Self Care

When medical schools interview prospective students, the question "How do you deal with stress?", or some variant, inevitably comes up.  Having been an interviewer on a few occasions, I know that every interviewee with at least basic interviewing skills will come up with some combination of the following:

Exercise
Rest
Adequate breaks
Healthy eating
Meditation
Yoga
Time with friends and family
Etc.

When I said those things in my medical school interviews, just like everyone else, I was very earnest.  I legitimately thought I would find the time and energy for all of them in my medical training.

(Insert sound of my laughter here.)

Medical training was the hardest and most life-altering thing I have ever done.  Not so much the first two years - those were almost entirely classroom based, and I had long ago mastered the art of sitting in lectures and writing exams - but definitely everything that came after.  The moment I set foot on a ward for the first time, I transformed into a human-shaped bundle of stress and anxiety, constantly terrified that I was going to be responsible for letting someone die.  And unlike with many of my classmates, that feeling didn't go away for a very long time.

My strategy for dealing with this terror was to pretty much never stop working.  I would come in earlier than everyone else, work through lunch, and stay late.  I convinced myself that double, triple, quadruple checking everything would make me perfect and prevent me from ever making a mistake.  (Spoiler alert:  It doesn't.)  Any time I thought about putting in less than 100% of my maximum effort at work, I would remind myself of what was at stake:  People will die if you screw up.

Not surprisingly, my perpetual state of panic and overwork wasn't very conducive to taking care of myself.  I essentially stopped exercising on day one of my clinical rotations.  I gave up cooking for myself and ordered food so often that the receptionists at the delivery services recognized my voice.  And I started spending all the money I wanted, whenever I wanted, because "I deserved it". 

Yoga?  Did my stomach doing nervous back flips count?
Healthy eating?  If I bought my Coke and Nacho Cheese Doritos from the vending machine on the Cardiology ward, did that make them healthy?

I don't know how long I would have continued being so completely and utterly negligent of myself had it not been for a few key events.  The first was a crisis at work, which woke me up to the fact that I might not ever graduate and earn a doctor's salary.  (Spoiler alert:  I did!  And I paid off my student loans yesterday!!!)  Suddenly it no longer felt okay to spend more money than I was earning, so I discovered the great Mr. Money Mustache, started a budget, and got my financial life back in order.  The second was some upheaval at work, during which I reached out to some of the other attendings, and which ultimately led to me being connected to a wonderful performance coach.  While I have only seen him twice, I credit him with enabling me to let go of my self-destructive perfectionism and to forgive myself for being human.

The third thing wasn't a specific event, but rather years of working with people with lifestyle-related illnesses.  I spend a lot of my time at work counseling people about the negative effects of poor diet and lack of exercise, as well as treating them when their bodies break down after years of misuse.  Somewhere around the thousandth time that I said "Pop is basically poison", the message started to sink into my brain.  I'm not immune to the things that affect my patients.  I also need to care for myself.

So slowly (sometimes oh so painfully slowly) I have started to change the bad habits that I learned in medical school.  I've almost completely abandoned sugar-sweetened beverages.  I've started mostly eating brown rice* and brown pasta.  I cook a lot of my meals from scratch, and I try to pack them full of veggies and other healthy things.  I'm even exercising again and (amazingly) kind of enjoying it.

And so many other things, like getting enough sleep and meditating and taking enough vacations and quitting Twitter.  All of the things that I said I would do in my medical school interview 13 years ago, I am finally getting around to.  And it feels really, really good.

*This is huge for me, because I love white rice with a fiery passion and can happily eat two large bowls of it, smothered in butter and salt, in one sitting.