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.