and a large bottle of water, we recovered from our food poisoning and resumed our traveling.  We had a few more days in Cairo, followed by three nights in Athens, three nights on a Greek island (Aegina), and a week in Amman, Jordan.  The days were very full, between being tourists and visiting family, so there never seemed to be a spare moment to update the blog.  Even my Facebook photos are a solid two weeks behind.

I would like to say more, but at the moment I've been awake and traveling for almost 26 hours (it's like being on call), and the cats get annoyed when I use my hands for typing instead of petting.  All I will say for now is that it was an amazing trip; the Middle East is a place unlike any I've ever been before.

The (Hopefully) Lowest Point of Our Trip

Me to my girlfriend at 3 am this morning:  "I think I'm going to have diarrhea again.  Do you need to vomit, or can I use the bathroom first?"

#alwayssaynotouncookedvegetables

Cairo

It took three flights, almost 24 hours, and a small meltdown in the Frankfurt airport, but my girlfriend and I are now comfortably settled in an apartment in the Heliopolis neighbourhood of Cairo.  The two days since we arrived have been devoted to seeing as many people as possible (my girlfriend lived in Cairo for three years and, being an extrovert unlike me, left behind a long list of people who love and miss her), adjusting to the seven hour time difference, and challenging the defences of our gastrointestinal tracts with street foods.  Shawarma...mmmm...

As we were waiting in the airport in our home city, we ran into our accountant, who was waiting to fly to his vacation home in Phoenix.  The girlfriend and I were already in vacation mode, eating hot dogs and deciding which of the many ebooks we had downloaded to read first, while the accountant was surrounded by his computer and cell phone and stacks of papers.  When he saw us, he quickly picked up his phone to call the Canada Revenue Agency about an issue with my tax return, and after speaking with someone, he called over to me to let me know that he had resolved the issue.  His voice was eager, like a child seeking praise. "Look at me!  I'm on vacation but I'm still working for you!  Aren't I great?"

And then he chatted with us about where we were going and how long we were going to be away.  When I told him that we were traveling for three weeks, and that I had left all of my work at the hospital, a momentary flash of disgust passed over his face.  He recovered quickly, but he still made it clear that he didn't approve of my prolonged absence.  "Three weeks?  No doctor goes away for three weeks!  That's crazy!"

Which it shouldn't be.  When I am at work, I work very hard, often giving up lunches to finish paperwork and coming in early so that I can fit in another urgent patient.  So why on Earth should I have to apologize to my accountant about wanting to take some time away for myself?  Why does medicine (and North American society as a whole) fetishize work so much that people are viewed as weak or as failures if they choose to do anything other than work?

I refuse to apologize for not wanting to give my entire life to medicine.  The further I get into my career, the more I realize I'm going to have to fight the dominant culture of medicine in order to take time for myself, but I'm prepared to do that.  Life outside of medicine is too sweet to squander it all simply to meet other people's expectations of me.

The Way Things Should Be

Like a number of my favourite bloggers (see here and here), I recently read Leo Babauta's post about how to not be frustrated all the time.  In the post, he argues that frustration arises from our desire for things to be different from how they are.

"It’s from not wanting things to be a certain way. Not wanting other people to behave a certain way. Not wanting ourselves to be a certain way."

 Yup.  Welcome to my life.  After reading the post, I started paying attention to how much mental energy I expend wishing that things were different, and I was shocked by the fact that there is pretty much a never ending stream of thought going through my head that judges everything in my life as inadequate.  For example:

When waking up in the morning: "I wish it wasn't Tuesday and that I didn't have to get up and go for a run, because I'm tired and want to stay in bed under the warm covers and running sucks and I'm out of shape and I'm never going to get in shape anyway."

When walking to clinic:  "I wish I didn't have so many patients booked because I'm sure some of them are going to be really challenging and then I'm going to feel rushed, and feeling rushed makes me stressed, and I hate being stressed, and if I were a better doctor I would never feel stressed."

When dictating:  " I hate dictating, it's so boring and it takes so much time, and I don't have enough time for fun things or for more important work because I'm always spending time dictating, and if I were a better doctor I wouldn't take so long to do my dictations."

When leaving work:  "It's nice that work is over, but the evenings are never long enough, and I have to do things that aren't fun like cook supper and wash dishes and that always ruins the little bit of time I have when I'm not working."

And on and on and on.  The funny thing is, before paying attention to my thoughts, I would have described myself as a positive person.   I'm generally pretty happy, and I'm usually able to find the positive side of a situation, so I was shocked to realize just how much negative crap goes through my head on a daily basis.

Once I was conscious of my thought patterns, I realized how incredibly draining all of the negative crap is.  So I'm trying to change it.  I'm trying to follow Babauta's advice to become aware of my frustration and to let go of my expectation that things will always go my way.

"You want things to go your way, want people to behave the way you want them to. But you don’t and can’t control the universe. You aren’t entitled to getting everything your way."

Now, when I start down the horrible negative thought death spiral, I try to catch myself and be aware of it.  And then I try simply to not engage in all of the negative thinking (sometimes easier said than done).  I acknowledge that I would rather be on my couch drinking an Old Fashioned than sitting in my office doing my 12th dictation of the day, but that isn't my reality.  Or that I wish my girlfriend wouldn't look like she's on a terrifying roller coaster ride every time I drive, but that is my reality.  And I am better off accepting these things (as much as I can) than I am constantly raging against them.

The amazing thing to me is that it's actually helping.  I don't dread dictations and paperwork nearly as much as I used to, and I'm more efficient at them because I'm not wasting time feeling like the most hard done by person on the face of the Earth.  I'm not freaking out when I take longer than planned with a patient, because I know that there is some cushion in my schedule, and life will go on even if my clinic runs overtime.  Things feel surprisingly easier, despite making what seems like a very minor change in my thinking.

Since that Babauta post, I've encountered the same ideas in a few different places.  (It's almost like the universe is trying to tell me something.)  I went to a workshop about physician burnout on Friday, and there was a session on mindfulness meditation that explored the same concepts.  I recently finished a really good book called 10% Happier, which is about a tv anchorman's experiences with mindfulness meditation.  The more I encounter the idea, the more I think I might benefit from spending more time exploring the concept of mindfulness.

Which will unfortunately have to wait, because on Thursday I hop on a plane for three weeks in Egypt, Greece, and Jordan.  While this sounds wonderful (vacation!), I'm honestly a bit terrified, because there are going to be some major challenges.  Such as 24 hours of travel, jet lag, staying in an apartment that is 100 stairs from the main floor (no elevator), highs of 44 C*, crowds, noise, and two out of three weeks spent with my girlfriend's family.  Oh, and the fact that most of the places we're traveling to hate the gays, so we'll have to pretend that we're roommates.  My goal for the trip (Let's call this my May goal, shall we?) is to be mindful of all the things about travel that frustrate me and to do my best to let go of them.

Or, at the very least, to not have a screaming match with my girlfriend in front of the pyramids.

*I think the hottest I've ever experienced was about 35 C, and I felt like I was going to die.

March/April Goals - Eat Food

Once again, I'm late with reflecting on last month's goals and setting out this month's goals.  Perhaps my goal for this month should be to be on time with my next post about goals?

Anyway...for March, I made a very vague commitment to "recognize what I need and to meet those needs".  I was feeling in a bit of a slump at the time, and I couldn't quite figure out what would make me feel better, so my goal was essentially an attempt to identify anything that would make me feel better and do it.  After a few days of self reflection, I realized that one of my biggest sources of unhappiness was feeling like I was spending all of my time doing the tedious parts of my job (dictating, editing dictations, reviewing labs) without ever being finished with it.  In response to this, I made it my priority to get all the stuff done, and I did.  (As I wrote about here).

In getting caught up on my work, and even more so in trying to prevent the work from reaccumulating, I have come to realize that I was making the fatal mistake of letting my work expand to fill the time available to me.  I'm usually in clinic only about 50% of the time, leaving me with more than enough time for office work when I'm not on call, and I was allowing the tedious work to unnecessarily fill up all of my non-clinic time.  I would come in a bit late, have a nice long coffee break, check Facebook, and do all kinds of things to procrastinate getting the work done because there wasn't a real urgency to doing it.  When I had another project to work on, such as a presentation with a firm deadline, then I would get more efficient at the tedious work to make time for the other project, but otherwise I was dawdling.  And feeling trapped in paperwork hell.

Forcing myself to finish my tedious work on a daily basis (as much as possible) has made me much more efficient.  I come in on time, I minimize non-work activities, and I use even the random five- or ten-minute chunks of available time between events to be productive.  There is absolutely no way that I want to stay later than I need to because I've been scrolling through Facebook instead of signing off on dictations.  By making much better use of my time, I've finally freed up some of the big chunks of time that I need for bigger projects.  Which feels awesome.

So, March goal?  Let's call it a success.

April Goal - Eat Food:

A lot of my time with patients is spent counseling them on living a healthy lifestyle.  Many of them hope that I hold a magical secret to living better, but in reality, my advice to them is always pretty basic:  Get exercise (30 minutes per time, 3-5 times per week).  Eat more healthy food (fruits, vegetables, lower-fat dairy, lower-fat meat/meat alternatives, whole-grain products).  Eat less unhealthy food (pop, chips, fast food, processed food, sugar).  Simple in theory, frustratingly difficult in practice.

After spending my days giving (what I think is) fundamentally sound advice, I unfortunately often go home and sit on my couch eating precisely the things I tell my patients not to.  I love pop.  And chocolate.  And ice cream.  And eating out in almost any restaurant, including the greasiest of greasy spoons.  I am an extraordinary hypocrite, and I know it's something I need to work on. 

About a week ago, my girlfriend and I watched an excellent documentary featuring Michael Pollan, an author who has written books about the problems with the industrial food system and with our current approach to eating healthily.  The documentary focuses around Pollan's simple advice on how to eat:

As I was watching the documentary, I was struck by how simple the advice was, and by how horribly I fail to live up to it.  Even though I actually like real, unprocessed, healthy foods.  The main reason I eat so much bad food is laziness and accessibility, both of which I can change.  So...I'm making two commitments for the months that fall under the heading of "Eat Food". 

1)  No pop.  It's something I don't need, and it's one of the worst things I can possibly consume.  So for this month (if not longer), I'm done with it. 

2)  Take one fruit and one vegetable in my lunch every day.  It's a small start, but it is at least a start.  I bought an assortment of vegetables at the grocery store today, I've cut up a bunch of vegetables to take in my lunches, and I'm ready to be successful at this one.

Now I'm off to Red Lobster for dinner.  I wonder if they sell any real food....

Values

Tonight I went to a talk about climate change by Naomi Klein, a Canadian writer and activist.  Going into it, I was worried that it was going to be a depressing lecture about how the Earth is doomed, complete with photos of polar bears floating adrift on melting icebergs.

Instead, the talk was a call for transformation - from fossil fuel to renewable energy, from a profit-driven economy to a human-centred society, from isolation to community.  It was 90 minutes of a left-wing, granola crunchy vision for humanity*, and I loved it.  Her talk encompassed everything I believe about how the world should strive to operate, only articulated in a vastly more intelligent and entertaining way than I ever could.

As I listened, I was hopeful that the world might just be capable of realizing the things I believe in:  environmental sustainability, racial/gender/sexual equality, empowerment of the poor and the marginalized.  And I wondered, what is my role in this?  As a physician (and as a queer, able-bodied, white, upper class woman), how do I live out my values and contribute to the society that I want to see?  How do I move beyond earning a paycheque and paying off debt to making a lasting change in my community?

I don't quite know yet, nor do I have the energy to really delve into this question late on a Friday night, but it is definitely something to think about.  Any ideas?

*Supported by a very solid research base and understanding of economics/politics/world systems. 

Happiness Over Money

Years ago, soon after I had started medical school, a friend of mine who is a physician came in from out of town for a visit.  During his stay, I inundated him with questions about medicine and work life balance and time off for physicians.  When the subject of vacation came up, I was quite surprised to hear that he could take almost as much time off as he wanted to, but he didn't.  It was, he said, too hard to give up the money.

At the time, I didn't understand.  I viewed vacation as a wonderful time of happiness and freedom, and I couldn't imagine passing it up for more money when doctors already make lots of money.

Fast forward eight or nine years, and I understand completely.  When the amount you earn is directly proportional to the amount you work, and especially when you still have 5-10 years of debt repayment ahead of you, it's really hard to justify time off from work.  Every day off is a calculation: 

One half day of clinic x X patients/half day x $Y/patient = I think I'll go to work.  

It's so easy to look at that calculation and think that I don't need a vacation and that it's okay for me to miss out on the things that make me happy.  Except that I do.  And it isn't.

So I'm learning to value my time more than my income.  It started today, with cancelling a half day clinic so that I can go to a really interesting conference on work life balance.  And then, emboldened by that decision, I decided to take an entire week off during our local theatre festival.  A week!  It took me hours to commit to the decision, but now that I've made it, it feels right.  It feels entirely right for me to make time for something that I love that gives me joy.

After all, why else am I here?

Exhaling

For weeks (months? years?) I've been feeling overwhelmed by work.  My desk has been covered with charts and lab results, my dictation inbox has been overflowing with letters to edit, and I've been weeks behind on my to do list.  No matter how much effort I put in, it seemed like I was never doing any better than keeping the piles from growing larger.  And I hated it.

About two weeks ago, I had finally had enough of all of the things that loomed over me, so I made it my goal to get caught up on everything.  Everything.  Whenever I had a spare minute, I tackled the things that needed to be done.  I went into work early and stayed late.  I worked through lunch.  I logged on from home when I had extra time in the evenings or on weekends.  I worked my butt off, and I got shit done.  And now?  I'm caught up.  There are zero charts on my desk and zero dictations to sign off on.

All done.

It feels amazing.  I no longer want to scream at my administrative assistant* when she brings a pile of lab results into my office.  I have actual time to do the big picture things, like read journal articles and prepare presentations and (maybe someday) finish the article on my fellowship research.  By getting caught up, it is now possible to keep up with the things that come in every day and to stay caught up. 

Best.  Feeling.  Ever.

The only problem?  I'm so used to existing in a state of chaos and panic that I don't know how to function with the stress gone.  With nothing screaming at me to pay attention to it, it's hard to pay attention to anything.  How is a procrastinator to function once they stop procrastinating?

*I have never done this, because I'm not a jerkface.  Any physician who yells at people in his or her workplace (or anyone else, for that matter) is a jerkface.

Notes Towards a Poem That Can Never Be Written

"The facts of this world seen clearly

are seen through tears;

why tell me then

there is something wrong with my eyes?

To see clearly and without flinching,

without turning away,

this is agony, the eyes taped open

two inches from the sun." - Margaret Atwood

Part of my girlfriend's job involves resettling Syrian refugees.  After experiencing almost unspeakable horrors in their home country, these people have now traveled halfway across the world to a foreign city searching for something better.  Which they don't always find.  The cold and the grey of a Canadian winter, even as it begins to melt into spring, isn't always inviting.  The residents of my city too aren't always welcoming towards more people who will need government support (more taxes on the already overtaxed) to establish themselves.  The low-income housing into which people are placed doesn't always match with the image of an affluent Canadian city.  Life here can be hard.

And so they talk.  They talk about many of the sad things from their pasts and about the disappointment that they don't leave the sadness behind when they physically leave their country.  They talk to my girlfriend, and she listens because she's a good person and can feel these people's need to unburden themselves, if only a little.  With each story, each heartbreaking story, some of the weight of their experience transfers from them to her.  Their loads lighten, hers becomes heavier.

And I see it in her.  I see it in how she laughs a little bit less and seems a little bit more distracted when we talk.  I see it when I awaken in the night, and she is already awake, her mind unable to rest.  And I know what it is like, to bear witness to the suffering of others, and to feel powerless.

And I wonder, how do we - the doctors, the nurses, the social workers, the myriad of helpers - stay intact?  How do we witness these things and not be destroyed by them?  How do we keep coming back, day after day, offering what little we have to offer, when all we see is the neverending need?

Advice That I Need Every Day (Click on the Picture)

Why I Continue to Live the Frugal(ish) Life

One of the best people I met during my fellowship training was our Educational Coordinator, S*.  S is slightly older than I am** and married later in life, so she could empathize with me during both the single-career-woman-looking-for-love and the single-career-woman-falling-in-love stages of my training.  She was also a huge advocate for me and the other fellow, which was invaluable in dealing with a system that was often indifferent and occasionally blatantly hostile to its trainees.  When I finally finished my training, one of the few things that made me sad was no longer working with her on an almost daily basis.  (Everything else was bliss.)

While I liked S from the very beginning, I really bonded with her after I abandoned my spendy ways and started living more frugally.  She would stop at my desk to chat fairly regularly, and one day we got talking about money after she caught me binge reading the great Mr. Money Mustache.  It turned out that she had learned to be frugal while living as a single person, and she'd carried that approach into married life, such that she and her husband currently live off a single income and bank the second one for retirement.  Over the remaining months of my fellowship, we talked regularly about the freedom that comes from living well below your means and about all the sources of happiness that don't require money.  In a financial sense, she and I clicked.

Which is why I was surprised the other day when I ran into her in the hallway, and she asked me "Are you getting used to living like an attending now?"  Her assumption, like everyone else's, was that I had abandoned frugal living as soon as my first fee-for-service patient entered my clinic.  In reality, for anyone who is curious, I'm living on almost exactly the same budget as I did during fellowship***, and every additional dollar I earn is either getting saved or applied to my debt.  Which makes many people (my accountant, my financial advisor, my spendthrift physician friends) ask me "Why?"  They point out, quite legitimately, that I could afford to be more liberal with my spending and to buy a house and a car that doesn't have a giant chunk out of its rear end.  They simply don't get why I keep living like a fellow despite my attending's salary.

For me, the answer is easy:  choice.  As long as I am in debt, as long as I am spending most or all of the money that I earn, then I have to keep working long hours as a physician.  If I buy the big house and the fancy car, then I'm always compelled to earn a high income to pay for them.  Which isn't so bad now, when I'm fresh from training and still somewhat keen, but who knows how I'll feel in 10 or 20 years.  Maybe I'll want to stop working full time and take three-day weekends every week.  Maybe I'll be sick of my subspecialty and want to retrain in another field.  Maybe I'll burn out altogether and want to move to the West Coast to smoke pot.  Who knows?  All that I know is that saving money now, and living on less, means that I can practice medicine because I choose to, not because I have to. 

Even in the short-term, frugality makes life better.  I can work at an inner city clinic, where I earn slightly less ridiculous amounts of money than I would at a tertiary care centre, because I don't have to maximize my salary at the expense of my happiness.  I can say no to extra weekends of call, even though I usually don't****.  I can sleep better at night knowing that I'm within a few months (maybe as little as two?) of having a legitimately positive net worth, even without counting my car.  All of this is way better than a $30 bottle of wine or a $200 dinner out. 

And let's be honest:  I'm really just pretending to be frugal.  I'm not living a Frugalwoods life of 10-cent rice and bean lunches over here.  I'm living off of more than the average family in my city.  I'm traveling to the Middle East in May, and I'm going out for Korean food tonight, and I'm buying weekend passes to our local music festival instead of volunteering.  As my accountant said recently, I'm living a "relatively modest" life.  It's only in comparison to the crazy excesses of many doctors that my life is in any way frugal.  And for that, I'm very lucky. 

*I'm so creative with the names.  You're welcome.

**5 years?  10?  15?  I'm terrible at guessing ages.

***I added $200 per month to my travel budget, because we love to travel and have some big trips planned this year, and I threw a bit of money at my budget to make up for the Great November Debacle so that I wouldn't have to spend a year recovering.

****That will happen once I hit a positive net worth.