Thursday, January 28, 2016

Goals: Review of January/Plan for February


My main goal for January, if you remember, was to go to the gym three times per week.  I think the best phrase to describe my performance is epic fail.  In total, I think I made it five times.  And the fifth only happened because my girlfriend resisted my desperate pleas to stay in the warm bed this morning and dragged me to the gym. 

Part of the failure wasn't my fault.  Soon after recovering from my horrible Christmas cold, at approximately the time when my chapped nostrils were starting to heal and I was getting used to being able to breathe without choking on phlegm, I got another cold.  So for at least 3-4 days I didn't have the respiratory function to run on the treadmill.  The rest of the failure was clearly my fault.  Some of the excuses I used for skipping the gym included not getting enough sleep, feeling groggy from getting too much sleep, the bed is warm, and of course "I don't want to".

I don't know how to do better.  While my resolve is generally good when I'm thinking about going to the gym during the day, it is abysmal at 6:45 in the morning when the room is dark and I am buried under my favourite duvet.  I'm hopeful that my girlfriend will be a positive influence, as she has committed to working out regularly, and she's vastly better at sticking to habits than I am.  (She still wears her retainer at night.  Over a decade after her braces came off.  I think I might have done that for a month, if that.)  I know that it isn't enough to rely on my girlfriend's commitment, but maybe her encouragement will help me in the early stages of developing this habit.

Recycled February goal:  Go to the gym three days a week.

My other January goal was to find a counselor.  Success!  Thanks to a service for physicians, I've actually been able to get an appointment with a psychiatrist for an initial assessment next week.  I'm a bit nervous about it because 1) it's in the hospital where I work and 2) I know some of the psychiatrists who are on the treatment team.  I can't say I like the possibility that someone I know, or worse yet one of my colleagues, could find out about this.  But...I believe very strongly that we shouldn't stigmatize mental illness, particularly in medical professionals, and one of the ways of breaking down the stigma is to show that good, competent physicians can struggle with mental health issues.  So I'm just going to suck it up and do it.

Second February goal:  Don't chicken out and skip the assessment with the psychiatrist.

Because it's rather boring to just recycle old goals, I'm setting one new big goal for the month.  I wrote recently about how much I hate winter, and my hatred just seems to grow as the season continues with no sign of an end.  Despite my plans to embrace winter, I've been doing a spectacular job of staying home on my couch, which isn't doing anything to make me a happier person.  So, I've set myself a goal of making two social plans with friends or family for every week in February.  It doesn't matter what it is, as long as it requires me to change out of my sweatpants and spend time with another person.  And it can't just be my girlfriend or friends of my girlfriend, as I'm way too reliant on her for social interactions (a problem when introverts date extroverts, and something I've been meaning to blog about for a while).  It has to be someone whose primary connection is to me.

It's been kind of fun to brainstorm things that I can do over the next month.  While restaurants and movies will undoubtedly feature heavily in my plans, I'm also thinking about taking my nieces to a play, having friends over for games, and hosting a potluck.  And maybe even going skating with friends in an attempt to get over my hatred of this miserable season.

Any other creative ideas?

Third February goal:  Spend time with people I love.  At least twice a week.  The girlfriend doesn't count.

Monday, January 18, 2016

How to Survive a Canadian Winter

I'm suffering from a horrible case of winter blahs at the moment.  Until a few weeks ago, we were having a very mild winter (0 to -10 C on most days), and it seemed completely bearable.  Then the weather dropped into the -20 to -40 C range, and everything started to feel unpleasant.  Our apartment never quite warms up, despite the heaters running continuously.  My skin freezes in an instant if I go outside without it fully covered.  And nothing feels quite worth going outside, no matter how fun or smothered in cheese it might be.

My instinct at this time of year is to cocoon myself in bed with cats, hot chocolate, and a pile of library books.  I have zero desire to work or to do any of the things necessary for maintaining my existence.  Laundry?  Groceries?  Dishes?  All of these things seem like too much effort when the outside world is frigid and the daylight disappears before I leave the hospital.  Every year I long to bypass these months, even though I recognize the finite nature of life and theoretically want to enjoy every precious moment of it.  For me, there is nothing precious about -40 C before the windchill*. 

This year is about being present though, which includes being present during the loathsome months between Christmas and the Spring melt.  So I'm trying to come up with ways of not being miserable until March.  Some of the things I've come up with?

Long johns**:  My girlfriend made me buy a pair of long johns last year, and they may be the only thing that keeps us from killing each other when the weather is cold.  (She is a crazy person who thinks that people should go outside despite the cold.  She is very wrong.)  Winter is slightly more bearable when I have long johns and an undershirt and a down jacket and a toque to keep the warmth inside.

The Conservatory:  Our local zoo has a plant conservatory, which is a rather unimpressive greenhouse filled with the type of tropical plants that you can buy at Walmart.  But!  It is ridiculously hot inside, and it has a glass ceiling, so visiting it in the Winter can feel just the tiniest bit like being outside in a warm place.

Winter foods:  Soups, stews, and casseroles smothered with cheese.  Warm and hearty things from my kitchen are all that keep me going on some days.

Hot tub:  I'm spoiled and live in a building with an indoor hot tub.  I really must spend more time warming my frozen bones in it.

Skating:  I haven't yet mustered up the strength to do this, but it seems like it would be good for me to get outside and participate in something Wintery.  Maybe I would hate Winter less if I actually enjoyed something about it.  Cross-country skiing is also a thought, and it would take advantage of the flatness of the region in which I live.

Sigh.  I don't think this list is helping.  I want to go to street festivals and run along the river and sit on a patio drinking overpriced cocktails.  Nothing about winter seems pleasant right now.  Maybe I should just blow my budget and go to Mexico.

If you have the misfortune of living somewhere that is frigidly cold right now, how do you manage to be happy despite the weather?  Or do you give up on being happy and just treat Winter like a horribly bad call shift and wait for it to pass?

*If you live someplace warm and don't know what a windchill is, I kind of hate you.

**Are there people who aren't familiar with long johns?  And toques?  I hate all of you.

Sunday, January 17, 2016

November Lessons?

(This post might be a bit obnoxious, as I'm writing about finances from the perspective of a well-paid physician with no children living in a low cost-of-living area.  Feel free to skip it!  Please don't hate me.  I do recognize the incredible privilege and good fortune in being able to write a post like this.)

November started out as a really good month financially.  I was on call for nine days, which meant that I was earning an on-call stipend and consult fees on top of my usual clinic income.  I had recently increased the number of patients I was seeing per clinic, so even my relatively constant clinic income had taken a jump.  I felt flush.  Money was coming in more quickly than it ever had, and so it seemed silly for me to be sticking to a budget and limiting my spending.

Big mistake.

My change in spending habits started slowly, with a takeout meal on a night when the fridge was full of leftovers ("I work hard!  I deserve sushi instead of spaghetti!), but it quickly escalated.  Soon I was eating out in the fancy restaurants that had never seemed remotely worth the cost, and I was offering to pick up the tab for my friends. 

And then I went to San Francisco.

The trip was a combined conference and brief vacation with my girlfriend, so I convinced myself that I could completely ignore my budget and classify most of my spending as business expenses*.  $20 tequila sampler at the hotel restaurant?  Business expense.  $39 flight of port and $20 plate of cheese at a wine bar?  Business expense.  In just over a week, I spent more money on restaurants and new clothes and Trader Joe's chocolate than I had spent in months. 

And I'm not going to lie - it felt amazing.  It was fun to spend without thinking about money or entering expenses into my budget.  $20 plates of cheese are tasty.  And I felt strangely powerful sitting in Jardiniere, which was filled with the pre-opera crowd dressed in tuxedos and ball gowns**,  eating fancy french fries and ordering overpriced wine from a sommelier.  After 16 years of sacrifice, it felt like I had arrived.

Reality hit the day after our dinner at Jardiniere, when we had to pack to go home, and we didn't have room in our suitcases for all of our new things.  Then, when we were preparing our forms for customs, we realized that we had spent almost to the very generous customs limit, something neither of us has ever done.  The worst moment, however, was getting the credit card bill in December.  The only time I've ever had such a ridiculously high credit card bill was when I paid my fees for my licensing exam.  It was painful.

As a result of the overspending, I ended up in the red in December.  This was a huge (and painful) contrast to previous months as an attending, during which I'd been paying back some of my student debt and making healthy contributions to my retirement savings.  The whole month of December felt like a terrible hangover, as I watched all of my earnings go to MasterCard.

My initial take home lesson from November was "Stick to the budget!  Keep living like a student!", and for a while that's precisely what I did.  But as I look back at the month now, I wonder if that's the only lesson I should take from it.  Because although the month was way beyond sustainable spending for me, there were also a lot of good things about it.  While eating the flight of port and the cheese plate, my girlfriend and I had a wonderful conversation about our relationship and the future that makes me happy whenever I think about it.  While having dinner at Jardiniere, we realized that we never want to become people who own ball gowns and think we're special because we're eating in an expensive restaurant.  And we got to see Idina Menzel in a shitty musical, which was on my girlfriend's bucket list.  (Seeing Idina Menzel, that is.  Not the shitty musical.)

So...what to take from this experience?  First and foremost is the recognition that it is easy to spend a lot of money in a very short time.  And although I am earning more than I ever had, I can't afford to spend indiscriminately when I still have a six-figure debt.  (Or probably ever.)  Second is the reminder that people adapt to things very quickly.  While the unrestricted spending felt exciting in the beginning, after only a month it was starting to feel very ordinary.  And going back to my previously comfortable budget felt horrible.

Looking back at the month now, I think the overarching lesson I'm going to take is that splurging is fun, but it can't (and shouldn't) be an everyday thing.  I'm going to keep sticking with my budget and dutifully saving my money, but I'm also going to make sure that I leave some money for the really self-indulgent expenses that are worth it (like going to wine bars with my girlfriend). 

Balance.  Once again, the lesson is balance.

*Please note that this was only from a budget perspective and not a tax perspective.  Hi Revenue Canada!  I'm not evading taxes by claiming booze as a business expense!  Please don't audit me!

**I was in jeans, because I hadn't realized from the website just how fancy the restaurant was.  Awkward!

Thursday, January 14, 2016

Book Review - Doctored

"Among my colleagues I see an emotional emptiness created by the relentless consideration of money.  Most of us went into medicine for intellectual stimulation or the desire to develop relationships with patients, not to maximize income.  There is a palpable sense of grieving.  The job for many has become just that - a job."

At the end of my recent pseudo-holiday (home call but no clinics), I picked up the book Doctored:  The Disillusionment of an American Physician by Sandeep Jauhar.  I can't recall now how I discovered this book, but it was in my list of books to read at my local library, and it had been a while since I'd read anything at all medical, so I decided to order it.  The book is the autobiography of a junior physician who is starting his practice as a Cardiologist in New York City.  In the beginning, he is idealistic and has big plans for improving the care of patients with congestive heart failure at his hospital.  As time goes on, however, he quickly realizes that the salary of an academic physician isn't enough to support a wife and a growing family in Manhattan, so he starts taking on more and more work to try to cover his bills.  First it's paid lectures for pharmaceutical companies, then it's moonlighting with a private practice physician reading stress tests and echocardiograms.  Very quickly, he finds himself becoming burnt out and depressed as he spends too much time doing work that he doesn't love.

I loved this book.  Part of it was the perfect timing of discovering a book by a junior physician (especially a nerdy internal medicine sub-specialist) at precisely the time when I'm starting my own career as a junior physician (and nerdy internal medicine sub-specialist).  I could relate to the sense of uncertainty about how to structure one's career and to the testing out of different things (like paid lectures for pharmaceutical companies, which is an entirely different post) .  I understood his desire to finally start seeing the financial payoff for all of the years of training and his cognitive dissonance at suddenly viewing the patients he cared about as sources of income.  In reading the book, I started to forget that I was reading and to feel like I was sitting in a coffee shop commiserating with a friend about how medicine hadn't turned out the way we had hoped it would.

What I liked best about the book, though, was the solution that the author arrived at.  Without giving too much away, I will say that the book isn't just a rant against modern medicine and the failings of the American medical system.  Instead, it's an exploration of what it means to be a physician and of how physicians can find happiness and purpose in an imperfect system.  It's realistic yet hopeful in exactly the way I needed it to be.  I may actually go against my plan to avoid buying books and get myself my own copy so that I can read it again.

At the very least, I'm adding Sandeep Jauhar to the list of people that I'd invite to dinner if I could invite anyone.  I think he, Gandhi, and my Dad would make for some interesting dinner conversation. 

"How to prevent the burnout that is so widespread in the profession?  There are many measures of success in medicine:  income, of course, but also creating attachments with patients, making a difference in their lives, providing good care while responsibly managing limited resources.  It is whether you find that meaning in your work that determines whether you feel successful or not."

Sunday, January 10, 2016

2016 - Looking Ahead

Much of medical training is about deferring happiness*.  Every study session, every 24-hour-plus call shift, is an exchange of the fun things I could be doing now for the benefits I hope to get in the future.  In my case, I invested 16 years into post-secondary education with the expectation that it would make me happier in the long run.

It occurred to me recently that I have finally left the stage of deferred happiness.  The studying and exams and overnight call are all behind me, and the time for enjoying life is here.  The unfortunate thing, however, is that I have spent so much of my life looking ahead and waiting that it's hard to adjust to being in the present and enjoying it for what it is.  Whenever I think about my life, it is reflexively with a forward-looking gaze, wondering what is over the next horizon and how soon I will get there.

Which is something that I want to change.  So my overarching goal for 2016 is to learn to be present.  To stop thinking about what comes next and instead focus on what is happening now.  To enjoy the life of a physician that I worked so hard and so long to create.  To be mindful of the multitude of blessings in my life.  To do this, I plan to set little goals for myself, along the lines of the "gradual, long-lasting change" that I talked about in December.  I'll probably set one or two goals every month, although sometimes I'll set weekly goals just to try something out for a short while.  All of the goals will be focused on making life better in the now, rather than banking happiness for the future.

For January, my main goal is a resurrected one:  get to the gym three days a week.  I had been doing well prior to catching the cold from hell, but I stopped entirely when I was sick and missed about two weeks.  This week I regained the ability to breathe through my nose, so I started going to the gym again, and I've made it all three days (go me!).  This may seem like a goal with a more long-term purpose (lose weight, get healthy, don't die of a stroke at 40), but I'm really doing it for the way that exercise makes me feel in the present.  It helps my anxiety, it helps with sleep, and it simply makes me a happier person than when I'm sitting on the couch eating cheese.

My minor goal for the month is to find a counselor.  My job weighs on me emotionally - I feel anxious about the possibility of screwing things up, and I am at times devastated by the bad health outcomes that my patients experience despite my best efforts.  Although I'm coping with all of this, I don't want my work life to be just about coping.  So I'm going to try to find a counselor with whom I can talk and debrief periodically.

We'll see how I do at the end of the month.

*SLukettG writes in her typically eloquent way about this in a post entitled "Marshmallows".  Definitely worth reading.

Saturday, January 9, 2016

Testing a Theory

I have a strong and somewhat irrational dislike of people who drive fancy cars.  I hate when people think that having money makes them special, and I particularly hate it when they prance around displaying their money to others*.  This is a somewhat unfortunate attitude to have as a physician, as many of my colleagues own fancy cars, and I can't help but judge them unfavourably when they park next to my grungy Corolla in a freshly washed BMD with a vanity plate that reads "DOC MD".

I've always maintained that all I need from my car is to get me from point A to point B, preferably without contributing too much to the nightmare of global warming.  When asked if I would be buying a new car when I finished medical training (because buying a new car is so much more important than paying off my six-figure debt), I would reply smuggly "I don't want a fancy car.  I'm going to drive my car into its grave."


Yesterday, while picking my girlfriend up from work, I started backing up my car while asking her about how her day at work was going.  I was clearly distracted by the conversation, because I drove my car straight into a dumpster.  It wasn't a case of seeing the dumpster and misjudging how far it was from my car, but rather a case of completely not noticing that the dumpster was there.  I was so oblivious to its presence that it took a moment before I realized that the loud crunching sound was somehow being caused by my actions.  Horrified, I got out of the car to discover that my left bumper was completely bent inwards.  In a 90 degree angle kind of way.

Amazingly, the damage was purely cosmetic.  The rear light was scratched a bit, but the plastic didn't break, and it's still fully functional.  And the bumper is plastic, so it won't rust despite the surface being horribly and irreparably damaged.

So, this is my test.  I said I didn't want a fancy car and I only needed it to get me from point A to point B; I guess we'll find out whether I really meant it.

*Not to mention the people with fancy cars who do not actually have money and are fools in addition to being snobs.

Friday, January 1, 2016

2015 - Looking Back

The gifts have been opened, the horrible Christmas cold has been survived, and the girlfriend and I are spending the last few days of holidays maximizing our laziness.  Our wardrobes alternate between sleep clothes and sweatpants, meals consist of assorted cheeses and chocolates from the dwindling supply of leftovers, and our main activity is binge watching Netflix on our laptops (The Good Wife for her; The Walking Dead for me).  If I didn't have to carry the pager and periodically put on grown up clothes to go to the hospital, it would be perfect.

Although it seems cliche, I thought I'd take this opportunity to reflect on the year that has passed.  While some parts of it have been hard, I would say that it's overall been a good one.

Work:  Without question, this has been the biggest event of the year.  After 16 years of post-secondary training, I finally completed all of my studies in June.  And then I started as an attending in August!  By the time my fellowship ended, I was feeling very "done" with being a trainee and with having to do what other people tell me to.  Now as an attending, I sometimes wish that someone else would tell me what to do.  I struggle daily with the stress of making my own decisions and being responsible for the outcomes of my patients.  I worry that I don't know enough - that I'm not enough - to be a good doctor for them.  And it sucks.

On the upside, though, I'm slowly learning to be the type of doctor that I want to be.  I'm taking time with my patients to get to know them and to earn their trust.  I'm learning to work with very diverse staff members, the vast majority of whom I enjoy and make my life easier.  And I'm developing more of the clinical experience and judgment that make someone a really good doctor.  So some of it is really good.

Also, I managed to complete the monstrous curriculum redevelopment project with more than 24 hours to spare before the deadline.  And I think I did a pretty good job.  So yay for me.

Finances:  2015 has mostly been a year of budgeting.  For the first half of the year, I was very careful with my money in order to save for an out-of-town elective* and for seven weeks of vacation after fellowship.  While the tight budget was stressful at times, there were some unexpected benefits to having to find ways to be happy without spending money.  On my vacation, for example, I saved money by volunteering at our local music and theatre festivals, and I created a lot of positive memories from the volunteering itself.

Once I started working, I did a very smart thing and kept up with the budget (although with some loosening given that I don't have major expenses for which to save).  I also went to my trusted financial advisor and said "Here is all the extra money I will be making.  Save it for me."  By not inflating my lifestyle along with my income, I've been able to make even more financial headway than I had hoped.  I'm ending the year approximately $40,000-$45,000 better off than I started it, and I'm hoping to be back to a positive net worth within a year of starting work.  Only $42,000 to go**.

(Full disclosure:  I did completely lose my financial shit in November, and it took me the entire month of December to recover.  I'm not perfect.  It was a good life lesson, and one that I may write about here if I make the time for it.)

Romance:  2015 is the first full calendar year that the girlfriend and I have spent together.  For both of us, it was a year of transitioning from the initial "Yay!  I'm in love!  Everything is wonderful!" phase into the "Hmmmm....I'm actually dating a real, imperfect human being" phase.  Some of it has been challenging, and there have been more discussions about the appropriate loading of the dishwasher than I thought two people could have in one year, but most of it has been wonderful.

After spending almost 15 years of my adult life as a single person, it is simultaneously incredible and strange to be sharing my life with someone.  I love having someone to debrief with at the end of the day and to wake up with on weekends.  (On weekdays, waking up is horrible, and it is made worse by the fact that my girlfriend starts work much later than I do.)  I love always having a date for weddings, particularly one who is less excited about dressing up than I am.  I find it strange that someone else gets an opinion about the type of soap that I buy and whether the cats sleep with me in the bed.  I am sometimes an asshole about sharing the couch.  (The spot in the corner by the lamp is always mine.)  It is imperfect, but it is also lovely, and I think I'm going to keep her.

Relationships:  My seven-week-long vacation was a great opportunity to reconnect with people in my life.  I spent time with my Mom, my grandmother who lives outside of the city, my nieces, and multiple friends whose lives are even busier than my own.  It was a great reminder of how many good people I have in my life and of how important they are to me.

Then work started and...well...time with other people is always the first thing to go.  This is something to work on.

Hobbies:  2015 was the year of the library.  I always have a stack of library books waiting to be read, as well as a running list on the library website of books to order when I need more.  I seem to mostly be reading non-fiction, with an emphasis on medical memoirs and strategies for life improvement (e.g. Gretchen Rubin), but there has been some good fiction thrown in there.  I'm thankful that my girlfriend reintroduced me to the library, as it has led me to read many books that I never would have been willing to spend money on and therefore would not have otherwise read.

The real positive to reading more is that I have been watching far less television than I used to.  While I still haven't given up cable, and I probably won't unless Top Chef gets cancelled, I have probably cut my television watching time in half.  (Not counting the 16 episodes of The Walking Dead that I have watched in the past week.)

Travel:  Due to the budget, 2015 has involved much less travel than other years.  I spent a month away from home on elective in February, and at the end of the month the girlfriend and I had a few days in the Rocky Mountains for vacation.  We similarly had a few days of vacation in San Francisco following a conference in November.  But that was it.  Even my seven weeks of holidays were spent entirely in my home city, without even a trip to the country to photograph grain elevators.  While I'm happy to have saved the money, I am feeling a bit of wanderlust.

Health:  There is a smear of cheese on my sweatshirt.  This pretty much sums up my commitment to health this year.  Although I did take up biking in the summer!  That counts for something, right?

That's it!  How was your 2015?

*In the end, I was reimbursed all of my expenses for my out-of-town elective, which was a huge boost to my budget.  Yay!

**I still have approximately $165,000 of debt though.  Ugh.  It'll be close to a decade before that beast is slain.